Unusual metastases of breast cancer: a single-center retrospective study

Abstract

Objectives: While clinical and radiological awareness of the usual, frequent metastatic sites of breast cancer is high, unexpected 'atypical' localisations may be more easily overlooked in the cancer management process. The aim of this article is to contribute to this awareness in order to facilitate and improve the diagnosis and follow-up of breast cancer.

Methods: In this study, we retrospectively evaluated breast cancer patients who were diagnosed and followed up between 2017 and 2022 in our hospital, which is an important oncology center.

Results: Of the 852 patients included in this study, 79 had an unusual metastasis localization. The most common unusual metastasis sites were mediastinal lymph nodes and brain. These sites were followed by atypical bone involvement, mesenteric lymph nodes, cervical lymph nodes, hilar lymph nodes and surrenal metastases. The most rare metastases were more common in the uterus and ovary, followed by pancreas, parotid gland, spleen, colon, pericardium-atrium, orbital soft tissues and lacrimal gland. . The unusual site of metastasis was mediastinal lymph nodes in 17.7% (n = 14), brain in 17.7% (n = 14), atypical bone sites in 12.6% (n = 10), mesenteric lymph nodes in 11.3% (n = 9), cervical lymph nodes in 11.3% (n = 9), hilar lymph nodes in 5% (n = 4) and surrenal in 6.3% (n = 5).

Conclusions: Sharing knowledge and experience about unusual metastases of breast cancer will contribute to the diagnosis and treatment of metastatic diseases by increasing the awareness of this issue. For this, multicentre studies should be conducted to combine these experiences.

Keywords

• Breast cancer
• unusual metastases
• rare metastases
• atypical metastases.

References

1. 1. Fu JX, Zou YN, Long-Li, Wang XJ. Widespread metastasis to the stomach 10 years after primary breast cancer: a case report and review of the literature. Medicine (Baltimore) 2020;99:e22527.
2. 2. Di Micco R, Santurro L, Gasparri M, Zuber V, Fiacco E, Gazzetta G, et al. Rare sites of breast cancer metastasis: a review. Transl Cancer Res 2019;8(Suppl 5):S518-52.
3. 3. Giestas S, Lopes S, Souto P, Agostinho C, Camacho E, Cipriano M, et al. Ampullary metastasis from breast cancer: a rare cause of obstructive jaundice. GE Port J Gasrtroenterol 2016;23:300-3.
4. 4. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.
5. 5. Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond) 2021;41:1183-94.
6. 6. Barros NA, Ferreira A, Rocha MJ, Castro L. Unusual breast cancer metastasis. BMJ Case Rep 2015;2015:bcr2014209125.
7. 7. McFarlane MEC. Metastasis to the breast: a rare site for secondary malignancy. Int J Surg 2006;4:204-5.
8. 8. Kim TY, Lee KH, Han SW, Oh DY, Im SA, Kim TY, et al. A new isolated mediastinal lymph node or small pulmonary nodule arising during breast cancer surveillance following curative surgery: clinical factors that differentiate malignant from benign lesions. Cancer Res Treat 2014;46:280-7.

