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      Bladder Cancer Metastasis to the Breast in a Male Patient: Imaging Findings on Mammography and Ultrasonography Translated title: 남자 환자에서 방광암의 유방 전이암: 유방촬영술 및 초음파 영상 소견

      case-report

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          Abstract

          Male breast cancer is rare, accounting for approximately 1% of breast cancers. Metastasis from extra-mammary malignancy to the breast in men is extremely rare. The most common primary tumors that metastasize to the breast in male are prostate, lung, stomach, colorectal cancer, melanoma, and sarcoma. To our knowledge, only a few cases of bladder cancer presenting with metastasis to the male breast have been reported, and metastasis with infiltration rather than mass is extremely rare. We report imaging findings on mammography and ultrasonography in a 59-year-old male with bladder cancer metastatic to the breast.

          Translated abstract

          남성 유방암은 드물며 유방암의 약 1%를 차지한다. 유방 외 악성 종양이 남성 유방으로의 전이는 매우 드물다. 남자에서 유방으로 전이되는 가장 흔한 원발성 종양은 전립선암, 폐암, 위암, 대장암, 흑색종 및 육종이다. 남자에서 방광암의 유방으로의 전이 유방암은 드물게 보고되었고, 종괴가 아닌 침윤성 소견의 전이 소견을 보이는 경우는 매우 드물다. 방광암이 유방으로 전이된 59세 남자 환자의 유방촬영술 및 초음파에서의 영상 소견을 보고하고자 한다.

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          Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor.

          The purpose of this study was to evaluate the metastatic pattern of muscle-invasive bladder cancer and to correlate the findings with the characteristics of the primary tumor. From a clinic population of 392 patients with muscle-invasive (pT2-4) bladder cancer seen at our institution from January 2004 through December 2009, we studied the cases of 150 consecutively registered patients with pathologically proven metastatic disease. The metastasis-free intervals and metastatic patterns of different T categories were compared by Kruskal-Wallis test and Freeman-Halton extension of Fisher's exact test. Patients were divided into two histologic categories, those with transitional cell carcinoma and those with atypical histologic features. The metastasis-free interval and metastatic pattern of these two groups were compared by Mann-Whitney test and Fisher's exact test. The study group consisted of 150 patients (116 men [77%], 34 women [23%]; median age, 64 years). The transitional cell carcinoma group consisted of 94 (63%) patients and the atypical histologic features group of 56 (37%) patients. The most common metastatic sites were lymph nodes (104 patients, 69%), bone (71 patients, 47%), lung (55 patients, 37%), liver (39 patients, 26%), and peritoneum (24 patients, 16%). Patients with tumors of a more advanced T category had shorter metastasis-free intervals (p = 0.001, df = 2). There was no significant difference in the metastatic patterns of tumors in the different T categories. Patients with atypical histologic features had a shorter median metastasis-free interval (3 months; range, 0-29 months) than patients with transitional cell carcinoma (12 months; range, 0-192 months) (p = 0.0001). Patients with atypical histologic features had a significantly higher incidence of peritoneal metastasis (p < 0.0002). Lymph nodes, bones, lung, liver, and peritoneum are the most common sites of metastasis from bladder cancer. Tumors in a more advanced T category and those with atypical histologic features metastasize earlier. Tumors with atypical histologic features also have a higher frequency of peritoneal metastasis.
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            Breast Metastases from Extramammary Malignancies: Typical and Atypical Ultrasound Features

            Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast.
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              Metastatic disease to the breast: clinical, pathologic, and radiographic features.

              Metastatic lesions to the breast are unusual. We add 21 cases to the previously reported 131 clinical cases. The most common sources are malignant melanomas and the lymphoma/leukemia group. Metastatic lesions to the breast tend to be painless discrete lumps that are generally small at the time of discovery. They usually occur in the upper outer quadrant and are commonly associated with axillary adenopathy. Occasionally, they are the initial manifestation of an occult extramammary primary cancer. Prognosis is poor but appears slightly improved since availability of more refined chemo- and immunotherapeutic regimens. The clinical, pathologic, and radiographic features of this problem are described.
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                Author and article information

                Journal
                Taehan Yongsang Uihakhoe Chi
                Taehan Yongsang Uihakhoe Chi
                JKSR
                Journal of the Korean Society of Radiology (Taehan Yŏngsang Ŭihakhoe chi)
                The Korean Society of Radiology
                1738-2637
                2288-2928
                May 2022
                04 November 2021
                : 83
                : 3
                : 687-692
                Affiliations
                Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea. 이화여자대학교 목동병원 영상의학과
                Author notes
                Corresponding author: Eun Suk Cha, MD. Department of Radiology, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel 82-2-2650-5977, Fax 82-2-2655-0984, escha@ 123456ewha.ac.kr
                Article
                10.3348/jksr.2021.0070
                9514537
                36238522
                6336f40f-208b-455f-88c4-8add9ffb02b1
                Copyrights © 2022 The Korean Society of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 April 2021
                : 04 June 2021
                : 05 July 2021
                Categories
                Breast Imaging
                Case Report

                breast neoplasms,urinary bladder neoplasms,gynecomastia,neoplasm metastasis,ultrasonography

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