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Biomarkers to diagnose metastatic breast carcinoma to the pancreas: A case report and update
Author(s) -
Shee Kevin,
Strait Alexander M.,
Liu Xiaoying
Publication year - 2019
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.24210
Subject(s) - medicine , estrogen receptor , metastatic breast cancer , fine needle aspiration , breast cancer , pancreas , pathology , adenocarcinoma , endoscopic ultrasound , progesterone receptor , oncology , immunohistochemistry , metastatic carcinoma , male breast cancer , cancer , carcinoma , biopsy , radiology
The patient is a 72‐year‐old female who presents with new onset jaundice. The patient has a past medical history significant for right‐sided estrogen receptor (ER)‐positive and left‐sided ER‐negative breast cancers in 2005 and 2009, respectively, and recent 1‐year history of ER‐positive right‐sided breast cancer with bone and brain metastases. CT scan and endoscopic ultrasound (EUS) revealed a new 2 cm mass in the head of the pancreas, leading to EUS‐guided fine‐needle aspiration of the lesion. Pathologic workup revealed adenocarcinoma with signet‐ring cells, representing either metastatic breast or primary pancreatic cancer. Immunohistochemistry and molecular diagnostic workup identified positive GATA‐binding protein 3 (GATA3) immunoreactivity and a mutation in Erb‐B2 receptor tyrosine kinase 2 (ERBB2), also known as human epidermal growth factor receptor 2 (HER2). Here, we review the diagnostic markers commonly used to differentiate metastatic breast vs primary pancreatic adenocarcinoma, and discuss the challenges of utilizing GATA3 immunoreactivity and ERBB2 mutations for diagnosis.