- Email: [email protected]
Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer
Journal of the Egyptian National Cancer Institute (2015) xxx, xxx–xxx
Cairo University
Journal of the Egyptian National Cancer Institute www.elsevier.com/locate/jnci www.sciencedirect.com
Case Report
Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer Bhanu Prasad Venkatesulu a, Supriya Mallick a b
a,*
, Ashok Singh b, P.K. Julka
a
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Received 14 March 2015; revised 29 March 2015; accepted 29 March 2015
KEYWORDS Non small cell carcinoma; Breast; Metastasis; Tamponade
Abstract Introduction: Lung cancer is the most common cause of cancer related death worldwide. Mostly these tumors present with cough, chest pain weight loss. However, presentation as breast mass and cardiac tamponade is very rare. Results: We are presenting a rare case of breast metastasis from primary lung cancer. This case presented as cardiac tamponade adding to the diagnostic dilemma. Conclusion: The importance of this case is to highlight molecular profiling as an applicable tool to distinguish extra-mammary metastasis that masquerade as mammary neoplasm thereby preventing unnecessary need of surgery and radiation therapy. ª 2015 Production and hosting by Elsevier B.V. on behalf of National Cancer Institute, Cairo University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Introduction Lung cancer is the most common cause of death from cancer worldwide [1]. Metastatic dissemination of lung cancer occurs in 56% of cases at presentation commonly to contra-lateral lung, liver, bone, adrenals, brain, lymph nodes [2,3]. We report a unique presentation of a lady with NSCLC with metachronous breast metastasis and cardiac tamponade emphasizing * Corresponding author. Tel.: +91 9899448450; fax: +91 11 26589243. E-mail address: [email protected] (S. Mallick). Peer review under responsibility of The National Cancer Institute, Cairo University.
importance of IHC in differentiation of breast primary and breast metastasis. Case report A 30 year old female presented with complaints of persistent cough for 4 months. Evaluation with 2 samples of sputum for acid fast bacilli and chest radiograph was found normal. She was started on daily regimen of anti-tuberculosis therapy. After 2 months, she developed dyspnea grade 2 (New York Heart association classification). In our Institute, on evaluation, she was thin built with ECOG performance status 2, with no known co-morbidities and familial malignancies. Clinical
http://dx.doi.org/10.1016/j.jnci.2015.03.006 1110-0362 ª 2015 Production and hosting by Elsevier B.V. on behalf of National Cancer Institute, Cairo University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
2
B.P. Venkatesulu et al.
Figure 1 CECT scan image showing large heterogeneous enhancing mass lesion with speculated margin in lung parenchyma with marked right sided pleural effusion and pericardial effusion with impending cardiac tamponade.
Figure 2 (a and b) Lymph node section shows an epithelial tumor replacing almost whole of lymphoid tissue and infiltrating into surrounding fibroadipose tissue. (c) Tumor cells show strong nuclear immunostaining for TTF-1, (d) no staining is seen for GCDFP-1.
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
Non-small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade
3
Figure 3 (e) Section from breast mass shows an epithelial tumor infiltrating into the adjacent parenchyma. Duct is not involved by the tumor. (f) Tumor cells show strong nuclear staining with TTF-1. (g, h, and j) Tumor is nonreactive with estrogen, progesterone and Her2 neu antibody.
