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We present a case of a woman with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who received gefitinib for 2 years and obtained a partial response. The patient then developed liver metastasis and a breast lesion, displaying high estrogen receptor (ER) expression and harboring the same EGFR mutation. From the radiological studies, it was not possible to make a differential diagnosis between primary breast cancer and breast metastasis from lung cancer. After the removal of the breast nodule, thanks to the clinical history, radiology, and above all, molecular and immunohistochemical investigations, a diagnosis of breast metastasis from lung adenocarcinoma was made. This case emphasizes the importance of a comprehensive clinical, pathological, and molecular analysis in the differential diagnosis between primary breast cancer and metastases from extramammary tumor to guide adequate treatment decision making.

Breast metastasis from gastric signet ring cell carcinoma is extremely rare in clinical practice. The estimated incidence is 0.5–1.3%. There are few cases reported in the literature (approx. less than 60) of breast metastasis from gastric signet ring cell carcinoma, and due to the rare association between gastric cancer and its extension to the breast, it is difficult to establish the diagnosis. Clinical history, histological findings, and immunohistochemical markers are helpful in distinguishing primary breast cancer from breast metastasis of gastric cancer. The treatment for breast metastasis from gastric carcinoma remains controversial. The prognosis of breast metastasis from gastric carcinoma is generally poor. We report a case of breast metastasis of gastric signet ring cell carcinoma in a 38-year-old woman. She started chemotherapy with ramucirumab, paclitaxel, and irinotecan. Three months later, a combined 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography showed a complete response. This is the first reported case of breast metastasis from gastric signet ring cell carcinoma with a complete response.

Solitary breast metastases from myxoid liposarcoma are extremely rare. Resection with negative margins seems as an effective treatment leading to improved survival.

Background Metastatic tumors to the breast reportedly account for 0.5% to 2.0% of all malignant breast diseases. Such metastatic tumors must be differentiated from primary breast cancer. Additionally, few reports have described metastases of gynecological cancers to the breast. We herein report two cases of metastasis of pelvic high-grade serous adenocarcinoma to the breast. Case presentation The first patient was a 57-year-old woman with a transverse colon obstruction. Colostomy was performed, but the cause of the obstruction was unknown. We found scattered white nodules disseminated throughout the abdominal cavity and intestinal surface. Follow-up contrast-enhanced computed tomography (CT) showed an enhanced nodule outside the right mammary gland. Core needle biopsy (CNB) of the right breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. We diagnosed the patient’s condition as breast and lymph node metastasis of a high-grade serous carcinoma of the female genital tract. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. The second patient was a 71-year-old woman with a medical history of low anterior resection for rectal cancer at age 49, partial right thyroidectomy for follicular thyroid cancer at age 53, and left lower lung metastasis at age 57. Periodic follow-up CT showed peritoneal dissemination, cancerous peritonitis, and pericardial effusion, and the patient was considered to have a cancer of unknown primary origin. Contrast-enhanced CT showed an enhanced nodule in the left mammary gland with many enhanced nodules and peritoneal thickening in the abdominal cavity. CNB of the left breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. Conclusions We experienced two rare cases of intramammary metastasis of high-grade serous carcinoma of female genital tract origin. CNB was useful for confirming the histological diagnosis of these cancers that had originated from other organs. A correct diagnosis of such breast tumors is important to ensure quick and appropriate treatment.

Introduction: Splenic parenchymal endometriosis has never been described to date. We report here the case of real parenchymal endometriosis of the spleen. Case description: In this case, a 54-year-old female patient presented a histologically proven metastatic recurrence of breast cancer in the internal breast chain. The CT-scan also detected a large cystic structure developed from the spleen, but non-suspected to be metastasis. The patient was treated with chemotherapy (paclitaxel) and a combination of targeted therapies (everolimus and trastuzumab). While a complete radiological and biological response was noted at 2 months, the splenic cyst gradually decreased over the years. When targeted therapies were stopped, a reincrease of the splenic lesion and de novo significant hypermetabolism of the splenic parenchyma on 18F-FDG PET scan were observed. A splenectomy was finally performed and revealed splenic parenchymal endometriosis. Conclusion: This case once again highlights the complexity of endometriosis disease, from a pathophysiological point of view, but also the difficulties of radiological characterisation, and diagnostic management.

Breast metastasis originating from non-mammary tumors is an uncommon event accounting for 0.5–6.6% of all breast neoplasms. The primary malignancies that reportedly metastasize to the breast most frequently are hematologic malignancies, such as leukemia and lymphoma and malignant melanoma. Breast cancer metastasis resulting from a primary lung neoplasm is significantly less commonly described in the literature. Herein, we present the unusual case of a patient with metastatic disease to the breast from a primary lung tumor.

