Metastatic lesions to the breasts: review of the imaging findings

Transcription

1 Metastatic lesions to the breasts: review of the imaging findings Poster No.: C-1919 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Helena Teixeira Rodrigues, R. A. E. K. Matsumoto, S. Jim Kim Hsieh, L. F. Chala, N. de Barros, G. G. Cerri; São Paulo/BR Keywords: Breast, Mammography, Ultrasound, MR, elearning, Cancer DOI: /ecr2015/C-1919 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 37

2 Learning objectives - To describe the imaging features of metastasis to the breasts from non-mammary malignancies at mammography, ultrasonography (US)and magnetic resonance imaging (MRI). - To demonstrate the limitations of these imaging findings in the differential diagnosis of metastatic extramammary neoplasms from primary breast cancer. - To illustrate the imaging findings of some breast metastasis from extramammary malignancies from our database. Page 2 of 37

3 Background - The first challenge facing a breast tumor is to distinguish it from a benign or a malignant primary breast lesion. - The differential diagnosis gets wider when we include mammary metastasis from extramammary malignant neoplasms. - Extramammary malignant neoplasms metastasis to the breasts are rare due to the large amount of fibrous tissue and relatively poor blood supply to the breasts, accounting for only 0,5-6,6% of breast tumors. - There is an overlap of the clinical findings in patients with primary breast cancer and those with metastasis to the breast. - Histopathologic with immunohistochemical results and clinical history should be considered in conjunction when differentiating a secondary mass from a primary breast carcinoma. - In patients with a history of malignancy, the time interval between the initial diagnosis of the primary tumor and mammary metastasis vary between 1 month and 15 years. - This interval is longer in melanoma and ovarian carcinoma - The most common primary tumors metastasizing to the breast are melanoma and lymphoma - Several other primary sources have been reported, such as lung oat cell cancer, lung adenocarcinoma, colon adenocarcinoma, gastric adenocarcinoma, pancreas adenocarcinoma, anaplastic ovarian carcinoma, serous ovarian adenocarcinoma, lipossarcoma, leukemia, and squamous cancer of vulva. - In children, rhabdomyosarcoma and lymphoma are the most common - Metastasis to the breast typically lie in the subcutaneous plane and therefore are usually palpable. Page 3 of 37

4 - Primary breast carcinomas arise from the glandular epithelium and are usually situated more deeply, but can also be palpable. - Metastasis to the breast may occur by two distinct routes: lymphatic and haematogenic. - Lymphatic metastasis imaging features can be indistinguishable from inflammatory carcinoma. - These features have been reported in metastases from stomach and ovarian carcinoma, tonsil and lung squamous carcinomas, pancreas carcinoma and cholangiocarcinoma of the liver. - Axillary lymphadenopathy is present in about 15 to 58% of the patients, more frequently seen in lymphomas. - A solitary discrete lesion is more commonly reported than a multiple or diffuse involvement and ususally represents haematogenic metastasis. Page 4 of 37

5 Findings and procedure details Imaging findings - Mammography - Solitary metastatic breast masses are more common than multiple or bilateral breast masses. - Masses with irregular shape and circumscribed margins. - Inflammatory changes and focal asimmetry had already been reported. Microcalcifications are not usually associated with metastasis, except for rare cases of ovarian, lymphoma, thyroid or mucin-producing gastrointestinal tract carcinoma metastasis. Imaging findings - Ultrasound - Usual finding: oval or round single mass - Mass margins: Circumscribed or indistinct. - Echogenicity: hypoechoic. - Posterior acoustic enhancement due to high cellularity. - Extraductal localization. Imagingfindings - MRI - The appearance of these lesions can be similar to primary breast cancer. - Usual finding: enhancing oval or irregular mass, with circumscribed or irregular margins. - A ring-enhancement pattern can be seen followed by subsequent washout of the lesions. - Non-mass enhancement: focal and asymmetric enhancement. Page 5 of 37

6 Images for this section: Fig. 1 Page 6 of 37

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36 Conclusion - Differentiation of a primary breast tumor from metastatic extramammary neoplasms represents a challenge. - Although etiology can hardly be defined based exclusively on imaging criteria, all radiologists should be aware of this entity in order to reduce misdiagnosis and inappropriate management. Page 36 of 37

37 References 1.SUROV, A; THOMSSEN, C; ARNOLD, D; HOLZHAUSEN, HJ; RUSCHKE, K; WIENKE, A; SPIELMANN, RP. Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features. The British Journal of Radiology, 85 (2012), e195e Metastasis in the Breast Mimicking Inflammatory Breast Cancer. Journal of Clinical Oncology,Vol 30, No 22 (August 1), 2012: pp e202-e MAOUNIS, N; TSIAFAKI, X; CHORTI, M; LEGAKI, S; ELLINA, E; EMMANOUILIDOU, A; DEMONAKOU, M. Metastasis to the breast from an adenocarcinoma of the lung with extensivemicropapillary component: a case report and review of the literature.maounis et al. Diagnostic Pathology 2010, 5:82. 4.KLEIN, RL; BROWN, AR; CASTRO, CMG; CHAMBERS, SK; GRAGUN, JM; LEBEAU, LG; LANG, JE. Ovarian Cancer Metastatic to the Breast Presenting as InflammatoryBreastCancer: A Case Report and Literature Review. Journal of Cancer 2010; 1: BABU, KS; ROBERTS, F; BRYDEN, F;McCAFFERTY, A; DOWNER, P; HANSELL, DT; JONES, R; MILROY, R. Metastases to Breast from Primary Lung Cancer. JThoracOncol. 2009; 4: Mark E O'DONNELL, ME;McCARVET, M; CARSON, J; MULLAN, FJ; WHITESIDE, MW; GARSTIN, WI. Non-epithelial malignancies and metastatictumours of the breast. Ulster Med J 2009;78(2): NOGUERA, JJ; MARTINEZ-MIRAVETE, P; IDOATE, F; DIAZ, L; MARTINEZREGUEIRA, F; PINA, L; ZORNOZA, G. Metastases to the breast: A review of 33 cases. Australasian Radiology, 2007; 51, LEE, SH; PARK, JM; KOOK, SH; HAN, BK; MOON, WK. Metastatic Tumors to the Breast: Mammographic and Ultrasonographic Findings. J Ultrasound Med, 2000; 19: Page 37 of 37