examination revealed 2 · 1 cm mobile hard lymph nodes in level IV of the right side of the neck, 3 · 3 cm mobile hard right anterior axillary group Lymph Node, with 1 · 1 cm lymph node in the left anterior axillary group. Breast, thyroid, chest and abdomen examinations were within normal limits. Sputum cytology was negative for malignancy. Bronchial washings showed atypical cells. Excision biopsy of the right cervical lymph node showed metastatic carcinoma with tumor cells immunopositive for thyroid transcription factor [TTF-1], negative for GCDFP-15 (gross cystic disease fluid protein) and negative for epidermal growth factor receptor (EGFR). Ultrasound of breast showed right breast ill-defined spiculated area of 1.9 cm in retroareolar location with dilated ducts in its periphery and thickened areolar skin. Multiple hyperechoic nodules were seen in peri areolar location and 7 O’ clock position. Right axillary lymph nodes largest of 1.2 cm in short axis dimension. BIRADS 5 (Breast Imaging and Reporting Data System), left breast was normal. Ultrasound guided breast biopsy showed invasive ductal carcinoma negative for estrogen receptor, progesterone receptor and Her 2 neu status with immunopositivity for TTF-1. During the course of evaluation the patient developed dyspnea of grade 4. Contrast enhanced computed tomography of chest (CECT) revealed 6.2 · 5.2 cm heterogeneous enhancing mass lesion with speculated margin in lung parenchyma with marked right sided pleural effusion and pericardial effusion with impending cardiac tamponade. Intercostal drainage tube (ICD) was placed at the right side and pericardiocentesis was done by pigtail catheter. Cytology of pericardial fluid revealed atypical cells. So the patient was staged as carcinoma lung stage IV (American joint committee on cancer-AJCC 7) with breast metastasis.
She was treated with 6 cycles of Paclitaxel 175 mg/m2 day 1 and carboplatin AUC5 day 2. Post 6 cycles CECT chest, abdomen and pelvis revealed progressive disease in view of new lesions in the right breast, left chest wall, increase in right pleural effusion and bilateral iliac bone metastasis. EGFR and ALK (anaplastic lymphoma kinase) by polymerase chain reaction (PCR) was negative. The patient was started on single agent thrice weekly gemcitabine 1.2 g/m2 day 1, 8, 15. CECT chest, abdomen, pelvis post 3 cycles revealed progressive disease in view of new lesions in right lower and left upper lobe of lung. Hence the patient was started on third line chemotherapy with Gefitinib 150 mg OD and tolerated it well at the time of writing this case report (see Figs. 1–3). Discussion Primary breast carcinoma is the most common malignancy in women worldwide. Metastatic involvement of the breast is a rarity with a reported frequency of 0.4–1.3%. In a review of 14,000 breast cancer cases between 1907 and 1999, 0.43% was reported to be metastasis [4]. According to case reports and case series most common sources of metastasis to breast are hematological malignancies (leukemia, lymphomas) malignant melanoma, tumors of lung, kidney, ovary, thyroid, small bowel carcinoids, and colo-rectum [5–8]. Metastasis to breast may be lymphatic or hematogenous. Lymphatic may be due to initial pleural seeding with chest wall lymphatic involvement which drains to ipsilateral axillary lymph nodes and retrograde spread to lymphatic system of
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
4
B.P. Venkatesulu et al. Table 1
Differences between a breast metastasis and primary breast carcinoma.
Metastasis to breast Clinical examination 1. Well circumscribed firm mobile masses 2. Rapidly growing painless lesion located in subcutaneous tissue 3. Skin involvement, nipple retraction and nipple discharge rare Mammography 1. Single, well defined 2. No distortion of adjacent architecture, no spiculation or no microcalcification, no skin involvement 3. Metastatic breast mass causes minimal proliferation of fibrous tissue surrounding the lesion hence appears same size on palpation and mammography Ultrasonogram 1. Hypoechoic, well bordered mass lesion that does not lead to distortion of adjacent structures Histological features 1. Micro-calcification rarely seen exception serous papillary carcinoma of ovary metastasis. 2. Elastosis absent 3. Carcinoma in situ not seen 4. Well circumscribed margins 5. Lymph vascular emboli more common 6. Pigmented and intra-nuclear inclusions are common (based on type of metastasis seen in malignant melanoma and hepatocellular carcinoma) Immunohistochemistry Usually Estrogen receptor Progesterone receptor Epidermal growth Factor receptor Gross cystic disease Fluid protein 15 Mammaglobin Cytokeratin 5/6
the breast. In hematogenous metastasis a solitary discrete lesion is more common. Tellate features on clinical examination, mammography, and ultra-sonogram of the breast may be used to delineate primary mammary neoplasms from extra-mammary metastasis. Yet cytological and histopathological examination remains gold standard for differentiation and diagnosis (Table 1). Immunohistochemistry plays a crucial role in differentiation. TTF-1 is expressed in 68–80% of lung adenocarcinomas and never reported in breast primary. ER is expressed in 80% and GCDFP-15 in 45–53% of breast carcinomas. Lung adenocarcinoma may show low ER 7.6–14.1% expression. 5.2–15% lung adenocarcinomas express GCDFP-1. Mammaglobin is expressed in 48–72.1% mammary adenocarcinomas but stains negatively in pulmonary adenocarcinoma [9–12]. Conclusion The importance of this case is to highlight IHC as an able tool to distinguish extra-mammary metastasis that masquerade as mammary neoplasm thereby preventing unnecessary need of surgery and radiation therapy.
