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Breast malignant, males, children

Breast cancer

Spread and metastases


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 10 November 2012, last major update February 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Local spread
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● 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
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● Axilla is most common site of nodal metastases
● Also supraclavicular and internal mammary region

Distant metastases
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● 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
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● 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 of metastatic sites
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● Colonic polyp (Arch Pathol Lab Med 1984;108:318)
● Endometrial polyp (Case of the Week #125)
● Liver (Arch Pathol Lab Med 2004;128:1418)
● Lung causing cor pulmonale (Arch Pathol Lab Med 1986;110:1197)
● Ovarian granulosa cell tumor (Hum Pathol 2002;33:445)
● Stomach #1 (Arch Pathol Lab Med 2001;125:567), #2 (World J Surg Oncol 2007;5:75)
● Thyroid follicular adenoma (Arch Pathol Lab Med 1994;118:551)

Gross images
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Liver-hepar lobatum (irregular nodularity, usually due to either
tertiary syphilis or metastatic tumor)


Micro images
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Breast cancer metastases:
       
To cervix

       
To endometrial polyp

       
To endometrial polyp (left to right): ER, PR, GCDFP15


To jaw - mandible

           
To liver

   
To lung

   
To oral cavity

   
To skin; tumor is p63 negative

       

       
To stomach


To thyroid


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)

Other images:

Androgen receptor+ ductal, lobular and ovarian carcinoma


Androgen receptor stains nuclei

Virtual slides
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Metastatic to heart and pericardium

Positive stains in unknown primary
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● 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
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Breast vs. lung: GCDFP15 (breast) and TTF-1 (lung)
Breast vs. ovary: GCDFP15 (breast) and WT1 (ovary) (Am J Surg Pathol 2004;28:1076), although breast mucinous carcinomas may also be WT1+ (Mod Pathol 2008;21:1217)

Differential diagnosis
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● Sarcoidosis may mimic metastatic breast cancer (Clin Breast Cancer 2007;7:804)

End of Breast malignant, males, children > Breast cancer > Spread and metastases


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