Ileal carcinoid tumor represents after prolonged remission as a solitary breast mass

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Abstract

While the metastatic spread of breast cancer is well documented, the breast is seldom a site for metastasis. Non-mammillary cancers can involve the breast or axilla, though this is exceedingly rare with few reported instances. Here, we present the case of a 62-year-old woman who attended an outpatient breast clinic with a history of an ileal carcinoid tumor complicated by multi-organ metastasis. Her disease was in clinical remission for several years, though she recently re-presented with a single solitary lesion to the breast that was later confirmed as a recurrence of her carcinoid tumor. This serves as an important reminder that the breast can indeed be a site for metastasis. As metastatic breast lesions can often be difficult to diagnose, it is essential to obtain a thorough medical history in order to determine the appropriate clinical course.

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Most cited references 8

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Non-mammary metastases to the breast and axilla: a study of 85 cases.

Deborah F DeLair, Adriana D Corben, Jeffrey P Catalano … (2013)

Non-mammary metastases to the breast and axilla are rare occurrences. However, they are important diagnostic considerations as their treatment and prognosis differ significantly from primary breast cancer. Between 1990 and 2010, we identified a total of 85 patients, 72 women and 13 men, with non-mammary malignancies involving the breast, axilla, or both. The tumor types consisted of carcinoma (58%), melanoma (22%) and sarcoma (20%). Ovary was the most common site of origin for carcinoma, and metastatic high-grade ovarian serous carcinoma was most frequently misdiagnosed as a primary breast carcinoma. Melanoma was the single most common non-carcinomatous tumor type to involve the breast and/or axilla, and uterine leiomyosarcoma was the most common type of sarcoma. Most patients (77%) had other metastases at the time of diagnosis of the tumor, but in 11% the breast or axillary lesion was the first presentation. Without a clinical history, non-mammary metastases were difficult to diagnose because the majority of cases presented with a solitary nodule and lacked pathognomonic pathologic features. There were, however, certain recurrent histological findings identified, such as the often relatively well-circumscribed growth pattern of the metastatic lesion surrounded by a fibrous pseudocapsule, and the absence of an in situ carcinoma. Overall, these patients had poor survival; 96% of patients with follow-up available are dead of disease, with a median survival of 15 months after the diagnosis of the breast or axillary lesion. This finding emphasizes the need to accurately identify these tumors as metastases in order to avoid unnecessary procedures and treatments in these patients.

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Metastases to the breast: differential diagnosis from primary breast carcinoma.

A.-C. Le Bihan, M Trojani, B Vergier … (1991)

Eight patients with breast metastases from primary tumors other than breast carcinoma were studied: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid, and 1 epidermoid cervical carcinoma. All had mammographic, histopathologic, and immunohistochemical examinations. The main problem was differential diagnosis from primary breast carcinoma. History of extramammary primary tumor was helpful but breast metastasis was the first clinical feature in 2 cases. Patients had noticed palpable, round, rapid growth masses which were mammographically benign. Pathologic diagnosis was difficult and immunohistochemical studies necessary, whenever the proliferation had histologic features of primary breast carcinoma or when no primary tumor was known. However, some histologic features were of value for diagnosis of metastasis: atypical histologic features for a primary breast carcinoma, a well-circumscribed tumor with multiple satellite foci, the absence of an intraductal component, and the presence of many lymphatic emboli. In adults, the most frequent types of tumors metastasizing in the breast are malignant melanoma and neuroendocrine-like tumors, especially small cell carcinoma and carcinoid. In children, rhabdomyosarcoma is the most common. Accurate diagnosis of breast metastasis is important to avoid unnecessary mastectomy and to implement an appropriate systemic therapy.

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Carcinoid-syndrome: recent advances, current status and controversies

Tetsuhide Ito, Lingaku Lee, Robert T Jensen (2018)

Purpose To review recent advances and controversies in all aspects of carcinoid-syndrome. Recent findings Over the last few years there have been a number of advances in all aspects of carcinoid syndrome as well as new therapies. These include new studies on its epidemiology which demonstrate it is increasing in frequency; increasing insights into the pathogenesis of its various clinical manifestations and into its natural history: definition of prognostic factors; new methods to verify its presence; the development of new drugs to treat its various manifestations, both initially and in somatostatin-refractory cases; and an increased understand of the pathogenesis, natural history and management of carcinoid heart disease. These advances have generated several controversies and these are also reviewed. Summary There have been numerous advances in all aspects of the carcinoid syndrome, which is the most common functional syndrome neuroendocrine tumors produce. These advances are leading to new approaches to the management of these patients and in some cases to new controversies.

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Author and article information

Journal

Journal ID (nlm-ta): J Surg Case Rep

Journal ID (iso-abbrev): J Surg Case Rep

Journal ID (publisher-id): jscr

Title: Journal of Surgical Case Reports

Publisher: Oxford University Press

ISSN (Electronic): 2042-8812

Publication date Collection: June 2019

Publication date (Electronic): 14 June 2019

Publication date PMC-release: 14 June 2019

Volume: 2019

Issue: 6

Electronic Location Identifier: rjz171

Affiliations

[1 ]Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA

[2 ]University of Illinois, Metropolitan Group Hospitals General Surgery Residency, Advocate Illinois Masonic Hospital, Chicago, IL, USA

[3 ]Department of Surgery, Mercy Hospital and Medical Center, Chicago, IL, USA

Author notes

Correspondence address. Medical Scientist Training Program, University of Illinois College of Medicine, 840 South Wood Street, 601 CSB, Chicago, IL 60612, USA. Tel: 312-413-7271; Fax: 312-413-8221; E-mail: principe@ 123456illinois.edu

Author information

Daniel R Principe http://orcid.org/0000-0003-4355-6597

Article

Publisher ID: rjz171

DOI: 10.1093/jscr/rjz171

PMC ID: 6565812

SO-VID: 9d6bd73b-5534-4194-ab70-1a21d770394a

License:

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 non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

History

Date received : 19 March 2019

Date accepted : 13 May 2019

Page count

Pages: 3

Funding

Funded by: National Cancer Institute 10.13039/100000054

Award ID: F30CA236031

Funded by: National Institutes of Health 10.13039/100000002