Primary mammary neoplasm 1. Diffuse irregular mass 2. Prediction for upper outer quadrant of breast 3. Skin involvement, nipple retraction and discharge commonly seen 1. Diffuse microcalcification, architectural distortion, compression of adjacent ducts, lobules with dermal thickening, periareolar thickening characteristic 2. Primary breast cancer causes significant fibrous tissue proliferation, hence mass feels larger on palpation compared to mammography 1. Hypoechoic nodular lesion, which is ‘taller than broader’ and has spiculated margins, posterior acoustic shadowing and microcalcifications 1. 2. 3. 4. 5.
Usually present Usually present Strongly favor primary breast carcinoma Usually infiltrating margin Lymph vascular emboli seen less compared to metastasis to breast 6. Not seen
May be + + + + + +
Disclosures The authors have nothing to disclose. Conflict of interest The authors have no conflict of interest. References [1] GLOBOCAN 2012: Estimated cancer incidence mortality, prevalence worldwide 2012; WHO. [2] Surveillance Epidemiology and End Results analysis: National Cancer Institute USA (1975–2011). [3] Quint LE, Tummala S, Brisson LJ, Francis IR, Krupnick AS, Kazerooni EA, et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996;62:246. [4] Georgiannos SN, Chin J, Goode AW, Sheaff M. Secondary neoplasms of the breast: a survey of the 20th century. Cancer 2001;92:2259–66. [5] Vizcaı´ no I, Torregrosa A, Higueras V, Morote V, Cremades A, Torres V, et al. Metastasis to the breast from extramammary
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
Non-small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade
[6]
[7]
[8] [9]
malignancies: a report of four cases and a review of literature. Eur Radiol 2001;11:1659–65. Noguera J, Martı´ nez-Miravete P, Idoate F, Dı´ az L, Pina L, Zornoza G, et al. Metastases to the breast: a review of 33 cases. Australas Radiol 2007;51:133–8. Shaaban H, Kapila K, Mostafa EK, Amanguno H, Hebbar GH, Francis I. Signet-ring cell adenocarcinoma of rectum with breast metastase diagnosed on FNA cytology: case report and literature review. Cytopathology 2012. http://dx.doi.org/ 10.1111/j.1365-2303.2012.00968. Bhirangi KS, Pinto DJ, Crosbie JJ. Solitary breast metastasis from carcinoma of colon. Ulster Med J 1997;66:138–9. Yang M, Nonaka D. A study of immunohistochemical differential expression in pulmonary and mammary carcinomas. Mod Pathol 2010;23:654–61.
5
[10] Zamecnik J, Kodet R. Value of thyroid transcription factor-1 and surfactant apoprotein A in the differential diagnosis of pulmonary carcinomas: a study of 109 cases. Virchows Arch 2002;440:353–61. [11] Takeda Y, Tsuta K, Shibuki Y, Hoshino T, Tochigi N, Maeshima AM, et al. Analysis of expression patterns of breast cancer-specific markers (mammaglobin and gross cystic disease fluid protein 15) in lung and pleural tumors. Arch Pathol Lab Med 2008;132:239–43. [12] Klingen TA, Chen Y, Gundersen MD, Aas H, Westre B, Sauer T. Thyroid transcription factor-1 positive primary breast cancer: a case report with review of the literature. Diagn Pathol 2010;5:37.
