Undifferentiated Subtype of Non-keratinizing Carcinoma of the Nasopharynx Metastasizing to the Breast: A Case Report and Literature Review
Keywords:
Breast, carcinoma, metastasis, nasopharyngeal carcinoma
Abstract
Nasopharyngeal carcinomas (NPCs) have a particularly high risk for aggressive clinical behavior. Metastatic tumors or secondary malignant neoplasms to the breast are uncommon. Breast metastasis of NPCs is very rare. We report a case of NPC in a 17-year-old female patient presenting with a mass in her left breast. The tumor consisted of an inflammatory infiltrate rich in lymphocytic or plasmacytic cells and composed of carcinoma cells having large, vesicular, round to oval nuclei with single, centrally located, eosinophilic nucleolus with eosinophilic cytoplasm. The epithelial tumor cells were strongly positive for pancytokeratin and CK19 and negative for CK7, CK20, progesterone, and estrogen receptors. NPCs are predominantly seen in adults with an average age of 50 years at diagnosis, and they are slightly more common in men than in women. The etiology of NPCs is generally multifactorial, such as genetic predisposition, Epstein-Barr virus infection, and environmental factors. A review of the literature on NPC yielded eight cases of metastasis to the breast. Excessive radical surgery is not suitable for metastatic tumors in the breasts of these patients, but isolated success has been obtained with a combination of local surgery and radiation therapy.References
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[19] Que J, Chien-Tai H, Shih-Sung C, Li-Ching L, Kue-Li L: Breast Metastases from Nasopharyngeal Carcinoma: a case report and literature review. Chin J Radiol 2003;28:323-327
[2] Chan JKC, Pilch BZ, Kuo TT, Wenig BM, Lee AWM: Tumours of the nasopharynx. In Barnes L, Eveson JW, Reichart P, Sidransky D. (Eds): Pathology and Genetics of Head and Neck Tumours, Lyon, IARC Press, 2005;81-106
[3] Ho FC, Tham IW, Earnest A, Lee KM, Lu JJ: Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a meta-analysis of clinical evidence. BMC Cancer 2012;21:12:98 PMID: 22433671, doi: 10.1186/1471-2407-12-98.
[4] Huang CJ, Leung SW, Lian SL, Wang CJ, Fang FM, Ho YH: Patterns of distant metastases in nasopharyngeal carcinoma. Kaohsiung J Med Sci 1996;12:229-34 PMID: 8683644
[5] Leach BI, Sun B, Petrovic L, Liu SV: Breast metastasis from nasopharyngeal carcinoma: A case report and review of the literature. Oncol Lett 2013;5:1859-1861 PMID: 23833656, DOI: 10.3892/ol.2013.1303
[6] Yeh CN, Lin CH, Chen MF: Clinical and ultrasonographic characteristics of breast metastases from extramammary malignancies. Am Surg 2004;70:287-90 PMID: 15098776
[7] Vaishnav KU, Pandhi S, Shah TS, Chaudhry A.Nasopharynx carcinoma: a rare primary for bilateral breast metastasis.BMJ Case Rep. 2012 Jul 9;2012. pii: bcr0320126083. doi: 10.1136/bcr.03.2012.6083.
[8] Liang N, Xie J, Liu F, Xu D, Yu X, Tian Y, Song M, Zhang J. Male breast metastases from nasopharyngeal carcinoma: A case report and literature review. Oncol Lett. 2014;7:1586-1588. Epub 2014 Feb 20.
[9] Maounis N, Chorti M, Legaki S, Ellina E, Emmanouilidou A, Demonakou M, Tsiafaki X: Metastasis to the breast from an adenocarcinoma of the lung with extensive micropapillary component: a case report and review of the literature. Diagn Pathol 2010;17:5:82 PMID: 21167048, doi: 10.1186/1746-1596-5-82.
[10] Hoda SA: Metastases in the Breast from Nonmammary Malignant Neoplasms. In Rosen PP (Ed): Rosen’s Breast Pathology, 4nd ed., Lippincott Williams&Wilkins, Philadelphia, 2014;937-956
[11] Sidler D, Thum P, Winterhalder R, Huber G, Haerle SK: Undifferentiated carcinoma of nasopharyngeal type (UCNT): a Swiss single-institutional experience during 1990-2005. Swiss Med Wkly 2010;140:273-9 PMID: 19950040, doi: smw-12844.
[12] Chu EA, Wu JM, Tunkel DE, Ishman SL: Nasopharyngeal carcinoma: the role of the Epstein-Barr virus. Medscape J Med 2008, 10:165 PMID: 18769688
[13] Gullo C, Low WK, Teoh G: Association of Epstein-Barr virus with nasopharyngeal carcinoma and current status of development of cancer-derived cell lines. Ann Acad Med Singapore 2008;37:769-77 PMID: 18989494
[14] Thompson LD: Update on nasopharyngeal carcinoma. Head Neck Pathol 2007;1:81-6 PMID: 20614287, doi: 10.1007/s12105-007-0012-7
[15] Barnes L: Diseases of the Nasal Cavity, Paranasal Sinuses, and Nasopharynx. In Barnes (Ed): Surgical Pathology of the Head and Neck, New York, Informa Healthcare, 2008;343-423
[16] Wakely PE: Nasopharengeal Carcinoma, Nonkeratinizing Undifferentiated Type. In Suster S (Ed): Head and Neck Pathology, New York, Demos Medical, 2011;17-18
[17] Regauer S: Nasopharynx and Waldeyer’s Ring. In Cardesa A, Slootweg PJ (Eds.): Pathology of the Head and Neck, New York , Springer, 2006;171-190
[18] Bhargava R, Dabbs DJ: Immunohistology of the Breast. In David J. Dabbs. (Ed): Diagnostic Immunohistochemistry Theranostic and Genomic Applications, Philadelphia, Elsevier Saunders, 2014;710-761
[19] Que J, Chien-Tai H, Shih-Sung C, Li-Ching L, Kue-Li L: Breast Metastases from Nasopharyngeal Carcinoma: a case report and literature review. Chin J Radiol 2003;28:323-327
Published
2015-07-26
Issue
Section
Case Report
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