Differentiation of breast and pulmonary carcinoma

Lung is a common metastatic site for breast carcinomas.  But also, women who have had a breast carcinoma are at a 30% increased risk of a second, extra-mammary, primary tumour, particularly of a primary lung carcinoma.  Thus 4% to 9% of women with a history of breast carcinoma can be expected to develop a primary lung carcinoma.  A solitary pulmonary nodule in a woman with such a history has a 52% probability of being a primary lung tumour, a 43% probability of being a metastasis from a breast primary and a 5% probability of being a being lesion such as a hamartoma2.  Although primary squamous carcinoma of the breast is rare, breast carcinomas may show focal squamous metaplasia which may lead to an erroneous diagnosis of a primary squamous carcinoma of the lung.

The combination of  ER, GATA-3 and mammaglobin detected 83.4% of mammary carcinoma, not significantly better than either ER/mammaglobin or GATA-3/mammaglobin, either of which detects 82.6% of mammary carcinomas.

References

1 Yang M, Nonaka D. A study of immunohistochemical differential expression in pulmonary and mammary carcinomas. Mod Pathol. 2010 May;23(5):654-61. (with corrections to the paper provided by author)

2 Casey JJ, Stempel BG, Scanlon EF, Fry WA. The solitary pulmonary nodule in the patient with breast cancer. Surgery. 1984 Oct;96(4):801-5.

3 Kaufmann O, Deidesheimer T, Muehlenberg M, Deicke P, Dietel M. Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites. Histopathology. 1996 Sep;29(3):233-40.

4 Wick, M. R., T. J. Lillemoe, et al. (1989). "Gross cystic disease fluid protein-15 as a marker for breast cancer: immunohistochemical analysis of 690 human neoplasms and comparison with alpha-lactalbumin." Hum Pathol 20(3): 281-7.

5 Striebel JM, Dacic S,Yousem SA. ross cystic disease fluid protein-(GCDFP-15): expression in primary lung adenocarcinoma. Am J Surg Pathol 2008; 32:426-32

6 Dennis JL, Hvidsten TR, Wit EC, et al. Markers of adenocarcinoma characteristic of the site of origin: development of a diagnostic algorithm. Clin Cancer Res 2005; 11:3766-72 FULL TEXT

7Lerwill, M. F. (2004). "Current practical applications of diagnostic immunohistochemistry in breast pathology." Am J Surg Pathol 28(8): 1076-91.

8 Sasaki E, Tsunoda N, Hatanaka Y, et al. Breast-specific expression of MGB1/mammaglobin: an examination of 480 tumors from various organs and clinicopathological analysis of MGB1-positive breast cancers. Mod Pathol 2007; 20:208-14

9 Bhargava R, Beriwal S,Dabbs DJ Mammaglobin vs GCDFP-15: an immunohistologic validation survey for sensitivity and specificity. Am J Clin Pathol 2007; 127:103-13

Raab SS, Berg LC, Swanson PE, Wick MR. Adenocarcinoma in the lung in patients with breast cancer. A prospective analysis of the discriminatory value of immunohistology. Am J Clin Pathol. 1993 Jul;100(1):27-35.

This page last revised 10.5.2010

©SMUHT/PW Bishop