title: Aggressive progression of breast cancer with microscopic pulmonary emboli possessing a stem cell-like phenotype independent of its origin.
abstract: Microscopic pulmonary tumor embolism is difficult to diagnose. Herein is presented the case of a patient who suffered from acute dyspnea and breast cancer on the right side. Two weeks after the breast cancer diagnosis the patient began to experience dyspnea. After 2 weeks of dyspnea, the patient died without an accurate diagnosis of dyspnea. Autopsy indicated massive microscopic pulmonary emboli of the breast cancer. Immunohistochemistry showed that most of the cancer cells in the primary site were negative for estrogen receptors, progesterone receptors Her2/neu oncogene (triple negative), and stem cell-like markers (OCT3/4, NANOG2, CD44, CD24, aldehyde dehydrogenase 1 (ALDH1)). The breast cancer cells in the lung (the metastasized site), however, were triple negative, but were enriched in stem cell-like markers (OCT3/4(+), NANOG2(+), CD44(+)/CD24(-/low), ALDH1(+)). This is a significant case report indicating that vascular emboli themselves contain the essential molecular signature of 'stemness' independent of the origin.
authors.affiliation: Department of Second Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. gloria@hama-med.ac.jp
authors.forename: Hideya
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogura
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Arai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Baba
authors.forename: Isao
authors.initials: I
authors.lastname: Kosugi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsutsui
authors.forename: Toshihide
authors.initials: T
authors.lastname: Iwashita
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000473:pathology*; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D011655:Pulmonary Embolism / Q000209:etiology / Q000473:pathology*; D013234:Stem Cells / Q000473:pathology*