Unusual intrathoracic foreign body: tree branch

Radiol Bras. 2016 Set/Out;49(5):340–346 345 The breast tumor was classified as clinical stage IV, with metastasis to the lungs (lymphangitis carcinomatosa identified on CT) and bones, and surgery for the breast lesion was therefore not indicated. Chemotherapy followed by endocrine therapy was the treatment strategy elected. After a year, the cancer was restaged. A CT scan of the upper abdomen showed parenchymal nodules suggestive of secondary implants in the spleen, which were also seen on ultrasound (Figure 2A). On the basis of an ultrasound-guided percutaneous biopsy, the patient was diagnosed with splenic metastasis of breast carcinoma (Figure 2B), and a new chemotherapy regimen was started exclusively for the splenic progression. Male breast cancer is rare, accounting for 0.6% of all cases of breast cancer and less than 1% of all carcinomas in men. The average age at diagnosis is 65 years. The most common complaint at diagnosis is of a palpable nodule, typically > 2.0 cm. Mammography and ultrasound are used in making the diagnosis, following the criteria for malignancy in female breast cancer. The most common histological subtype is invasive ductal carcinoma, which often tests positive for estrogen and progesterone. The treatment of choice is mastectomy and, if necessary, ipsilateral axillary drainage, lymph node involvement being seen in 50–60% of cases. The success of chemotherapy and radiotherapy, as well as hormone therapy (tamoxifen being the drug of choice), in the treatment of female breast cancer, allows us to extrapolate that they can also be used in cases of male breast cancer. The metastatic pattern of male breast cancer follows that of female breast cancer in that the bones, lungs, and liver are the most common sites. Splenic metastasis of breast cancer, as shown in this case, is rare in the literature, and the few cases reported have all been in women. Metastases to the spleen are fairly uncommon, can be single or multiple, and often occur in the context of multi-organ metastatic carcinoma, usually without clinical significance, splenectomy being palliative in symptomatic patients. Bruna Maria Thompson, Flávio Ferrarini de Oliveira Pimentel, Jaime Afonso Coelho Nogueira Diógenes, Marcelo Hajime Kohayagawa, Maria Regina Vianna