Although ovarian cancer often presents as a widespread disease, metastases to the breast and/or axillary lymph nodes are a very rare event, accounting for only 0.03–0.6% of all breast cancers. Its early recognition and accurate distinction from primary breast cancer are of crucial importance to choose an adequate systemic therapy over unnecessary surgeries. We presented the case of a 53-year-old woman who was diagnosed with breast metastases 2 years after the diagnosis of advanced primary serous ovarian cancer. The patient underwent primary cytoreductive surgery and platinum-based chemotherapy in combination with bevacizumab, followed by bevacizumab maintenance for 18 months. After 2 years of negative follow-ups, the disease unexpectedly spread to the left breast and axillary lymph nodes. No axillary lymph node dissection or breast surgery was performed. The patient received axillary radiotherapy and multiple chemotherapy lines: gemcitabine/cisplatin, liposomal doxorubicin, topotecan, olaparib/cediranib, paclitaxel, and cisplatin. Unfortunately, none of these treatments improved her prognosis and she died 3 years after the disease recurrence. Ovarian cancer metastasis to the breast reveals a disseminated disease with a poor prognosis. Currently, no valid treatment options are available as the disease shows multidrug chemoresistance. In the era of precision medicine, the characterization of genetic and molecular markers may play a role in offering new promising targeted therapies.

Background: Metastases to breast and axilla from extramammary sites are uncommon and have been reported in only 2% of breast malignancies. Ovarian cancer metastatic to breast and axillary lymph nodes is extremely rare and only accounts for 0.03%-0.6% of all breast neoplasms. The most common histologic feature of ovarian cancer metastatic to breast is papillary serous adenocarcinoma. Differentiating the secondary breast malignancies from primary ones is crucial as the treatment and prognosis are different, which could avoid many unnecessary procedures. Prognosis is generally poor because most patients have simultaneous spread of the disease. Case presentation: A 67-year-old woman with a history of ovarian cancer, undergoing chemotherapy presented with redness and swelling in her left breast and pathologic axillary lymph nodes. Work ups revealed ovarian cancer metastases to breast and axillary lymph nodes. She underwent chemotherapy with second line chemotherapeutics. The results were satisfying and the patient is well. Conclusion: The history of cancer in patients with a breast mass, even if clinically benign, may give rise to potential metastases. Screening with physical examination and serial mammography for patients with ovarian cancer could be beneficial. Early and accurate diagnosis of breast metastatic tumors is critical for proper management and preventing unnecessary and possibly harmful procedures.

The occurrence of breast metastasis from prostate carcinoma and primary breast carcinoma in men may cause a diagnostic dilemma. This report aims to present a patient diagnosed with metastatic castrate-resistant prostatic adenocarcinoma who developed breast metastasis mimicking as a second primary. A 57-year-old male patient presented with a breast mass while undergoing hormonal therapy for prostatic adenocarcinoma. The initial histopathologic diagnosis of the breast specimen was an infiltrating ductal breast carcinoma. The breast mass enlarged after four cycles of docetaxel. Immunostaining with prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) was done on the breast specimen revealing a negative PSA and a moderately staining PSAP. These stains confirmed the diagnosis of a breast metastasis from prostatic adenocarcinoma. The differentiation between primary breast carcinoma and breast metastasis from prostate carcinoma is crucial. Hence, immunohistochemistry staining should be utilized for diagnosis and appropriate management. World J Oncol. 2020;11(1):37-40 doi: https://doi.org/10.14740/wjon1258

Ovarian cancer is the second most common gynecologic cancer after uterine cancer in the United States. Ovarian cancer ranks sixth in cancer deaths among women, accounting for more deaths than other female reproductive system cancers. Breast metastasis in ovarian cancer is a rare presentation and predicts a poor prognosis and challenging management. Our case is a 42-year-old Chinese woman with high-grade serous ovarian carcinoma that presents with metastasis to the breast during the course of her illness. Genetic evaluation of the ovarian tumor showed two BRCA1 pathogenic variants. Germline pathogenic variant of c.2110_2111DelAA and a somatic variant of c.4071_4096+14del40. Our patient was offered different treatment regimens but showed progression of her disease. The low survival rate and high recurrence rate in ovarian cancer show that we still need to investigate our current approved treatments. Our report aims to shed light on the genetic evaluation of ovarian tumors and treatment options available in refractory cases of progressive ovarian cancer. Furthermore, we explain our investigational therapy regimen and the reasoning behind it.