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
Cairo University
Journal of the Egyptian National Cancer Institute www.elsevier.com/locate/jnci www.sciencedirect.com
Case Report
Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer Bhanu Prasad Venkatesulu a, Supriya Mallick a b
a,*
, Ashok Singh b, P.K. Julka
a
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
Received 14 March 2015; revised 29 March 2015; accepted 29 March 2015
KEYWORDS Non small cell carcinoma; Breast; Metastasis; Tamponade
Abstract Introduction: Lung cancer is the most common cause of cancer related death worldwide. Mostly these tumors present with cough, chest pain weight loss. However, presentation as breast mass and cardiac tamponade is very rare. Results: We are presenting a rare case of breast metastasis from primary lung cancer. This case presented as cardiac tamponade adding to the diagnostic dilemma. Conclusion: The importance of this case is to highlight molecular profiling as an applicable tool to distinguish extra-mammary metastasis that masquerade as mammary neoplasm thereby preventing unnecessary need of surgery and radiation therapy. ª 2015 Production and hosting by Elsevier B.V. on behalf of National Cancer Institute, Cairo University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).
Introduction Lung cancer is the most common cause of death from cancer worldwide [1]. Metastatic dissemination of lung cancer occurs in 56% of cases at presentation commonly to contra-lateral lung, liver, bone, adrenals, brain, lymph nodes [2,3]. We report a unique presentation of a lady with NSCLC with metachronous breast metastasis and cardiac tamponade emphasizing * Corresponding author. Tel.: +91 9899448450; fax: +91 11 26589243. E-mail address: [email protected] (S. Mallick). Peer review under responsibility of The National Cancer Institute, Cairo University.
importance of IHC in differentiation of breast primary and breast metastasis. Case report A 30 year old female presented with complaints of persistent cough for 4 months. Evaluation with 2 samples of sputum for acid fast bacilli and chest radiograph was found normal. She was started on daily regimen of anti-tuberculosis therapy. After 2 months, she developed dyspnea grade 2 (New York Heart association classification). In our Institute, on evaluation, she was thin built with ECOG performance status 2, with no known co-morbidities and familial malignancies. Clinical
http://dx.doi.org/10.1016/j.jnci.2015.03.006 1110-0362 ª 2015 Production and hosting by Elsevier B.V. on behalf of National Cancer Institute, Cairo University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
2
B.P. Venkatesulu et al.
Figure 1 CECT scan image showing large heterogeneous enhancing mass lesion with speculated margin in lung parenchyma with marked right sided pleural effusion and pericardial effusion with impending cardiac tamponade.
Figure 2 (a and b) Lymph node section shows an epithelial tumor replacing almost whole of lymphoid tissue and infiltrating into surrounding fibroadipose tissue. (c) Tumor cells show strong nuclear immunostaining for TTF-1, (d) no staining is seen for GCDFP-1.
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
Non-small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade
3
Figure 3 (e) Section from breast mass shows an epithelial tumor infiltrating into the adjacent parenchyma. Duct is not involved by the tumor. (f) Tumor cells show strong nuclear staining with TTF-1. (g, h, and j) Tumor is nonreactive with estrogen, progesterone and Her2 neu antibody.
examination revealed 2 · 1 cm mobile hard lymph nodes in level IV of the right side of the neck, 3 · 3 cm mobile hard right anterior axillary group Lymph Node, with 1 · 1 cm lymph node in the left anterior axillary group. Breast, thyroid, chest and abdomen examinations were within normal limits. Sputum cytology was negative for malignancy. Bronchial washings showed atypical cells. Excision biopsy of the right cervical lymph node showed metastatic carcinoma with tumor cells immunopositive for thyroid transcription factor [TTF-1], negative for GCDFP-15 (gross cystic disease fluid protein) and negative for epidermal growth factor receptor (EGFR). Ultrasound of breast showed right breast ill-defined spiculated area of 1.9 cm in retroareolar location with dilated ducts in its periphery and thickened areolar skin. Multiple hyperechoic nodules were seen in peri areolar location and 7 O’ clock position. Right axillary lymph nodes largest of 1.2 cm in short axis dimension. BIRADS 5 (Breast Imaging and Reporting Data System), left breast was normal. Ultrasound guided breast biopsy showed invasive ductal carcinoma negative for estrogen receptor, progesterone receptor and Her 2 neu status with immunopositivity for TTF-1. During the course of evaluation the patient developed dyspnea of grade 4. Contrast enhanced computed tomography of chest (CECT) revealed 6.2 · 5.2 cm heterogeneous enhancing mass lesion with speculated margin in lung parenchyma with marked right sided pleural effusion and pericardial effusion with impending cardiac tamponade. Intercostal drainage tube (ICD) was placed at the right side and pericardiocentesis was done by pigtail catheter. Cytology of pericardial fluid revealed atypical cells. So the patient was staged as carcinoma lung stage IV (American joint committee on cancer-AJCC 7) with breast metastasis.
