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Metastatic nasopharyngeal carcinoma presenting as an isolated breast mass: A diagnostic pitfall and a review of literature.

Abstract Metastases to breast are much rarer than primary breast tumors. We now present a case of 45-year-old female, who presented with an isolated breast mass. A positron emission tomography-computed tomography (PET-CT) done revealed hypermetabolic right breast nodules, soft tissue deposits, and multiple nodal involvement. The biopsy from the breast and axillary lymph node showed dense lymphoid infiltrate and was interpreted initially as granulomatous inflammation. However, the lumps were hard and suspicious for primary breast cancer, so an immunohistochemistry for cytokeratin was performed which highlighted the epithelial cell clusters masked within the inflammatory infiltrate and the diagnosis of undifferentiated carcinoma, lymphoepithelioma-like was made. After the diagnosis was made, it was realized that the patient had been treated earlier for a nasopharyngeal carcinoma (NPC). The in situ hybridization (ISH) test for Epstein-Barr virus-encoded RNA ISH was positive in the tumor cells, and hence, a diagnosis of metastatic NPC was finally made. The patient subsequently developed extensive nodal, skeletal, and soft tissue metastatic disease but was alive till September 2015. Although extremely rare, metastatic NPC can occur in the breast and the above case highlights that it mimics an inflammatory lesion. This case highlights the importance of the multidisciplinary approach for appropriate tumor diagnosis and patient management.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title indian journal of pathology & microbiology
Publication Year Start




PMID- 28195109
OWN - NLM
STAT- MEDLINE
DA  - 20170214
DCOM- 20170313
LR  - 20170313
IS  - 0974-5130 (Electronic)
IS  - 0377-4929 (Linking)
VI  - 60
IP  - 1
DP  - 2017 Jan-Mar
TI  - Metastatic nasopharyngeal carcinoma presenting as an isolated breast mass: A
      diagnostic pitfall and a review of literature.
PG  - 119-121
LID - 10.4103/0377-4929.200058 [doi]
AB  - Metastases to breast are much rarer than primary breast tumors. We now present a 
      case of 45-year-old female, who presented with an isolated breast mass. A
      positron emission tomography-computed tomography (PET-CT) done revealed
      hypermetabolic right breast nodules, soft tissue deposits, and multiple nodal
      involvement. The biopsy from the breast and axillary lymph node showed dense
      lymphoid infiltrate and was interpreted initially as granulomatous inflammation. 
      However, the lumps were hard and suspicious for primary breast cancer, so an
      immunohistochemistry for cytokeratin was performed which highlighted the
      epithelial cell clusters masked within the inflammatory infiltrate and the
      diagnosis of undifferentiated carcinoma, lymphoepithelioma-like was made. After
      the diagnosis was made, it was realized that the patient had been treated earlier
      for a nasopharyngeal carcinoma (NPC). The in situ hybridization (ISH) test for
      Epstein-Barr virus-encoded RNA ISH was positive in the tumor cells, and hence, a 
      diagnosis of metastatic NPC was finally made. The patient subsequently developed 
      extensive nodal, skeletal, and soft tissue metastatic disease but was alive till 
      September 2015. Although extremely rare, metastatic NPC can occur in the breast
      and the above case highlights that it mimics an inflammatory lesion. This case
      highlights the importance of the multidisciplinary approach for appropriate tumor
      diagnosis and patient management.
FAU - Pai, Trupti
AU  - Pai T
AD  - Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
FAU - Nair, Nita
AU  - Nair N
AD  - Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra,
      India.
FAU - Pantvaidya, Gauri
AU  - Pantvaidya G
AD  - Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra,
      India.
FAU - Deodhar, Kedar
AU  - Deodhar K
AD  - Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
FAU - Shet, Tanuja
AU  - Shet T
AD  - Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - India
TA  - Indian J Pathol Microbiol
JT  - Indian journal of pathology & microbiology
JID - 7605904
RN  - 0 (Biomarkers, Tumor)
RN  - 0 (RNA, Viral)
RN  - 68238-35-7 (Keratins)
SB  - IM
MH  - Biomarkers, Tumor/analysis
MH  - Biopsy
MH  - Breast/diagnostic imaging/pathology
MH  - Breast Neoplasms/diagnostic imaging/*pathology/*secondary
MH  - Carcinoma/diagnostic imaging/*pathology/*secondary
MH  - Female
MH  - Herpesvirus 4, Human/genetics/isolation & purification
MH  - Histocytochemistry
MH  - Humans
MH  - Immunohistochemistry
MH  - In Situ Hybridization
MH  - Keratins/analysis
MH  - Microscopy
MH  - Middle Aged
MH  - Nasopharyngeal Neoplasms/*complications/*diagnosis/pathology
MH  - Nasopharynx/pathology
MH  - Positron Emission Tomography Computed Tomography
MH  - RNA, Viral/analysis/genetics
EDAT- 2017/02/15 06:00
MHDA- 2017/03/14 06:00
CRDT- 2017/02/15 06:00
AID - IndianJPatholMicrobiol_2017_60_1_119_200058 [pii]
AID - 10.4103/0377-4929.200058 [doi]
PST - ppublish
SO  - Indian J Pathol Microbiol. 2017 Jan-Mar;60(1):119-121. doi:
      10.4103/0377-4929.200058.

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