Metastatic breast cancer manifested as refractory anemia and gastric polyps

Gastric metastasis from breast cancer is uncommon and typically occurs in patients with disseminated disease. The vast majority of patients with gastric lesions have a known preexisting diagnosis of breast cancer. In contrast, we describe a case in which a minimal breast cancer was found to be the primary tumor during the workup of a patient first diagnosed with carcinoma of unknown primary and subsequently presumed to have metastatic gastric cancer. Our case illustrates that a diagnosis of breast cancer metastatic to the stomach may require a high index of suspicion, as well as a meticulous breast workup. It also emphasizes that even tiny breast cancers have a small but real risk of metastatic spread. Determination of the correct primary source in these cases may not be only an academic exercise, since the treatment and prognosis of metastatic breast cancer (especially receptor positive) and metastatic gastric cancer are different.     

Metastatic tumors to the breast: mammographic and ultrasonographic findings.

We evaluated the mammographic (n = 16) and ultrasonographic (n = 15) findings of 18 patients with metastatic breast carcinoma. Fifteen patients showed multiple or diffuse lesions and three patients showed single lesions. Ten patients (55.6%) had bilateral lesions. Mammography revealed high density (15 cases, 93.8%), round to oval (11 cases, 68.8%) lesions with poorly defined or obscured margins (12 cases, 75.0%). No associated calcification was found in any lesion. Ultrasonographically, poorly defined (8 cases, 53.3%), irregularly shaped (8 cases, 53.3%), hypoechoic (14 cases, 93.3%), heterogeneous (8 cases, 53.3%) lesions were predominantly distributed superficially (11 cases, 73.3%). Axillary lymphadenopathy was detected in six patients (33.3%). The longest diameter of most of the lesions was less than 2.0 cm (13 cases, 81.3%). We conclude that metastatic tumors to the breast appear as relatively small, superficially located, poorly defined, irregular nodules without calcification on mammography and ultrasonography. However, when the metastatic lesion is diffuse, the appearance is indistinguishable from that of inflammatory breast carcinoma.     

Metastatic tumors in the breast: sonographic findings

The sonographic findings observed in eight patients with metastatic tumors in the breast were reviewed. Solitary breast nodules were present in four patients; multiple metastases were seen in the other four patients, with bilateral lesions in two of them. A total number of 20 breast masses was appreciated. All lesions had a round or oval shape and hypoechoic, solid echopattern, when compared with the surrounding breast parenchyma. In three patients, they presented with many small medium-level internal echoes while, in the other five patients they were almost anechoic, with only a few low-level echoes within. Regular and well-defined margins were seen in four patients; in the remaining four patients, irregular walls were seen. The posterior walls of the lesions were well defined, and great acoustic attenuation was never seen. In one case, slight acoustic enhancement was present posterior to the lesions from non-Hodgkin's lymphoma. Multiple masses in the same patient always had the same sonographic features. While evaluating a breast mass in a patient with a known malignancy elsewhere in the body, the absence of an acoustic shadow posterior to the lesion may allow the metastatic nature of the disease to be considered as a diagnostic possibility.     

Treating breast cancer with cell-based approaches: an overview

Introduction: Breast cancer is the most common malignancy in women. Despite there being considerable progress in the treatment of this disease, metastatic dissemination is still considered an incurable condition at the present time, causing 500,000 deaths worldwide every year. Although most of the research efforts have been focused on pharmacological approaches, over the last three decades, the use of bone marrow and peripheral blood-derived cell therapy approaches have been attempted and developed.

Areas covered: This review will briefly address cell therapy for breast cancer, including autologous stem cell transplantations for overcoming the myelosuppressive effects of high-dose chemotherapy, allogeneic stem cell transplants and adoptive immunotherapy using bone-marrow derived T-cells.

Expert opinion: The treatment of breast cancer using bone marrow or peripheral-blood derived cells has evolved from a supportive care approach to allow dose escalation of conventional chemotherapy to a therapeutic strategy aimed at eliciting immune cell mediated anticancer immunity. This latter principle has led to the development of adoptive immunotherapies, either with ‘natural’ or genetically engineered effectors, which are being intensively investigated for their great potential against several solid tumors, including breast cancer.     

Metastatic prostate cancer mimicking primary osteosarcoma of the jaw: an infrequent clinical case

Prostate cancer metastasizing to the mandible is a rare occurrence. This case describes a patient whose presenting symptom was a painless swelling of the left mandible. Radiological investigation demonstrated a lesion within the left mandibular ramus, and subsequent biopsy confirmed the diagnosis of metastatic prostate cancer.     

Metastatic renal cell carcinoma presenting as a breast mass in a woman with history of primary breast cancer

Metastatic extramammary breast tumours are uncommon and differential diagnosis with primary breast carcinoma may prove to be difficult. We report a case of a metastasis of a renal cell cancer in the breast in a woman with a history of primary breast cancer. On follow-up of her breast carcinoma, a lump was detected via mammography and ultrasound. Core needle biopsy revealed a metastatic extramammary lesion originating from an asymptomatic renal cell carcinoma. We conclude that the diagnosis of metastasis to the breast from extramammary tumours is important to avoid unnecessary surgery and insure proper treatment of the primary disease.