Oncologists in the Ob/Gyn department at Umberto I Hospital in Rome have just published the details of a female patient who was originally believed to have breast cancer. The 49-year-old hairdresser was found to have a hard lump, about 3 centimeters in diameter, lying against the lowest layers of her right breast. But when her doctors performed a biopsy and tested the cells, they discovered that the lump was not what they thought it was.
“Estrogen receptors and progesterone receptors were negative,” writes Dr. Marialuisa Framarino-Dei-Malatesta, the paper’s lead author. “The final diagnosis was metastatic epithelioid malignant pleural mesothelioma.”
Pleural mesothelioma is a highly aggressive cancer that arises on the pleural membrane that encases the lungs. It is usually caused by on-the-job exposure to asbestos, something that is unusual but not unheard of in the hairstyling industry where asbestos-containing hairdryers used to be the norm.
What is most unusual about the Italian case is that mesothelioma spread to breast tissue. As Dr. Framarino-Dei-Malatesta observes, such metastases are rare and point to the importance of ruling out breast cancer in order to decide how to treat such a patient and predict prognosis. Breast cancer and mesothelioma cells do have similarities, which is why sophisticated immunohistochemical testing for a variety of mesothelioma biomarkers can be especially valuable.
Mesothelioma is one of the rarest and most difficult cancers to treat. Unlike breast cancer, which often responds well to chemotherapy and radiation, mesothelioma is typically resistant to both. Suspicion of mesothelioma, especially if cancer is detected in an area other than the mesothelial membrane, usually depends heavily on patient history, including exposure to asbestos.
Framarino-Dei-Malatesta, M, et al, “Breast cancer or metastasis? An unusual case of metastatic malignant pleural mesothelioma to the breast”, February 25, 2015, World Journal of Surgical Oncology, Epub ahead of print