She was treated with 6 cycles of Paclitaxel 175 mg/m2 day 1 and carboplatin AUC5 day 2. Post 6 cycles CECT chest, abdomen and pelvis revealed progressive disease in view of new lesions in the right breast, left chest wall, increase in right pleural effusion and bilateral iliac bone metastasis. EGFR and ALK (anaplastic lymphoma kinase) by polymerase chain reaction (PCR) was negative. The patient was started on single agent thrice weekly gemcitabine 1.2 g/m2 day 1, 8, 15. CECT chest, abdomen, pelvis post 3 cycles revealed progressive disease in view of new lesions in right lower and left upper lobe of lung. Hence the patient was started on third line chemotherapy with Gefitinib 150 mg OD and tolerated it well at the time of writing this case report (see Figs. 1–3). Discussion Primary breast carcinoma is the most common malignancy in women worldwide. Metastatic involvement of the breast is a rarity with a reported frequency of 0.4–1.3%. In a review of 14,000 breast cancer cases between 1907 and 1999, 0.43% was reported to be metastasis [4]. According to case reports and case series most common sources of metastasis to breast are hematological malignancies (leukemia, lymphomas) malignant melanoma, tumors of lung, kidney, ovary, thyroid, small bowel carcinoids, and colo-rectum [5–8]. Metastasis to breast may be lymphatic or hematogenous. Lymphatic may be due to initial pleural seeding with chest wall lymphatic involvement which drains to ipsilateral axillary lymph nodes and retrograde spread to lymphatic system of
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
4
B.P. Venkatesulu et al. Table 1
Differences between a breast metastasis and primary breast carcinoma.
Metastasis to breast Clinical examination 1. Well circumscribed firm mobile masses 2. Rapidly growing painless lesion located in subcutaneous tissue 3. Skin involvement, nipple retraction and nipple discharge rare Mammography 1. Single, well defined 2. No distortion of adjacent architecture, no spiculation or no microcalcification, no skin involvement 3. Metastatic breast mass causes minimal proliferation of fibrous tissue surrounding the lesion hence appears same size on palpation and mammography Ultrasonogram 1. Hypoechoic, well bordered mass lesion that does not lead to distortion of adjacent structures Histological features 1. Micro-calcification rarely seen exception serous papillary carcinoma of ovary metastasis. 2. Elastosis absent 3. Carcinoma in situ not seen 4. Well circumscribed margins 5. Lymph vascular emboli more common 6. Pigmented and intra-nuclear inclusions are common (based on type of metastasis seen in malignant melanoma and hepatocellular carcinoma) Immunohistochemistry Usually Estrogen receptor Progesterone receptor Epidermal growth Factor receptor Gross cystic disease Fluid protein 15 Mammaglobin Cytokeratin 5/6
the breast. In hematogenous metastasis a solitary discrete lesion is more common. Tellate features on clinical examination, mammography, and ultra-sonogram of the breast may be used to delineate primary mammary neoplasms from extra-mammary metastasis. Yet cytological and histopathological examination remains gold standard for differentiation and diagnosis (Table 1). Immunohistochemistry plays a crucial role in differentiation. TTF-1 is expressed in 68–80% of lung adenocarcinomas and never reported in breast primary. ER is expressed in 80% and GCDFP-15 in 45–53% of breast carcinomas. Lung adenocarcinoma may show low ER 7.6–14.1% expression. 5.2–15% lung adenocarcinomas express GCDFP-1. Mammaglobin is expressed in 48–72.1% mammary adenocarcinomas but stains negatively in pulmonary adenocarcinoma [9–12]. Conclusion The importance of this case is to highlight IHC as an able tool to distinguish extra-mammary metastasis that masquerade as mammary neoplasm thereby preventing unnecessary need of surgery and radiation therapy.
