Radiation-induced lung cancer

Case contributed by Dr Henry Knipe

Presentation

Past history of breast cancer. Follow-up CT.

Patient Data

Age: 60 years
Gender: Female
CT

Previous left mastectomy and underlying subpleural reticular opacity, focal triangular-shaped opacity, and traction bronchiectasis. 

CT

Three months later

Subpleural opacity underlying the left mastectomy is increased in size. Left hilum is bulky. Left breast prosthesis overlies the chest wall. 

Nuclear medicine

FDG-18 PET-CT

Left subpleural opacity is very avid, along with multiple avid left hilar and paratracheal lymph nodes. No evidence of distant metastatic disease. 

The patient underwent an image-guided percutaneous core biopsy.

Histopathology

MICROSCOPIC DESCRIPTION: The smears and cell block sections contain scattered malignant cells presenting in large groups, clusters and as single cells. The tumour cells have high N:C ratio, irregular nuclear outline, hyperchroamsia, macronucleoli and abundant pale cytolasm with mucin. Necrosis and frequent mitoses are noted. The background contains scattered lymphoid cells and macrophages.

COMMENT Tumour cells stain positive CK7 and weak positive Gata-3. Negative with CK20 and CDX2. Features are nonspecific and a breast metastasis and primary cancer are possible. 

Case Discussion

The patient had left breast cancer resected with post-operative chemotherapy and radiation therapy 15 years ago. After comparison with the previous breast histopathology, it was thought that this more likely represents a primary lung cancer rather than a breast cancer metastasis. This is supported by radiological appearances, which are also more consistent with a lung primary than metastatic breast cancer and that late recurrence of breast metastasis is uncommon. 

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Case information

rID: 50904
Case created: 27th Jan 2017
Last edited: 3rd Feb 2017
Systems: Chest, Oncology
Inclusion in quiz mode: Included

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