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Mediastinal Metastasis of Breast Cancer Mimicking a Primary Mediastinal Tumor

Authors
  • Yamashita, Takashi1
  • Watahiki, Mana2
  • Asai, Katsuyuki1
  • 1 Division of General Thoracic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
  • 2 Division of Breast Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
Type
Published Article
Journal
The American Journal of Case Reports
Publisher
International Scientific Literature, Inc.
Publication Date
Sep 24, 2020
Volume
21
Identifiers
DOI: 10.12659/AJCR.925275
PMID: 32968040
PMCID: PMC7521463
Source
PubMed Central
Keywords
License
Green

Abstract

Case series Patients: Female, 48-year-old • Female, 47-year-old Final Diagnosis: Metastatic breast cancer Symptoms: Edema of left upper limb • no symptom Medication: — Clinical Procedure: Median sternotomy • small incisional biopsy Specialty: Surgery Objective: Challenging differential diagnosis Background: Breast cancer is becoming a common disease in women. It progresses slowly and may recur after a long time. Therefore, when a tumor is found in the chest of a patient with a history of breast cancer, an immediate concern is whether it is a primary tumor or a metastatic tumor. However, mediastinal metastasis is extremely unlikely to occur before lung metastasis, and breast cancer is not likely to have a solitary mediastinal metastasis. Additionally, patients should not undergo invasive procedures unnecessarily, so careful consideration is required. Case Reports: We present 2 cases. In case 1, a 48-year-old woman with a history of breast cancer had a mediastinal tumor. Based on imaging findings, cystic thymoma was suspected. Thoracoscopic intraoperative rapid biopsy showed a lymphocyte-predominant tumor tissue; therefore, the tumor was resected via a median sternotomy. The final pathological diagnosis was breast cancer metastasis. In case 2, a 47-year-old woman who underwent breast cancer resection 15 years earlier was referred for upper limb edema. Based on imaging findings, a left medial vein occlusion due to mediastinal tumor was diagnosed. Our experience in case 1 suggested that a biopsy alone should be performed first. A tumor biopsy was performed through a small transverse neck incision in case 2, and the final diagnosis was metastatic breast cancer of the mediastinum. Conclusions: In patients with a suspected primary mediastinal tumor on imaging, the possibility of a metastatic tumor should be considered if they have a history of breast cancer, regardless of how long in the past it was.

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