Lung Adenocarcinoma with Ipsilateral Breast Metastasis: A Simple Coincidence? Hsu-Ching Huang, MD, Jen-Fan Hang, MD, Mei-Han Wu, MD, Teh-Ying Chou, MD,

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Lung Adenocarcinoma with Ipsilateral Breast Metastasis: A Simple Coincidence? Hsu-Ching Huang, MD, Jen-Fan Hang, MD, Mei-Han Wu, MD, Teh-Ying Chou, MD,

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Lung Adenocarcinoma with Ipsilateral Breast Metastasis: A Simple Coincidence? Hsu-Ching Huang, MD, Jen-Fan Hang, MD, Mei-Han Wu, MD, Teh-Ying Chou, MD, PhD, Chao-Hua Chiu, MD Journal of Thoracic Oncology Volume 8, Issue 7, Pages 974-979 (July 2013) DOI: 10.1097/JTO.0b013e31828f6873 Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 A, Photomicrograph of a representative case shows atypical glands (right upper quadrant) in the breast parenchyma (hematoxylin and eosin stain, 100×). B, These cancer cells are highlighted by nuclear staining with TTF-1. C, The atypical glands are not immunoreactive to GCDFP-15 staining; on the contrary, the normal mammary gland is (left lower quadrant). D, Tumor emboli is observed in a lymphatic vessel, which is demonstrated by D2-40 immunostaining. HE, hematoxylin and eosin; TTF-1, ;GCDFP-15, . Journal of Thoracic Oncology 2013 8, 974-979DOI: (10.1097/JTO.0b013e31828f6873) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 A, Pretreatment chest CT scan. B, Posttreatment chest CT scan shows tumor reduction of the primary lung cancer (arrow head), the breast metastasis (thick arrow), and the axillary lymph node (thin arrow). CT, computed tomography. Journal of Thoracic Oncology 2013 8, 974-979DOI: (10.1097/JTO.0b013e31828f6873) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 The other five cases share with the index case the same clinical manifestations, including ipsilateral pleural effusion/thickening, enlarged axillary lymph node (middle panel), and breast metastasis (lower panel). Journal of Thoracic Oncology 2013 8, 974-979DOI: (10.1097/JTO.0b013e31828f6873) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 A, Lung cancer cells can metastasize to axillary lymph node through a lymphatic drainage route from mediastinal, intercostal and/or supraclavicular lymph nodes. B, Alternatively, we propose that lung cancer cells may seed on the parietal pleura, invade the lymphatic vessels, drain off to ipsilateral axillary lymph nodes, and metastasize to the ipsilateral breast, through a retrograde lymphatic spreading. Journal of Thoracic Oncology 2013 8, 974-979DOI: (10.1097/JTO.0b013e31828f6873) Copyright © 2013 International Association for the Study of Lung Cancer Terms and Conditions