Background Breast metastasis in hematological malignancies is a rare phenomenon, and it is primarily seen in acute myeloid leukemia (AML). In patients with acute lymphoblastic leukemia (ALL), this condition is even rarer. Case presentation. We present a case of a precursor B cell ALL involving breast in a 40-year-old female and its imaging features on mammography and ultrasound. Histopathology of core needle biopsy (CNB) specimen allowed us to diagnose ALL with extramedullary metastases. The patient was referred to oncology for further management. Conclusion To conclude, ALL infiltrating breast is rare but should be given due consideration, especially in the cases of known primary hematopoietic malignancy, particularly in patients presenting with a history of sudden lumps in the breast. A CNB can give reliable results in combination with flow cytometry and immunocytochemistry, circumventing the need for an excisional biopsy and allowing the commencement of early treatment.

While metastatic disease to the breast has been documented from many primary neoplasms with incidence ranging from 0.2% to approximately 2.7% among reported clinical cases, breast cancer metastases resulting from a primary lung neoplasm is significantly less commonly reported in the literature. Routes of metastatic spread of lung neoplasms include both hematologic and lymphatic routes. We present a case of biopsy proven lymphangitic spread of primary lung neoplasm to the ipsilateral breast and axillary nodes mimicking inflammatory breast cancer. It remains crucial to differentiate between extramammary diseases with metastatic deposits in the breast from a primary breast neoplasm as treatment remains very different between these entities. As in this case, the pathologic, histologic, and immunohistochemistry analyses are critical in determining the origin of the malignant cells and formulating a treatment plan. Keywords: Breast metastasis, Inflammatory breast carcinoma, Cancer, Lung cancer

Alveolar rhabdomyosarcoma (RMS) is one of the most common pediatric soft-tissue neoplasms. Breast involvement either as primary tumor or metastasis is extremely rare. Herein, we report a case of primary limb alveolar RMS with breast metastases in a young premenarcheal girl that relapsed only to the metastatic breast site after achieving complete response. Accordingly, we believe that investigations of the mammary glands should be part of the routine diagnostic workup in adolescent females with RMS. Local therapeutic measures to control breast disease, including surgery or radiotherapy has to be considered for better prognosis. Newer radiation modalities aiming at reducing side effects should be developed.

BACKGROUND Breast metastasis from extra mammary malignancies is rare. An incidence of 0.2%-1.3% has been reported in the literature, including that from different types of malignant neoplasms. CASE SUMMARY We present a case of a 29-year-old nonsmoking woman with breast metastasis from lung adenocarcinoma. Computed tomography revealed atelectasis in the right middle lobe of the lung and ipsilateral pleural effusion. Additionally, on physical examination, a small mass was noted in her right breast. The patient underwent bronchoscopy, needle thoracentesis, and breast biopsy. Following cytology, histology and immunohistochemistry, primary lung adenocarcinoma with metastasis to the breast was diagnosed. Only 63 cases, including our patient, have been reported in the literature since 2000, and this is the second in a woman under 30 years of age. CONCLUSION This atypical presentation may cause a significant diagnostic dilemma, but the contribution of immunohistochemistry is crucial to the accuracy of the final diagnosis.

Breast metastases from gynecologic cancers are rare. Cervical cancer most commonly metastasizes to the lung, liver or bone. When cervical cancer metastasizes to the breast, the presentation is usually a solitary breast mass; rarely, however, breast metastases can mimic inflammatory breast cancer. We present a case of metastatic cervical adenocarcinoma presenting clinically as inflammatory breast cancer and review the relevant literature., Highlights • Cervical metastases to the breast usually present as a solitary mass. • We present a rare case of metastatic cervical adenocarcinoma presenting as inflammatory breast cancer. • Radiological and pathological investigation facilitate discrimination between cervical metastasis and primary breast cancer.

Background: Lung adenocarcinoma with breast metastasis is rare. In the present study, a case of an advanced patient with breast metastasis from lung adenocarcinoma with EGFR 21 exon p.L858R mutation who underwent EGFR TKI combined with PD1 inhibitor is reported.Case presentation: A 62-year-old female patient diagnosed with lung adenocarcinoma who had undergone six times disease progress and breast metastasis in fifth-time disease progress.The patient underwent left breast puncture and axillary lymph node in ultrasound-guided and the postoperative pathological diagnosis of metastatic lung adenocarcinoma was confirmed. And then gene detection showed EGFR 21 exon p.L858R mutation. Breast metastasis from lung adenocarcinoma was diagnosed and the patient is being treated with Almonertinib combined with PD1 inhibitor.Conclusion: Breast metastasis is rare and lung adenocarcinoma might be the primary disease. Gene indection is important. And for lung cancer patients with recurrent pleural effusion, visit of the breast should be included in the follow-up process. In addition, the treatment model of interspersed immunotherapy after EGFR resistance has brought new ideas for the treatment of lung cancer with breast metastasis.

