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Metastatic melanoma presenting as an isolated breast tumor: a study of 20 cases with emphasis on several primary mimickers.
MedLine Citation:
PMID:  23276173     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Context.-The mammary gland can be a site of metastasis in patients with malignant melanoma, which is easily recognized microscopically if clinical information is available. Nonetheless, metastatic melanoma presenting as an isolated mammary tumor can be more challenging to diagnose because it can simulate a primary breast carcinoma clinically and morphologically. Objective.-To review metastatic melanoma to the breast, presenting as primary breast carcinomas clinically and morphologically. Design.-The authors report 20 cases of metastatic melanoma clinically presenting as breast tumors. Cases with widespread metastatic presentation were excluded. Results.-Epithelioid and spindle cell tumors predominated, suggesting mammary ductal, papillary, or sarcomatoid carcinoma. Most cases (16 of 20) were submitted for consultation or second opinion owing to their unusual presentation in the breast, or to perform predictive/prognostic immunohistochemical assays. Seven cases had a remarkable phenotypic spectrum expanding the differential diagnosis to large cell lymphoma, leiomyosarcoma, medullary carcinoma, malignant schwannoma, and liposarcoma. Tumor cells were negative for cytokeratin stains and positive for S100 protein, HMB-45, and Melan-A. Negative staining was also observed for epithelial membrane antigen, CD45, desmin, estrogen and progesterone receptors, and human epidermal growth factor receptor 2. Conclusions.-Metastatic melanoma may simulate a broad spectrum of primary breast malignancies. Although the application of a simple panel of antibodies assists in rendering the correct interpretation, lesions presenting as isolated breast tumors may introduce a significant diagnostic difficulty, especially when there is inadequate patient history and/or limited biopsy material. Further challenges are introduced by the extraordinary phenotypic plasticity of metastatic melanoma. Awareness of this pattern variance is essential to avoid inappropriate treatment, especially in cases simulating a "triple negative," poorly differentiated carcinoma of the breast.
Authors:
Carlos E Bacchi; Sheila C Wludarski; Abiy B Ambaye; Janez Lamovec; Tiziana Salviato; Giovanni Falconieri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pathology & laboratory medicine     Volume:  137     ISSN:  1543-2165     ISO Abbreviation:  Arch. Pathol. Lab. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7607091     Medline TA:  Arch Pathol Lab Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-9     Citation Subset:  AIM; IM    
Affiliation:
From Consultoria em Patologia, Botucatu, SP, Brazil (Drs Bacchi and Wludarski); the Department of Pathology, University of Vermont College of Medicine, Burlington (Dr Ambaye); the Department of Pathology, Institute of Oncology, Ljubljana, Slovenia (Dr Lamovec); the Department of Pathology, Pordenone General Hospital, Pordenone, Italy (Dr Salviato); and the Department of Pathology, General Hospital S. Maria della Misericordia, Udine, Italy (Dr Falconieri).
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