Isolated metastasis to the scalp in occult breast cancer: a clinical case

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Abstract

Malignancies remain a serious socio-economic health problem worldwide. Among them, breast cancer (BC) in women ranks 1st in the structure and 4th in mortality. Occult breast cancer accounts for 0.1 to 1% of all BC. In this type, metastases to the scalp are extremely rare. This article presents a case of metastatic lesion of the scalp in occult breast cancer. Patient S., 82 years old, presented with a skin tumor in the parietal region, which she noticed about 2 years ago. It has grown recently, with local alopecia and hyperemia around the lesion. A comprehensive examination was performed. Cytology of the punctate showed malignant cells. Mammography and ultrasound showed no specific changes in the breast and lymph nodes. Spiral computed tomography of the chest and abdomen showed no signs of tumor. The lesion was surgically removed. Histological examination revealed adenocarcinoma metastasis. Immunohistochemical examination revealed tumor cells with diffuse and strong expression of estrogen receptors, diffuse and weak expression of progesterone receptors, strong and focal-diffuse expression of cancer embryonic antigen (CEA), and epithelial membrane antigen (EMA). The proliferative activity index of Ki-67 was less than 20%, Her2-neu 0. Considering the morphology and immunohistochemical data, the lesion was a metastasis of breast cancer with a luminal type A molecular biological variant. Skeletal bone scintigraphy revealed no metastatic lesions. The patient was diagnosed with an occult type of breast cancer, stage IV cTxN0M1, with metastasis to the scalp. Hormone therapy with aromatase inhibitors was administered. There were no signs of recurrence during the follow-up for 6 months. Isolated scalp metastasis in occult breast cancer is extremely rare. Practitioners should consider this type of distant metastasis of malignancies in differential diagnosis.

About the authors

Nikolai A. Ognerubov

Penza Institute for Advanced Training of Physicians – branch of the Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN-code: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law)

Russian Federation, Penza

Ruslan S. Sergeev

Regional Oncological Clinical Dispensary

Email: russlannn777@mail.ru
ORCID iD: 0009-0000-2832-0557

oncologist

Russian Federation, Penza

Aleksej O. Hizhnyak

Tambov Regional Oncological Clinical Dispensary

Email: dr.hizhnyak@yandex.ru
ORCID iD: 0009-0001-8229-2179

oncologist

Russian Federation, Tambov

Marina A. Ognerubova

Tambov Regional Oncological Clinical Dispensary

Email: gostyaeva.m.a@mail.ru
ORCID iD: 0000-0003-0576-5451

oncologist

Russian Federation, Tambov

Magomed A. Dzhabrailov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

Email: magomedrambler@mail.ru
ORCID iD: 0000-0002-4360-8329

Cand. Sci. (Econom.)

Russian Federation, Tambov;Tambov

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2. Fig. 1. Patient S., 82 y.o., mammography: a – craniocaudal view; b – mediolateral view. The skin of the mammary glands is not thickened, and the nipple is not retracted. Type A breast density according to ACR. Fibrous-fatty involution with no nodular masses was observed. BI-RADS 1.

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3. Fig. 2. Histological examination of the surgical specimen. A malignant tumor with predominantly glandular structure and areas of alveolar structure. Hematoxylin and eosin staining, ×10.

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4. Fig. 3. Immunohistochemical examination of the surgical specimen. Diffuse strong nuclear ER expression in tumor cells, ×10.

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5. Fig. 4. Immunohistochemical examination of the surgical specimen. Diffuse weak nuclear expression of progesterone receptors in tumor cells, ×10.

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6. Fig. 5. Immunohistochemical examination of the surgical specimen. Diffuse-focal strong nuclear and cytoplasmic expression of CEA, ×10.

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7. Fig. 6. Immunohistochemical examination of the surgical specimen. The proliferative activity index Ki-67 was less than 20%, ×10.

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