Presentation
Past history of breast cancer. Follow-up CT.
Patient Data
Previous left mastectomy and underlying subpleural reticular opacity, focal triangular-shaped opacity, and traction bronchiectasis.
Subpleural opacity underlying the left mastectomy is increased in size. Left hilum is bulky. Left breast prosthesis overlies the chest wall.
Left subpleural opacity is very avid, along with multiple avid left hilar and paratracheal lymph nodes. No evidence of distant metastatic disease.
The patient underwent an image-guided percutaneous core biopsy.
Histopathology
MICROSCOPIC DESCRIPTION: The smears and cell block sections contain scattered malignant cells presenting in large groups, clusters and as single cells. The tumor cells have high N:C ratio, irregular nuclear outline, hyperchroamsia, macronucleoli and abundant pale cytolasm with mucin. Necrosis and frequent mitoses are noted. The background contains scattered lymphoid cells and macrophages.
COMMENT Tumor cells stain positive CK7 and weak positive Gata-3. Negative with CK20 and CDX2. Features are nonspecific and a breast metastasis and primary cancer are possible.
Case Discussion
The patient had left breast cancer resected with post-operative chemotherapy and radiation therapy 15 years ago. After comparison with the previous breast histopathology, it was thought that this more likely represents a primary lung cancer rather than a breast cancer metastasis. This is supported by radiological appearances, which are also more consistent with a lung primary than metastatic breast cancer and that late recurrence of breast metastasis is uncommon.
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