Case Report
 
Metastatic breast cancer with GATA3, CK7 and ER positivity? A diagnostic pitfall
Diane-Ngan Trang1, Hongbo Wang2, Marlo Nicolas3, Alia Nazarullah1
1Department of Pathology and Laboratory Medicine, University of Texas Health, 7703 Floyd Curl Drive, MC#7750, San Antonio, Texas, USA
2Department of Pathology, Baylor Scott & White Medical Center, 2401 S. 31st Street, MS-01-266, Temple, Texas, USA
3Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA

Article ID: 100021Z11DT2018
doi: 10.5348/100021Z11DT2018CR

Corresponding Author:
Alia Nazarullah, M.D.
Assistant Professor/Clinical
Department of Pathology and Laboratory Medicine
University of Texas Health, 7703 Floyd Curl Drive, MC#7750
San Antonio, Texas, USA - 78229

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How to cite this article
Trang DN, Wang H, Nicolas M, Nazarullah. Metastatic breast cancer with GATA3, CK7 and ER positivity? A diagnostic pitfall. J Case Rep Images Pathol 2018;4:100021Z11DT2018.


ABSTRACT

Introduction: Carcinoma of unknown primary can often be a challenge for clinicians and pathologists, and immunohistochemical stains (IHC) are often used as a useful diagnostic aid to narrow down the primary site of origin. In this context, co-expression of CK7, GATA3 and ER is highly suggestive of metastatic carcinoma from breast primary. This case highlights a major diagnostic pitfall in the interpretation of these stains.

Case Report: A woman in her fifth decade presented with a possible thoracic vertebral lesion. The core biopsy showed cortical bone and a detached tissue with polygonal cells with eosinophilic cytoplasm and atypical,hyperchromatic nuclei with mild pleomorphism.  These cells were strongly positive for CK7, GATA3, patchy positive for ER, and negative for CDX2, CK20, TTF1, thyroglobulin, mammaglobin, Melanin A, and PAX8 IHC stains.  The interpretation based on these findings was metastatic breast adenocarcinoma. The patient received tamoxifen for stage 4 ER-positive breast cancer, in spite of no clinical or radiologic findings of a breast lesion. A 16 months after the initial diagnosis, the patient was referred to our institution. We noted prominent blood vessels and a few compressed glands positive for PAX8 resembling inactive endometrial glands within the detached fragment containing the atypical cells. The fact that intermediate and cytotrophoblasts express GATA3, cytokeratins and ER, along with the presence of inactive endometrial-type glands led us to conclude that the detached tissue likely represents a contaminant from an endometrial implantation site.

Conclusion: This case reminds us that the immunohistochemical profile of trophoblasts is very similar to breast, and can cause major diagnostic pitfalls leading to erroneous diagnosis of metastatic breast cancer with severe consequences. IHC stains are not always specific, and should always be interpreted in the context of morphology.

Keywords: Floater, GATA-3, Immunohistochemistry, Pitfall


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Author Contributions
Diane-Ngan Trang – Substantial contributions to conception and design, Drafting the article, Critical revision of the article
Hongbo Wang – Acquisition of data, Analysis and interpretation of data, Drafting the article
Marlo Nicolas – Conception and design, Acquisition of data, Analysis and interpretation of data
Alia Nazarullah – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Diane-Ngan Trang et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.