Primary serous peritoneal carcinomas (PSPCs) are rare, and dissemination other than intraperitoneal implantation is even rarer. Breast is an extremely unusual location of metastasis for PSPC. The distinction of breast metastasis of PSPC from primary breast cancer is crucial because the treatment and the prognosis are entirely different. Here we present a case of breast and axillary lymph node metastases from PSPC that were identified on staging FGD PET/CT.

Despite the high prevalence of lung cancer among other primary tumors, metastasis of this particular malignancy in the breast is very rare. We report three new cases of lung cancer with breast metastases and discuss radiological and clinical findings. Radiologically, each case displayed different characteristics. First, one of them had bilateral superficially and deeply located irregular lesions. Second, the patient presented with findings similar to inflammatory breast cancer. The third case had a circumscribed mass, resembling a benign complicated cyst. To guide clinicians for proper patient management, radiologists should be aware of the scope of typical and atypical imaging findings of metastatic involvement of the breast.

Highlights • CRC metastasizes commonly to the regional lymph nodes, liver, lung, and rarely to breast. • The radiologic investigations can play a role in the differentiation between the diagnosis of primary breast cancer and metastases. • Immunohistochemically, the majority of breast adenocarcinomas are: negative for CDX2 and CK20 and positive for CK7, while colorectal adenocarcinomas are: positive for CDX2 and CK20, and negative for ER, PR, HER2, and CK7. • The management plan of CRC metastases to the breast is complex and requires a multidisciplinary team., Introduction and importance Although primary breast cancer is the most common tumor in women, breast metastases are rare findings. We report the first case in English literature with CRC metastases to the breast and adrenal gland concurrently. Case presentation A 42-year-old Caucasian female complained of abdominal pain over the last 3 days. Her history was remarkable for stage 2 colon cancer and she was free of disease for 2 years before the presentation, due to receiving Surgical-chemotherapy. The radiologic investigation showed a well-defined cystic mass in the left adrenal gland and left breast nodule. After adrenalectomy, the diagnosis of the mass was metastatic mucinous adenocarcinoma. During the surgical preparation, bilateral breast lumps were noticed. Histopathology of breast mass showed mucinous adenocarcinoma. Immunohistochemical staining revealed that the neoplastic gland was positive for CDX2, CK20, and P53 mutation and negative for CK7, PR, ER, and HER2. Overall, the diagnosis was metastatic colorectal adenocarcinoma to the breast. Clinical discussion Metastatic lesions in the adrenal gland tend to be bilateral with irregular shape. Breast metastases are singular unilateral lesions with predominance in the left breast. Biopsy and immunohistochemistry make the final diagnosis. The management plan is complex and depends on many factors like the general condition of the patient and the presence of other metastases. However, breast metastases may be a clinical clue to disseminated disease. Conclusion Breast metastases should be in the differential diagnosis in patients with a history of colorectal adenocarcinoma, in order to provide the appropriate clinical care.

Background Accurate diagnosis of metastatic tumors in the breast is crucial because the therapeutic approach is essentially different from primary tumors. A key morphological feature of metastatic tumors is their lack of an in situ carcinoma component. Here, we present a unique case of metastatic ovarian carcinoma spreading into mammary ducts and mimicked an in situ component of primary carcinoma. To our knowledge, this is the second case (and the first adult case) confirming the in situ-mimicking growth pattern of a metastatic tumor using immunohistochemistry. Case presentation A 69-year-old Japanese woman was found to have a breast mass with microcalcifications. She had a known history of ovarian mixed serous and endocervical-type mucinous (seromucinous) carcinoma. Needle biopsy specimen of the breast tumor revealed adenocarcinoma displaying an in situ-looking tubular architecture in addition to invasive micropapillary and papillary architectures with psammoma bodies. From these morphological features, metastatic serous carcinoma and invasive micropapillary carcinoma of breast origin were both suspected. In immunohistochemistry, the cancer cells were immunoreactive for WT1, PAX8, and CA125, and negative for GATA3, mammaglobin, and gross cystic disease fluid protein-15. Therefore, the breast tumor was diagnosed to be metastatic ovarian serous carcinoma. The in situ-looking architecture showed the same immunophenotype, but was surrounded by myoepithelium confirmed by immunohistochemistry (e.g. p63, cytokeratin 14, CD10). Thus, the histogenesis of the in situ-like tubular foci was could be explained by the spread of metastatic ovarian cancer cells into existing mammary ducts. Conclusion Metastatic tumors may spread into mammary duct units and mimic an in situ carcinoma component of primary breast cancer. This in situ-mimicking growth pattern can be a potential pitfall in establishing a correct diagnosis of metastasis to the breast. A panel of breast-related and extramammary organ/tumor-specific immunohistochemical markers may be helpful in distinguishing metastatic tumors from primary tumors.