9. 9. Charalabopoulos K, Dalavaga Y, Stefanou D, Charalabopoulos A, Bablekos G, Constantopoulos S. Direct endobronchial metastasis is a rare metastatic pattern in breast cancer. Int J Clin Pract 2004;58:641-4.
10. 10. Yang R, Jia L, Lv Z, Cui J. Case report: Hilar metastasis of breast cancer: a single-center retrospective case-control study. Front Surg 2023;10:1025287.
11. 11. Almajed MR, Obri MS, Kamran W, Entz A. Malignant cardiac tamponade: a complication of untreated breast cancer. Cureus 2022;14:e26787.
12. 12. Katalinic D, Stern-Padovan R, Ivanac I, Aleric I, Tentor D, Nikolac N, et al. Symptomatic cardiac metastases of breast cancer 27 years after mastectomy: a case report with literature review--pathophysiology of molecular mechanisms and metastatic pathways, clinical aspects, diagnostic procedures and treatment modalities. World J Surg Oncol 2013;11:14.
13. 13. Kim JS, Kim K, Shin KH, Kim JH, Ahn SD, Kim SS, et al. Cervical lymph node involvement above the supraclavicular fossa in breast cancer: comparison with Stage IIIC (KROG 18-02). J Breast Cancer 2020;23:194-204.
14. 14. Jung J, Kim SS, Ahn SD, Lee SW, Ahn SH, Son BH, et al. Treatment outcome of breast cancer with pathologically proven synchronous ipsilateral supraclavicular lymph node metastases. J Breast Cancer 2015;18:167-72.
15. 15. Cao XS, Cong BB, Yu ZY. Parotid gland metastasis from carcinoma of the breast detected by PET/CT: case report and review. Medicine (Baltimore) 2018;97:e10616.
16. 16. Jung HK, Lim YJ, Kim W. Breast cancer metastasis to the parotid: a case report with imaging findings. Am J Case Rep 2021;22:e934311.
17. 17. Razem B, Slimani F. An early orbital metastasis from breast cancer: a case report. Int J Surg Case Rep 2021;78:300-2.
18. 18. Nickelsen MN, VON Holstein S, Hansen AB, Prause JU, Heegaard S. Breast carcinoma metastasis to the lacrimal gland: two case reports. Oncol Lett 2015;10:1031-5.
19. 19. Ram H, Singhai A, Kumar S, Singh R. Carcinoma of breast metastasising to mandible. BMJ Case Rep 2015;2015:bcr2014206571.
20. 20. Corti C, Antonarelli G, Criscitiello C, Lin NU, Carey LA, Cortés J, et al. Anti-tumour treatment targeting brain metastases in breast cancer. Cancer Treat Rev 2022;103:102324.
21. 21. Sun, H, Xu, J, Dai, S, Ma, Y, Sun, T. Breast cancer brain metastasis: current evidence and future directions. Cancer Med 2023;12:1007-24.
22. 22. Bailleux C, Eberst l, Bachelot T. Treatment strategies for breast cancer brain metastases. Br J Cancer 2021;124:142-55.
23. 23. Kuksis M, Gao Y, Tran W, Hoey C, Kiss A, Komorowski AS, et al.The incidence of brain metastases among patients with metastatic breast cancer: a systematic review and meta-analysis, Neuro Oncol 2021;23:894-904.
24. 24. Liu A, Feng Y, Chen B, Li L, Wu D, Qian J, et al. A case report of metastatic breast cancer initially presenting with esophageal dysphagia. Medicine (Baltimore) 2018;97:e13184.
25. 25. Taniai T, Haruki K, Matsumoto M, Sakamoto T, Shiba H, Yanaga K. Incidental abdominal lymph node metastases from a known breast cancer in resected specimen of invasive pancreatic ductal adenocarcinoma: report of a case. Int Cancer Conf J 2019;8:190-4.
26. 26. Kimchy AV, Umoren MD, Rosenberg JJ, Ilagan C, Nithagon P, Shafa S, et al. Breast cancer metastasis to the gastrointestinal tract with unusual endoscopic and histologic presentations. ACG Case Rep J 2022;26:e00938.
27. 27. Stefanopoulos A, Telakis E, Zlatinoudis C, Theodoulou A, Tzaida O, Filippakou A, et al. Diminutive colon metastasis from breast cancer: an unexpected finding in a patient undergoing ulcerative colitis surveillance. ACG Case Rep J 2023;10:Ne01077.
28. 28. Tang T, Zhang L, Li C, Zhou T. Gastric and adrenal metastasis from breast cancer: case report and review of literature. Medicine (Baltimore) 2020;99:e18812.
29. 29. Stroescu C, Gilca I, Chirita D, Poenaru R, Puşcaşu A, Pescaru D, et al. Solitary adrenal metastases from breast invasive ductal carcinoma. Chirurgia (Bucur) 2017;112:473-6.
30. 30. Chen Y, Zhang L, Sun T, Cheng MY, Zou J, Wang K. Case report: solitary splenic metastasis occurring 19 months after primary treatment for occult breast cancer. Front Oncol 2022;12:957490.
31. 31. Nagao A, Noie T, Horiuch H, Yamada H, Momiyama M, Nakajima K, et al. Long-term survival after pancreatic metastasis resection from breast cancer: a systematic literature review. Surg Case Rep 2021;7:39.
32. 32. Akizawa Y, Kanno T, Horibe Y, Shimizu Y, Noguchi E, Yamamoto T, et al. Ovarian metastasis from breast cancer mimicking a primary ovarian neoplasm: a case report. Mol Clin Oncol 2021;15:135.
33. 33. Xu DL, Zhang XT, Wang GH, Li FB, Hu JY. Clinical features of pathologically confirmed metastatic bone tumors--a report of 390 cases. Ai Zheng 2005;24:1404-7.
34. 34. Houssami N, C.M. Costelloe CM. Imaging bone metastases in breast cancer: evidence ocomparative test accuracy. Ann Oncol 2012;23:834-43.
35. 35. Tahara RK, Brewer TM, Theriault RL, Ueno NT. Bone metastasis of breast cancer. Adv Exp Med Biol 2019;1152:105-29.
36. 36. Lee L, Keller A, Clemons M. Sternal resection for recurrent breast cancer: a cautionary tale. Curr Oncol 2008;15:193-5.
37. 37. Wang R, Zhu Y, Liu X, Liao X, He J, Niu L. The clinicopathological features and survival outcomes of patients with different metastatic sites in stage IV breast cancer. BMC Cancer 2019;19:1091.
38. 38. Karaosmanoglu AD, Onur MR, Karcaaltincaba M, Akata D, Ozmen MN. Secondary tumors of the urinary system: an imaging conundrum. Korean J Radiol 2018;19:742-51.
39. 39. Arps DP, Healy P, Zhao L, Kleer CG, Pang JC. Invasive ductal carcinoma with lobular features: a comparison study to invasive ductal and invasive lobular carcinomas of the breast. Breast Cancer Res Treat 2013;138:719-26.
40. 40. Korhonen T, Kuukasjärvi T, Huhtala H, Alarmo EL, Holli K, Kallioniemi A, et al. The impact of lobular and ductal breast cancer histology on the metastatic behavior and long term survival of breast cancer patients. Breast 2013;22:1119-24.
41. 41. García-Fernández A, Lain JM, Chabrera C, Font MG, Fraile M, Barco I, et al. Comparative long-term study of a large series of patients with invasive ductal carcinoma and invasive lobular carcinoma. loco-regional recurrence, metastasis, and survival. Breast J 2015;21:533-7.