Framarino-dei-Malatesta Marialuisa, Sammartino Paolo, Derme Martina, Iannini Isabella, Masselli Gabriele, Pecorella Irene
World J Surg Oncol. 2015 Feb 25;13:79. doi: 10.1186/s12957-015-0491-z.
Metastases to the breast from extramammary malignancies are very rare, and ruling out the diagnosis of primary breast tumor is important in order to decide on clinical management and predict prognosis.
Clinical examination revealed in a 49-year-old hairdresser a 3-cm hard lump adherent to the underlying layers in the right breast. Trucut biopsy was performed. Histology showed a solid proliferation of medium-sized neoplastic polygonal cells. Immunohistochemical analysis showed tumor cells diffusely positive for cytokeratin 8/18 and calretinin and focally positive for cytokeratin 5/6 and Wilms' tumor 1, e-cadherin, and human bone marrow endothelial-1. Estrogen receptors and progesterone receptors were negative. The final diagnosis was metastatic epithelioid malignant pleural mesothelioma.
Immunohistochemistry is an important tool for a conclusive diagnosis of malignant pleural mesothelioma. Owing to the degree of histological and immunohistochemical overlap, a high level of clinical suspicion is essential in order to avoid unnecessary mutilating surgery.
乳腺外恶性肿瘤转移至乳腺极为罕见，排除原发性乳腺肿瘤的诊断对于确定临床治疗方案及预测预后至关重要。
临床检查发现一名49岁的美发师右乳有一个3厘米的硬块，与深层组织粘连。进行了粗针活检。组织学检查显示中等大小的肿瘤性多边形细胞呈实性增生。免疫组织化学分析显示肿瘤细胞细胞角蛋白8/18和钙视网膜蛋白弥漫性阳性，细胞角蛋白5/6、威尔姆斯瘤1、E-钙黏蛋白和人骨髓内皮-1局灶性阳性。雌激素受体和孕激素受体均为阴性。最终诊断为转移性上皮样恶性胸膜间皮瘤。
免疫组织化学是确诊恶性胸膜间皮瘤的重要工具。由于组织学和免疫组织化学存在重叠程度，高度的临床怀疑对于避免不必要的致残性手术至关重要。