A 13-year-old girl presented with dull lumbar pain and recent paraplegia. Clinical examination found a breast mass associated with an axillary adenopathy. Imaging revealed a large mass in the posterior mediastinum with spinal cord compression. Histological analysis confirmed the diagnosis of neuroblastoma with mammary metastases. To the best of our knowledge, breast metastasis is being reported for the first time in a mediastinal neuroblastoma.

BackgroundLung adenocarcinoma with breast metastasis is rare. In the present study, a case of an advanced patient with breast metastasis from lung adenocarcinoma with EGFR 21 exon p.L858R mutation who underwent TKI-inhibitors is reported.Case presentationA 62-year-old female patient diagnosed with lung adenocarcinoma who had undergone seven times disease progress and breast metastasis in sixth time disease progress.The patient underwent left breast puncture and axillary lymph node in ultrasound-guided and the postoperative pathological diagnosis of metastatic lung adenocarcinoma was confirmed. And then gene detection showed EGFR 21 exon p.L858R mutation. Breast metastasis for lung adenocarcinoma was diagnosed and the patient are being treated with Almonertinib.ConclusionBreast metastasis is rare and lung adenocarcinoma might be the primary disease. Gene indection is important. And for lung cancer patients with recurrent pleural effusion, visit of the breast should be included in the follow-up process.

Purpose The aim of this study was to report the prevalence of secondary breast malignancies and analyze their radiological characteristics. Materials and methods We collected 42,505 pathological reports of mammary biopsies performed from January 2000 to January 2019 in our hospital database, from which we screened reports of secondary cancer of the breast. We collected and analyzed imaging data from computed tomography (CT), ultrasound (US), and mammography. Mammograms, CT scans, and US images were reviewed by two breast radiologists. Prevalence of secondary breast malignancy among suspicious breast masses and all breast malignancies were calculated. Results Out of 42,505 histopathology reports from mammary biopsies, we found 19,354 malignancies. We identified 33 cases of secondary breast cancers (0.08% of suspicious breast lesions, 0.17% of breast malignancies). Most common metastases were from lymphoma (23 cases, 0.05% of suspicious breast lesions, 0.12% of breast malignancies) and melanoma (six cases, 0.01% of suspicious breast lesions, 0.03% of breast malignancies). All secondary lesions were hypoechoic on US and showed high density on mammogram. On CT, 83% of the lesions appeared solid/dense, and 17% were mixed, alternating areas of iso/hyperdensity with areas of hypodensity. Conclusion Secondary breast cancer had a prevalence of 0.17% among all breast malignancies. No specific imaging features, characteristic of secondary breast cancer, were found.

Gallbladder cancer (GBC) is the commonest malignancy among biliary tract cancers. Locoregional spread in GBC is more common than distant metastasis. The liver and abdominal lymph nodes is the most common site of distant metastasis. Breast metastasis is a rare site of dissemination. GBC is an aggressive tumor and carries a poor prognosis, with a five-year survival rate of less than 10%. Metastasis to the breast from a gallbladder is significantly less and accounts for very few cases. Here, we are reporting a rare case of carcinoma gallbladder metastasis to the breast who survived for 38 months from the diagnosis of GBC and around 25 months after breast metastasis.

Background Medullary thyroid carcinoma very rarely metastasizes to the breast. Hematogenous spread to the liver, lungs, or mediastinum is more common. Case We describe the morphologic and immunohistochemical features of a 63‐year‐old woman who presented with a BIRADS‐5 category nodule in the right breast and enlarged axillary lymph nodes. Core biopsy showed suggested breast cancer with neuroendocrine or apocrine differentiation. The immunohistochemical profile showed (RE−/RP−/HER‐2−) and Ki67 10%. Chromogranin and synaptophysin were positive; AR and GCDFP‐15 were negative. On reviewing the patient's clinical history, it was discovered that she had been treated for medullary thyroid carcinoma 15 years earlier. Additional stains showed positivity for TTF‐1, CEA, and calcitonin. These findings were consistent with a diagnosis of breast metastasis from medullary thyroid carcinoma. We discuss briefly the morphologic features and the possible key features in order to make an accurate diagnosis. Conclusion This case highlights the importance of investigating a history of cancer in patients with discordant or unusual histologic or immunohistochemical findings, as this can help avoid misdiagnosis and inappropriate treatment.

