Breast malignant, males, children
Breast cancer
Spread and metastases

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 20 October 2016, last major update January 2012

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Spread and metastases [title] breast cancer

Cite this page: Spread and metastases. website. Accessed May 27th, 2018.
Definition / general
  • To skin or chest wall
  • Nipple invasion more common if tumors are within 2.5 cm of nipple
  • Local recurrence after surgery appears as nodules, often near old scar, but can be simulated clinically by post-surgical granulomas

Nodal metastases
  • Axilla is most common site of nodal metastases
  • Also supraclavicular and internal mammary region

Distant metastases
  • Common sites are adrenal gland, bone (desmoplasia may cause dry taps in bone marrow), central nervous system (more often basal-like phenotype - high grade, CK 5/6+, EGFR+, ER negative, Am J Surg Pathol 2006;30:1097), liver, lung/pleura (often mammaglobin+, Mod Pathol 2007;20:208), ovary (60 - 80% are bilateral, are GCDFP15+)
  • Lobular carcinoma tends to metastasize to abdominal / pelvic cavities including GI tract, ovaries and serosal surfaces

Occult primary
  • If enlarged axillary node contains carcinoma, but no breast mass or other tumor is detected clinically or radiologically, usually a primary breast carcinoma will eventually be found in adjacent breast, although it may be very small (usually < 2 cm)
  • Radiation therapy may be adequate therapy for patients with occult primary (Oncology 2006;71:456)
  • Melanomas may also present with occult primary
  • Metastatic breast carcinomas to GI tract are usually positive for GCDFP15 (78%), ER (72%), CK5/6 (61%); also PR (33%), androgen receptors and HER2; negative for CDX2 and CK20 (Arch Pathol Lab Med 2005;129:338)
  • Androgen receptor nuclear staining suggests breast or ovarian primary (Diagn Pathol 2006;1:34)
Case reports
Microscopic (histologic) images

Images hosted on PathOut server:

Breast cancer metastases - to cervix

Breast cancer metastases - to endometrial polyp

Breast cancer metastases - to endometrial polyp (left to right): ER, PR, GCDFP15

To thyroid:
lobular carcinoma
and entrapped
thyroid follicles

To thyroid:
ER stains breast
tumor but not
papillary thyroid
carcinoma (AFIP)

To thyroid: false
positive thyroglobulin
stain due to diffusion
from trapped follicles
and nonspecific
absorption (AFIP)

Images hosted on other servers:

To jaw - mandible

To liver

To lung

To stomach

To oral cavity

To thyroid

Androgen receptor stains nuclei

Androgen receptor+
ductal, lobular and
ovarian carcinoma

Positive stains
  • GCDFP15, lactalbumin, ER and PR staining are relatively specific for breast primary
  • Breast carcinoma is usually CK7+/CK20- (also carcinomas of lung and ovary, but GI, pancreaticobiliary and some ovarian tumors are CK20+)
  • Mammaglobulin in more sensitive but less specific than GCDFP15 (Am J Clin Pathol 2007;127:103)

Markers to distinguish specific primaries
Differential diagnosis