Clinicopathologic features and treatment of breast metastasis from nasopharyngeal carcinoma: A report of two cases and literature review

Abstract

Abstract. Breast metastasis is a rare pattern of distant metastasis from nasopharyngeal carcinoma (NPC) following curative treatment. The present study reported two patients with breast metastasis from NPC and reviewed four such patients reported in the literature, including the analysis of clinical profiles, pathological diagnoses, treatment strategies and outcomes. The breast is a potential metastatic site for patients with NPC following curative treatment; however, thus far, only metachronous breast metastasis has been reported. Infection with Epstein-Barr virus (EBV) was identified in the breast metastasis sites of the two patients investigated in the current study using in situ hybridization for EBV-encoded small RNAs. Patients with breast metastases from NPC consistently and simultaneously develop metastases in other sites. In addition, the two current patients had poor prognoses. Therefore, chemotherapy was the primary treatment strategy administered. A solitary breast metastasis was identified in the male patient. At the most recent follow-up 10 years subsequent to undergoing a Halsted mastectomy, the patient remained alive, however the patient is now lost to follow-up. This case indicates that patients exhibiting NPC with a solitary breast metastasis may still gain long-term survival by undergoing radical mastectomy; therefore, radical mastectomy should be considered in such patients. IntroductionAlthough breast cancer is the most common malignancy among female individuals, the breast is an uncommon site of metastasis from extramammary malignant neoplasms. In addition, metastases to the breast represent only 0.3-2.7% of all malignant mammary tumours (1). Excluding contralateral mammary tumours, the most common sources of primary tumour metastasis to the breast are, in decreasing order of frequency, melanoma, lymphoma, lung and ovarian cancer (2). Metastases from the head and neck cancer are rare, and those from nasopharyngeal carcinoma (NPC) are extremely rare (2).Diagnosis of breast metastasis from NPC is difficult, even when the patient has a medical history of another primary cancer. Experience of dealing with this clinical setting is lacking; in fact, only four documented cases have been reported in the literature thus far (3-5), and comprehensive descriptions of the biological behavior and optimal treatment of this entity are lacking. To reveal important aspects of breast metastasis from NPC, the present study reports two cases from the Sun Yat-Sen University Cancer Center (SYSUCC; Guangzhou, China) and reviews previous case reports of breast metastasis from NPC, emphasizing the clinicopathological and radiological features, diagnosis, treatment strategies, and outcomes.To the best of our knowledge, the current case study describes the only case of a male patient in this clinical setting exhibiting long-term survival after undergoing salvage treatment. In addition, this is the first study to review all available cases of breast metastasis from NPC. Case reportPatients. From the pathology files of t...

Nasopharyngeal carcinoma metastasis to the breast

“…However, we believe that the clinical history, histopathological findings, and IHC profile clearly confirm the diagnosis of NPC metastatic to the breast in our patient. The ideal treatment for metastatic NPC is chemotherapy and radiotherapy, and patients with solitary breast metastasis from NPC may gain long term survival, as observed by Xiao et al 3 In conclusion, this case highlights the rarity of the NPC lesion and importance of clinical, histopathological, and IHC examination, along with the patients' history, for appropriate diagnosis and treatment.…”

“…It has been observed that a metastatic breast tumor could occur immediately after the first course of treatment or within 24 months of treatment completion. 1,3 In our case, the patient developed breast metastasis after 21 months of initial treatment for NPC. A comparison of the present case report with previous cases of NPC metastasizing to the breast is summarized in Table 1.…”

“…[7][8][9] Although metastatic NPC in the breast is seen mainly in female patients, 2 cases have been reported in males as well. 3,10 The mechanism by which NPC metastasizes to the axillary lymph nodes is not completely understood and can be explained by the following ways: i) retrograde lymphatic drainage due to obstruction; when the large supraclavicular lymph nodes block the lymphatic ducts, as in our patient, metastasis can spread retrograde to the axillary lymph nodes; 11 ii) the destructive effect of radiotherapy during the first treatment, which cuts off blood supply to the tumor; this is unfavorable for tumor growth and causing it to relocate and occur far from the nasopharynx such as the axilla. 12 The previous literature has reported the age range of the breast metastases from NPC in the fifth and sixth decades of the patients' lives; our patient was also in her fifth decade.…”

“… 1 , 2 Metastasis to the breast from head and neck tumors is very rare, and primaries from nasopharyngeal carcinoma (NPC) are extremely rare. 3 Nasopharyngeal carcinoma differs from other head and neck carcinomas by its distinctive geographic location and relationship with the Epstein-Barr virus (EBV) infection. Metastatic sites are usually multifocal and involve the skeleton, lymph nodes, lungs, and liver.…”

Camptothecin inhibits the progression of NPC by regulating TGF‑β‑induced activation of the PI3K/AKT signaling pathway

“…A previous study has suggested that future perspectives for clinical research should include prospective and observational cohort studies, which may assess the effects of different risk factors in the development of NPC and the effectiveness of investigational treatments (5). Although previous studies have investigated numerous anticancer drugs including nimotuzumab, oxaliplatin and gemcitabine for the treatment of NPC (6)(7)(8)(9), the therapeutic outcomes are not encouraging so far. Therefore, exploring efficient anticancer agents and the potential underlying molecular mechanisms of cellular migration and metastasis in NPC are required.…”