Renal cell carcinoma (RCC) defines a varied class of primary renal neoplasms which arise from the renal cortex. Because RCC often progresses silently to a very advanced metastatic stage, the majority of RCC cases are diagnosed either incidentally on abdominal imaging or upon presentation of invasive disease at metastatic sites. This case profiles a 57-year-old woman with distant history of resected RCC who presented with a posterior breast mass that was diagnosed as metastatic recurrence of RCC through mammogram, ultrasound, and core biopsy. Although the breast is an unusual site for metastasis, clinicians should consider metastatic RCC as a possible etiology when evaluating women with history of RCC and a newly discovered breast mass.

Background Gastric cancer is rare during pregnancy and often diagnosed at a later stage due to overlapping symptoms of pregnancy. Breast metastasis of gastric cancer is another uncommon entity. We present a rare case of breast metastasis of gastric cancer during pregnancy. Case report A 26-year-old female was diagnosed with gastric cancer at 14 weeks of gestation and underwent total gastrectomy. She rejected adjuvant chemotherapy and continued pregnancy without any follow-up. Cancer recurred in bilateral breasts at 34th week of gestation mimicking primary inflammatory breast cancer. Management and outcome It was difficult to diagnose breast metastasis during pregnancy because of overlapping pregnancy symptoms. Following an unresponsive period to antibiotherapy, a fine needle biopsy on breast was performed and signet cell adenocarcinoma metastasis was determined. We started chemotherapy after delivery. There was a near complete response after first line of chemotherapy. Unfortunately, cancer was relapsed within three months and we started second-line chemotherapy. Discussion To our knowledge, this is the fourth case reported in medical literature of gastric cancer presented with breast metastasis during pregnancy. We will try to draw attention to diagnosis, treatment and different presentation of gastric cancer during pregnancy with review of the literature.

The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer and manifest variety forms of clinical presentation. Breast cancer has the ability to metastasize to any site such as the ovaries, lung, liver, bone, brain, gastrointestinal tract and skin. The skin is not a common site for metastatic spread. We would like to report a case of a 56 years old female patient with an infectious mass in her left inframammary fold with discharge. The patients had a one-year history of left breast pruritus and with a mass which increased in size over two months. There was axillary lymphadenopathy, tenderness, and erythema of breast skin around the mass in the physical examination and just elevated erythrocyte sedimentation rate in laboratory tests. The patient did not benefit from antimicrobial therapy. The histological examination revealed a tumor with sheets of malignant cells and many necrotic areas. The diagnosis was invasive ductal breast carcinoma, cutaneous metastases, and lymphatic embolization.

Background:Breast metastases from extramammary sites are extremely rare, with an incidence of 0.4%–1.3% reported in the literature. Insufficient knowledge about its pathology and genetic mutation often leads to misdiagnosis and delayed treatment.Case presentation:We present 2 patients with synchronous (case 1) or metachronous (case 2) breast nodules, revealed as atypical breast metastases from pulmonary adenocarcinomas, in which ALK or ROS1 rearrangement were finally detected in breast mass. After they failed sequential treatments with standard chemotherapies for lung and breast cancer, we reexamined breast lump biopsy and found they were all lung adenocarcinoma metastasis to the breast with the presence of an ALK rearrangement in one case and of ROS1 rearrangement in the other. Eventually these 2 patients were treated with crizotinib. Both the primary tumor and the metastasis of these 2 patients were significantly regressed.Conclusion:Whenever a diagnosis of a suspected tumor with sites at more than one organ is made, pathologic as well molecular pathologic examinations designated for organ-specific cancers should be done.

Breast metastasis from ovarian cancer is a rare event, with vary clinical and imaging presentations, depends on the form of dissemination of the disease and may mimic primary benign and malignant lesions.Confirmation of the diagnosis is of pivotal importance to choice an adequate therapeutic planning, allowing to avoid unnecessary surgeries and to provide appropriate systemic therapy. In this manuscript, we present a case of breast metastasis from ovarian cancer. The patient presented to our Institute with a localized, palpable mass in the upper outer quadrant of the right breast. Mammography and breast sonography showed a singular, round, and homogenous mass with regular borders. No suspicious axillary node was observed. Lesion biopsy revealed the presence of epithelial malignant tumor cells, compatible with a tube-ovarian serous histotype. So, although it could be rare, secondary malignant neoplasm should be considered in the differential diagnosis of breast lesions in patients with a personal history of ovarian cancer. Keywords: Breast metastasis, Intramammary metastasis, Ovarian cancer

