title: The Great Mimicker: Metastatic Breast Carcinoma to the Head and Neck with Emphasis on Unusual Clinical and Pathologic Features.
abstract: Distant metastases are relatively common in breast cancer, but spread to the head and neck region is uncommon and can be diagnostically challenging. Pathology databases of two academic hospitals were searched for patients. The diagnoses were by morphologic comparison with the primary breast specimen (when available) or through the use of immunohistochemical stains characteristic of breast carcinoma (cytokeratin 7, mammaglobin, GCDFP15, and/or GATA3 positive-excluding new primary tumors at the respective head and neck sites). Of the 25 patients identified, only 22 (88.0 %) had a known history of breast carcinoma. Time from primary diagnosis to head and neck metastasis was highly variable, ranging from 1 to 33 years (mean = 10.9 years). The most common locations were neck lymph nodes (8 cases), orbital soft tissue (5), oral cavity (3), skull base (3), mastoid sinus (2), nasal cavity (1), palatine tonsil (1), and facial skin (1). Clinical presentations were highly variable, ranging from cranial nerve palsies without a mass lesion to oral cavity erythema and swelling to bone pain. Histologically, two cases showed mucosal (or skin)-based mass lesions with associated pagetoid spread in the adjacent epithelium, a feature normally associated with primary carcinomas. Three tumors were misdiagnosed pathologically as new head and neck primary tumors. This series demonstrates the extreme variability in clinical and pathologic features of breast cancer metastatic to the head and neck, including long time intervals to metastasis.
authors.affiliation: Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Dikson Dibe
authors.initials: DD
authors.lastname: Gondim
authors.affiliation: Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.|Otolaryngology- Head and Neck Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chernock
authors.affiliation: Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.|Otolaryngology- Head and Neck Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: El-Mofty
authors.affiliation: Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA. james.lewis@vanderbilt.edu.|Otolaryngology- Head and Neck Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA. james.lewis@vanderbilt.edu.|Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Room 3020D - Surgical Pathology, Nashville, TN, 37232-7415, USA. james.lewis@vanderbilt.edu.|Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA. james.lewis@vanderbilt.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000556:secondary*; D006801:Humans; D008875:Middle Aged
keywords: Breast; Carcinoma; Head; Metastatic; Neck