Bilateral breast masses as the manifestation of lung adenocarcinoma in pregnancy

CLINICAL IMAGE Lung carcinoma mimicking breast cancer 1 Computed tomography identified an infiltrative mass in the right upper lobe (31 mm 74 mm), pleural effusion, as well as multiple bone metastases, multiple liver metastases, adrenal and renal lesions, and skeletal metastases.Mammography and breast ultrasound showed bilateral irregular, well -defined, hypoechogenic breast nodules (14-19 mm; Breast Imaging Reporting and Data System, 4c).Such lesions can mimic primary BC, including triple -negative phenotypes, which is why tissue diagnosis with immunohistochemistry is the golden standard. 4FIGURE 1A-1F shows the diagnostic imaging performed.Liver biopsy demonstrated adenocarcinoma-CK7+, TTF1+, HER2-, and Ki67 of approximately 42%-consistent with pulmonary origin.Breast biopsies in both cases showed adenocarcinoma metastatis immunoprofile: CK7+/TTF1+/ER-/ PR-/HER2-/GATA3-/GCDFP-/ mammaglobin-.The result supported lung origin rather than primary breast carcinoma.Microscopic images of histology samples are presented in FIGURE 1G and1H.Key features that can distinguish between metastatic and primary breast carcinoma include: absence of an in -situ component, multiplicity / bilaterality, and a lack of breast markers, such as ER/ PR/HER2/GATA3/GCDFP/mammaglobin, with positive lung markers (TTF -1).The treatment proposed by a multidisciplinary board included stereotactic radiotherapy for brain metastases, brachytherapy for ocular metastasis, and systemic therapy (chemotherapy or immunotherapy) pending molecular testing (programmed cell death ligand 1 and next generation sequencing).The patient remained clinically stable and was discharged with follow -up scheduled for oncology, ophthalmology, radiotherapy, and palliative care.The therapy consisted of paclitaxel, gemcitabine, and radiotherapy of the brain.The treatment followed current standards of care. 5etastatic breast disease originating from lung cancer is a rare clinical condition, even rarer