Metastatic spread of gastric carcinoma to the breast is rare. In previous decades, reports on this subject were minimal and primarily limited to case reports. At present, little is known on the clinicopathological features and prognosis of this condition, and breast metastasis remains a challenging clinical problem. A total of 54 cases of breast metastasis from gastric cancer were collected from databases between January 1960 and December 2016. The present study included 3 cases of gastric cancer with breast metastasis from Renji hospital and 51 additional cases from previous studies. The clinicopathological features of patients, including epidemiology, symptoms, macroscopic presentation, pathological diagnosis, imaging, treatment and overall survival time, were analyzed. The median survival time was 8.6 months. All but one of the patients were female, and the median age at diagnosis of breast metastasis was 43 years old (age range, 22-72 years). A majority of patients presented with Borrmann class III disease, signet ring cell carcinoma, T4 tumor types, lymph node involvement, initial stage IV gastric cancer, primary lesions in the gastric antrum, left breast metastasis and palpable breast nodules. The median interval between the primary gastric carcinoma diagnosis and presentation of breast metastasis was 1.25 months (range, 0-72 months). The expression of the estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 and gross cystic disease fluid protein-15 was negative in the patients with breast metastases. In univariate analysis, age, gastric tumor size, gastric lymph node involvement and breast metastasis histology were significantly associated with overall survival (OS) time (P=0.001, 0.039, 0.034 and

Metastases to the breast from extramammary neoplasms are extremely rare, with an incidence ranging from 0.2% to 2.7% among reported clinical cases.1, 2 In addition to leukemia and lymphoma, primary tumors that commonly metastasize to the breast include melanoma, rhabdomyosarcoma, and lung cancer.3 The scarcity of breast metastasis may be explained by the poor blood supply of the large amount of fibrous tissue in the breast4 or hormone status.5 Moreover, breast metastasis from lung cancer is highly unusual. In addition, it can be difficult to distinguish a metastasis from primary breast cancer when lung cancer histology indicates adenocarcinoma, and such metastases can be misinterpreted as triple‐negative breast cancer. We report a case of metastases to the breast from lung adenocarcinoma. Immunohistochemical and genetic methods enabled differentiation of metastatic disease from primary breast carcinoma.

Metastases to the breast are very uncommon as compared to primary tumours. Breast is an unusual site for metastasis from renal cell carcinoma. Only occasional cases are reported in the literature. These metastases must be clearly diagnosed as the treatment of primary breast cancer and metastases differs markedly. Treatment of isolated metastases from renal cell carcinoma is usually surgical resection. We report two cases of isolated metachronous metastases to breast from renal cell carcinoma.

Breast metastasis of the well differentiated neuroendocrin tumor (WDNET) of the ileum is very rare. A case of a 62-year-old woman with ileal WDNET, who underwent restaging with Ga-68 DOTATATE PET/CT due to progression of metastatic lesions under the treatment with somatostatin analog and mammalian target of rapamycin inhibitors. Ga-68 DOTATATE PET/CT demonstrated intense increased uptake in the subsantimetric nodular lesion in the upper outer quadrant of the left breast. The histopathologic findings obtained by tru-cut biopsy revealed WDNET metastasis (Ki-67 proliferation index 1%).İyi diferansiye ileal nöroendokrin tümör (NET) meme metastazı oldukça nadirdir. Altmış iki yaşında iyi diferansiye NET tümör tanılı kadın hastaya, metastatik lezyonlarının somatostatin analoğu ve rapamisinin memeli hedefi inhibitörleri ile tedavi görmekte iken progrese olması nedeniyle yeniden evreleme amacıyla Ga-68 DOTATATE PET/BT görüntüleme yapıldı. Ga-68 DOTATATE PET/BT görüntülemede, sol meme üst dış kadrandaki subsantimetrik nodüler lezyonda yoğun artmış aktivite tutulumu izlendi. Lezyondan yapılan tru-cut biyopsinin histopatolojik incelemesinde iyi diferansiye NET metastazı olduğu tespit edildi (Ki-67 proliferasyon indeksi %1).

Metastatic neuroendocrine tumors to breast are very rare with less than 30 cases reported worldwide. The first case was reported in 1957 according to literature. Among these 13 cases reported as breast lump as initial presentation. As the tumor is not so common, the radiological features are not well defined leading to misdiagnosis. Bilateral breast metastasis from pancreatic neuroendocrine tumors has not been mentioned in the literature. Here, we present a case of pancreatic neuroendocrine tumor with metastasis to bilateral breast.