Primary mammary neoplasm 1. Diffuse irregular mass 2. Prediction for upper outer quadrant of breast 3. Skin involvement, nipple retraction and discharge commonly seen 1. Diffuse microcalcification, architectural distortion, compression of adjacent ducts, lobules with dermal thickening, periareolar thickening characteristic 2. Primary breast cancer causes significant fibrous tissue proliferation, hence mass feels larger on palpation compared to mammography 1. Hypoechoic nodular lesion, which is ‘taller than broader’ and has spiculated margins, posterior acoustic shadowing and microcalcifications 1. 2. 3. 4. 5.
Usually present Usually present Strongly favor primary breast carcinoma Usually infiltrating margin Lymph vascular emboli seen less compared to metastasis to breast 6. Not seen
May be + + + + + +
Disclosures The authors have nothing to disclose. Conflict of interest The authors have no conflict of interest. References [1] GLOBOCAN 2012: Estimated cancer incidence mortality, prevalence worldwide 2012; WHO. [2] Surveillance Epidemiology and End Results analysis: National Cancer Institute USA (1975–2011). [3] Quint LE, Tummala S, Brisson LJ, Francis IR, Krupnick AS, Kazerooni EA, et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996;62:246. [4] Georgiannos SN, Chin J, Goode AW, Sheaff M. Secondary neoplasms of the breast: a survey of the 20th century. Cancer 2001;92:2259–66. [5] Vizcaı´ no I, Torregrosa A, Higueras V, Morote V, Cremades A, Torres V, et al. Metastasis to the breast from extramammary
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006
Non-small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade
[6]
[7]
[8] [9]
malignancies: a report of four cases and a review of literature. Eur Radiol 2001;11:1659–65. Noguera J, Martı´ nez-Miravete P, Idoate F, Dı´ az L, Pina L, Zornoza G, et al. Metastases to the breast: a review of 33 cases. Australas Radiol 2007;51:133–8. Shaaban H, Kapila K, Mostafa EK, Amanguno H, Hebbar GH, Francis I. Signet-ring cell adenocarcinoma of rectum with breast metastase diagnosed on FNA cytology: case report and literature review. Cytopathology 2012. http://dx.doi.org/ 10.1111/j.1365-2303.2012.00968. Bhirangi KS, Pinto DJ, Crosbie JJ. Solitary breast metastasis from carcinoma of colon. Ulster Med J 1997;66:138–9. Yang M, Nonaka D. A study of immunohistochemical differential expression in pulmonary and mammary carcinomas. Mod Pathol 2010;23:654–61.
5
[10] Zamecnik J, Kodet R. Value of thyroid transcription factor-1 and surfactant apoprotein A in the differential diagnosis of pulmonary carcinomas: a study of 109 cases. Virchows Arch 2002;440:353–61. [11] Takeda Y, Tsuta K, Shibuki Y, Hoshino T, Tochigi N, Maeshima AM, et al. Analysis of expression patterns of breast cancer-specific markers (mammaglobin and gross cystic disease fluid protein 15) in lung and pleural tumors. Arch Pathol Lab Med 2008;132:239–43. [12] Klingen TA, Chen Y, Gundersen MD, Aas H, Westre B, Sauer T. Thyroid transcription factor-1 positive primary breast cancer: a case report with review of the literature. Diagn Pathol 2010;5:37.
Please cite this article in press as: Venkatesulu BP et al. Non small cell carcinoma of lung with metachronous breast metastasis and cardiac tamponade: Unusual presentation of a common cancer, J Egyptian Nat Cancer Inst (2015), http://dx.doi.org/10.1016/j.jnci.2015.03.006