Virchows Archiv A

, Volume 386, Issue 1, pp 117–124 | Cite as

Solitary breast metastasis: First manifestation of an occult carcinoid of the ileum

  • Walter Schürch
  • Esther Lamoureux
  • René Lefebvre
  • Jean-Panet Fauteux
Case Report

Summary

A metastasis to the breast was the first manifestation of a clinically occult ileal carcinoid in a 53 year old woman. Modified radical mastectomy was performed after the breast neoplasm had been interpreted clinically and pathologically as a primary carcinoma. Permanent sections demonstrated the tumor to be composed of sheets of small uniform cells subdivided into lobules by delicate vascular septa. Silver impregnation revealed the presence of argentaffin cytoplasmic granules. This feature, with the added ultrastructural findings which showed pleomorphic neurosecretory-type granules within the cytoplasm of the tumor cells strongly suggested a metastasis to the breast from a midgut carcinoid. The subsequently performed barium study of the small bowel showed an infiltrating neoplastic lesion in the terminal ileum, which after surgical excision and histologic examination proved to be two typical argentaffin carcinoids with pleomorphic cytoplasmic granules. This report thus clearly demonstrates the importance of a combined light microscopic, histochemical and ultrastructural analysis of this breast neoplasm in order to establish its metastatic origin and to separate it from a primary carcinoma or a primary carcinoid of the breast.

Key words

Carcinoid Argentaffin Metastasis Breast 

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References

  1. Capella, C., Solcia, E., Frigerio, B., Buffa, R.: Endocrine cells of the human intestine. An ultrastructural study. In: Endocrine gut and pancreas, T. Fujita (ed.), chap. 4, pp. 43–59. Amsterdam: Elsevier Scientific Publishing Company 1976Google Scholar
  2. Charache, H.: Metastatic tumors in the breast. Surgery 33, 385–390 (1953)Google Scholar
  3. Chodoff, R.J.: Solitary breast metastasis from carcinoid of the ileum. Am. J. Surg. 109, 814–815 (1965)Google Scholar
  4. Cubilla, A.L., Woodruff, J.A.: Primary carcinoid tumor of the breast. A report of eight patients. Am. J. Surg. Pathol. 1, 283–292 (1977)Google Scholar
  5. Dawson, E.K.: Metastatic tumour of the breast, with report of a case. J. Pathol. 43, 53–60 (1936)Google Scholar
  6. Deeley, T.J.: Secondary deposits in the breast. Br. J. Cancer 19, 738–743 (1965)Google Scholar
  7. Devitt, P.G.: Carcinoid tumor of the breast. Br. Med. J. 2, 327 (1978)Google Scholar
  8. Farrow, J.H.: Bilateral mammary cancer. Cancer 9, 1182–1188 (1956)Google Scholar
  9. Haagensen, CD.: Metastatic tumors of the breast. In: Diseases of the breast, chap. 24, 2nd edition, pp. 498–499. Philadelphia: W.B. Saunders 1971Google Scholar
  10. Hajdu, S.I., Urban, J.A.: Cancers metastatic to the breast. Cancer 29, 1691–1696 (1972)Google Scholar
  11. Harrist, T.J., Kalisher, L.: Breast metastasis: An unusual manifestation of a malignant carcinoid tumor. Cancer 40, 3102–3106 (1977)Google Scholar
  12. Hawley, P.R.: A case of secondary carcinoid tumors in both breasts following excision of primary carcinoid tumour of the duodenum. Br. J. Surg. 53, 818–820 (1966)Google Scholar
  13. Kaneko, H., Hōjō, H., Ishikawa, S., Yamanouchi, H., Sumida, T., Saito, R.: Norepinephrine-producing tumors of bilateral breasts. A case report. Cancer 41, 2002–2007 (1978)Google Scholar
  14. Kuiper, D.H., Gracie, W.A. Jr., Pollard, H.M.: Twenty years of gastrointestinal carcinoids. Cancer 25, 1424–1430 (1970)Google Scholar
  15. Lack, E., Mercer, L.: A modified Grimelius argyrophil technique for neurosecretory granules. Am. J. Surg. Pathol. 1, 275–277 (1977)Google Scholar
  16. Lillie, R.D., Glenner, G.G.: Histochemical reactions in carcinoids tumors of the human gastrointestinal tract. Am. J. Path. 36, 623–651 (1960)Google Scholar
  17. Pressman, P.I.: Malignant melanoma and the breast. Cancer 21, 784–788 (1973)Google Scholar
  18. Sandison, A.T.: Metastatic tumours in the breast. Br. J. Surg. 47, 54–58 (1959)Google Scholar
  19. Stout, A.P.: Carcinoid tumors of the rectum derived from Erspamer's pre-enterochrome cells. Am. J. Path. 18, 993–1009 (1942)Google Scholar
  20. Turner, M., Gallager, H.S.: Occult appendiceal carcinoid. Report of a case with fatal metastases. Arch. Pathol. 88, 188–190 (1969)Google Scholar
  21. Taxy, J.B., Tischler, A.S., Jerome, S.J., Battifiona, H.: Carcinoid tumor of the breast: A possible variant of lobular carcinoma. Lab. Invest. 40, 287–288 (1979)Google Scholar
  22. Virchow, R.: Die krankhaften Geschwülste, vol. I, p. 69. Berlin: A. Hirschwald, 1863Google Scholar
  23. Williams, E.D., Azzopardi, J.G.: Tumors of the lung and the carcinoid syndrome. Thorax 15, 30–36 (1960)Google Scholar
  24. Williams, E.D., Sandler, M.: The classification of carcinoid tumours. Lancet 1, 238–239 (1963)Google Scholar
  25. Zetzel, L., Scully, R.E.: Case reports of the Massachusetts General Hospital. N. Engl. J. Med. 256, 703–707 (1951)Google Scholar

Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • Walter Schürch
    • 1
  • Esther Lamoureux
    • 1
  • René Lefebvre
    • 1
  • Jean-Panet Fauteux
    • 1
  1. 1.Département de Pathologie et Département de Chirurgie, Hôtel-Dieu de Montréal et Faculté de MédecineUniversité de MontréalCanada

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