Skip Navigation LinksHome > January 2014 - Volume 9 - Issue 1 > Lung Adenocarcinoma with Ipsilateral Pleural and Breast Meta...
Text sizing:
Journal of Thoracic Oncology:
doi: 10.1097/01.JTO.0000438376.45132.9c
Letters to the Editor

Lung Adenocarcinoma with Ipsilateral Pleural and Breast Metastases

Liam, Chong-Kin MBBS, MRCP; Pang, Yong-Kek MD, MRCP; Kow, Ken-Siong MBBCh, MRCP

Free Access
Article Outline
Collapse Box

Author Information

Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Disclosure: The authors declare no conflicts of interest.

Address for correspondence: Chong-Kin Liam, MBBS, MRCP, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. E-mail:

Back to Top | Article Outline

To the Editor:

We congratulate Huang et al.1 for their elegant description on how lung adenocarcinoma cells may metastasize to the ipsilateral parietal pleura, invade the chest wall lymphatic vessels which drain to the ipsilateral axillary lymph nodes, retrogradely spread to the intramammary lymphatics, and finally establish ipsilateral breast metastasis. It is plausible that the presence of the clinical triad of ipsilateral pleural effusion or thickness, enlarged ipsilateral axillary lymph nodes that are palpable or evident on computed tomography (CT), and ipsilateral breast metastasis provides support for this proposed mechanism for ipsilateral breast metastasis from lung cancer. In addition, the presence of intact fat planes between the chest wall and breast tissue on CT scan excludes direct tumor invasion of the breast from the ipsilateral parietal pleural metastasis as a less likely mechanism.1

We also like to add that the absence of enlarged mediastinal (N2 or N3 disease) and ipsilateral supraclavicular (N3 disease) lymph nodes on CT scan and the latter also on palpation is needed to discount the other possible mechanism of lymphatic spread to ipsilateral axillary lymph nodes from mediastinal lymph nodes, through intercostal lymphatics2 or retrogradely through supraclavicular nodes.3

Whatever the mechanism of spread to the axillary lymph nodes, breast metastasis is an infrequent manifestation of advanced disseminated lung cancer and is associated with an extremely poor prognosis and a short survival.4,5

As Huang et al.1 has stated, differentiating primary from metastatic breast carcinoma is of great clinical importance because of the different clinical implication and management options. Metastatic breast lesions, which are very rare compared with primary breast carcinoma, tend to be found in the subcutaneous fat, whereas primary breast cancers develop in the glandular tissue. As opposed to primary breast cancers, metastatic tumors to the breast are characteristically superficially located, poorly defined, irregular nodules or masses without calcification on mammography and ultrasound examination.5

Chong-Kin Liam MBBS, MRCP

Yong-Kek Pang MD, MRCP

Ken-Siong Kow MBBCh, MRCPDepartment of Medicine

Faculty of Medicine

University of Malaya

Kuala Lumpur, Malaysia

Back to Top | Article Outline


1. Huang HC, Hang JF, Wu MH, et al. Lung adenocarcinoma with ipsilateral breast metastasis: a simple coincidence? J Thorac Oncol. 2013;8:974–979

2. Satoh H, Ishikawa H, Kagohashi K, et al. Axillary lymph node metastasis in lung cancer. Med Oncol. 2009;26:147–150

3. Marcantonio DR, Libshitz HI. Axillary lymph node metastases of bronchogenic carcinoma. Cancer. 1995;76:803–806

4. Williams SA, Ehlers RA 2nd, Hunt KK, et al. Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. 2007;110:731–737

5. Lee SK, Kim WW, Kim SH, et al. Characteristics of metastasis in the breast from extramammary malignancies. J Surg Oncol. 2010;101:137–140

Copyright © 2014 by the European Lung Cancer Conference and the International Association for the Study of Lung Cancer.


Article Tools


Other Ways to Connect



Visit on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.

 For additional oncology content, visit LWW Oncology Journals on Facebook.