Cancer of the uterine cervix is one of the leading gynecological malignancies of developing nations including India. A 45-year-old female presented with menstrual irregularities and other nonspecific symptoms. After initial workup, she was diagnosed with carcinoma cervix, Stage IV A, while she was being planned to take up radical concomitant chemoradiotherapy, she developed widespread nodules over various sites over the body, which were histopathologically proven as metastatic lesions. She was treated with a palliative intent by radiotherapy and chemotherapy. Only a few such cases have been reported in the literature with variable outcomes. These rare presentations should be thoroughly worked up and studied to know more about their biological behavior.

Metastatic breast involvement from extra-mammary neoplasms is unusual with a low incidence of 0.5% to 1.2% in clinical practice, 2.7% in cytological series, and 1.7% to 6.6% in autopsy series of all breast malignancies. Nearly 500 cases have been reported in small series and case reports. Gastric carcinoma rarely metastasizes to the breast. There are only 38 cases reported in PubMed. In this study, we present a case report of a 49-year-old woman who was diagnosed with right breast metastasis from a gastric carcinoma and undertake a literature review to pay attention to the diagnosis, treatment, and the prognosis of the disease.

Breast metastases from an extra-mammary malignancy are rare. Among the lung malignancies that metastasise in the breasts, previous literature has described approximately 30 cases of NSCLC and only a few cases of SCLC. Here, we present a 54-year-old woman with metachronous breast metastasis from pulmonary small cell carcinoma. She presented with a soft tissue mass in the right lung hilum. After bronchoscopy with biopsy, SCLC was verified. Th e patient was given 4 cycles of etoposide and cisplatin followed by radiation therapy. Seven months after the diagnosis of primary lung cancer, the patient palpated a mass in her right breast. Clinical examination and further diagnostics revealed the suspected malignancy, and a radical mastectomy was performed. Immunohistochemical findings suggested metastatic SCLC in the breast. Differentiation between primary and metastatic cancer in the breast is very important for therapeutic planning

Purpose Incidental hepatic lesions identified on breast MR can be a diagnostic dilemma due to concern for liver metastases or other significant hepatic lesions. The purpose of this study was to identify the incidence and nature of liver lesions seen on breast MR, and determine if additional imaging is necessary. Methods and materials Imaging reports of all breast MR examinations performed at our institution from January 1, 2010 to December 31, 2011 were reviewed to identify reports with hepatic abnormalities. Lesion characteristics, subsequent diagnosis, duration of follow up and additional imaging results (if performed) were all recorded. Results Of 1664 breast MRs, incidental hepatic lesions were seen in 207 studies (12.4%) in 169 patients. In 154 of 169 patients (91.1%) the lesions were characterized as T2 hyperintense and clearly as bright as adjacent fat on T2-weighted or localizer sequences. 0 of these 154 lesions were clinically significant at clinical or radiological follow-up. In the remaining 8.9% (15 of 169), lesions were characterized as not as bright as adjacent fat on T2 weighted or localizer imaging. In two cases, lesions were confirmed as incidental hepatic metastatic disease. Conclusion 91.1% of incidental hepatic lesions were circumscribed, T2 hyperintense lesions and characterised as clearly as bright as adjacent fat on T2 weighted imaging at additional review. None of which were clinically significant at clinical or radiological follow-up. We advocate that circumscribed T2 hyperintense lesions which are clearly as bright as adjacent fat on T2 weighted imaging are of unlikely clinical significance and follow-up imaging should not be recommended, reducing the rate of additional imaging from 37.3% to 5.3%.

Rhabdomyosarcoma mainly occurs in the pediatric age group, with the primary tumor originating from the trunk, neck, and extremities. Metastasis of rhabdomyosarcoma to the breast is very rare. Previous reports have suggested that the mammographic finding of breast rhabdomyosarcoma is an oval-shaped mass with irregular margins and the US finding is a solitary nodular lesion. We report a case of breast metastasis from pleural rhabdomyosarcoma in a 21-year-old woman, presenting as diffuse non-mass involvement and edematous change without a nodular mass.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasia (GTN). It most commonly occurs after a delivery but may arise after any type of pregnancy. PSTT arises after neoplastic transformation of intermediate trophoblastic cells. The most commonly reported symptoms are abnormal bleeding or amenorrhea. Due to the rarity of this disease, evidence on prognostic factors as well as optimal treatment is limited. While treatment for early-stage disease is usually limited to surgery, multimodal treatment with chemotherapy and surgery may be important for metastatic disease. Metastatic disease may be associated with minimal elevations of human chorionic gonadotropin (hCG). Here we present an unusual case of a patient with PSTT and an isolated breast metastasis who was successfully treated with surgical resection and single-agent chemotherapy., Highlights • PSTT is a rare form of GTN involving intermediate trophoblast cells. • Metastatic disease to the breast is rare. • Surgery with single agent chemotherapy is proposed for resectable metastatic PSTT.