Unraveling The Mystery.
Keywords:
Neuroendocrine Breast Carcinoma, Histopathological Analysis, Immunohistochemistry, Hormone Receptor Positive, Molecular Profiling, Precision MedicineAbstract
Background: Neuroendocrine breast carcinomas (NEBCs) are a unique and, as yet, poorly understood subtype of breast cancer affecting two to five percent of all breast cancers. Because NEBC is histologically similar to invasive ductal carcinoma, it is difficult to diagnose, and immunohistochemistry analysis is also required. Because it is rare, there is no consensus on the best management approaches, and treatment is frequently selected from standard breast cancer regimens. Case Presentation: A case is described of a 77-year-old woman presenting with a right breast tumor that was growing. On clinical examination, the mass in the upper outer quadrant was a 3 × 3 cm oval mass, a firm and movable mass, with no evidence of axillary lymphadenopathy. The two questionable lesions were seen on ultrasound and PET-CT imaging tests. The second lesion was neuroendocrine differentiated invasive carcinoma of no special type, and the first lesion's histopathological analysis was invasive mammary carcinoma with localized neuroendocrine differentiation (30%). Immunohistochemistry was positive for chromogranin expression localized and for synaptophysin positivity high. The tumor was hormone receptor positive; therefore, the patient was started on medication afterwards following a modified radical mastectomy (MRM). Discussion: A localized neuroendocrine differentiation in a primary breast carcinoma demands a careful histopathological and immunohistochemical analysis. There is an early-stage disease due to the lack of distant metastases and locoregional lymphadenopathy. Long-term monitoring is essential, however, because NEBC is unexpected and said to be still the primary course of therapy; however, molecular profiling may help identify new therapeutic targets in the future. Conclusion: It demonstrates the complexity of diagnosis and treatment of NEBC, and put a challenge to improve the reporting of the cases, form the treatment guideline, as well as molecular research of this rare disease. Since such a rare cancer may be treated in such a novel way, there is hope other developments in precision medicine and tailored medicines may improve outcomes for the patient.
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[1] Sun, H., Dai, S., Xu, J., Liu, L., Yu, J., & Sun, T. (2022). Primary Neuroendocrine Tumor of the Breast: Current Understanding and Future Perspectives. Frontiers in Oncology, 12, 848485. https://doi.org/10.3389/fonc.2022.848485
[2] Tan, P. H., Ellis, I., Allison, K., Brogi, E., Fox, S. B., Lakhani, S., et al. (2019). WHO Classification of Tumours of the Breast. Histopathology, 74(5), 513–520. https://doi.org/10.1111/his.13811
[3] Bussolati, G., & Badve, S. (2012). Carcinomas with Neuroendocrine Features. In: WHO Classification of Tumours of the Breast (4th ed.). Lyon, France: IARC Press.
[4] Lai, B., Tsang, J., Poon, I., Shao, Y., Chan, S., Tam, F., Cheung, S., Shea, K. H., & Tse, G. (2020). The clinical significance of neuroendocrine features in invasive breast carcinomas. The Oncologist, 25(12), e1318–e1329. https://doi.org/10.1634/theoncologist.2020-0081
[5] Wei, B., Ding, T., Xing, Y., Wei, W., Tian, Z., Tang, F., et al. (2010). Invasive Neuroendocrine Carcinoma of the Breast: A Distinctive Subtype of Aggressive Mammary Carcinoma. Cancer, 116(19), 4463–4473. https://doi.org/10.1002/cncr.25352
[6] Yang, L., Roy, M., Lin, H., Shen, Y., Albarracin, C., Huo, L., et al. (2021). Validation of Prognostic Significance of the Proposed Uniform Classification Framework in Neuroendocrine Neoplasms of the Breast. Breast Cancer Research and Treatment, 186(2), 403–415. https://doi.org/10.1007/s10549-021-06099-6
[7] Lavigne, M., Menet, E., Tille, J., Laé, M., Fuhrmann, L., Bonneau, C., et al. (2018). Comprehensive Clinical and Molecular Analyses of Neuroendocrine Carcinomas of the Breast. Modern Pathology, 31(1), 68–82. https://doi.org/10.1038/modpathol.2017.107
[8] Tamura, T., Kurishima, K., Nakazawa, K., Kagohashi, K., Ishikawa, H., Satoh, H., & Hizawa, N. (2015). Specific organ metastases and survival in metastatic non-small-cell lung cancer. Molecular and Clinical Oncology, 3(1), 217–221. https://doi.org/10.3892/mco.2014.410
[9] Juhlin, C. C., Zedenius, J., & Höög, A. (2020). Clinical Routine Application of the Second-Generation Neuroendocrine Markers ISL1, INSM1, and Secretagogin in Neuroendocrine Neoplasia: Staining Outcomes and Potential Clues for Determining Tumor Origin. Endocrine Pathology, 31(4), 401–410. https://doi.org/10.1007/s12022-020-09645-y
[10] Mohanty, S., Kim, S., DeLair, D., Bose, S., Laury, A., Chopra, S., et al. (2016). Comparison of Metastatic Neuroendocrine Neoplasms to the Breast and Primary Invasive Mammary Carcinomas With Neuroendocrine Differentiation. Modern Pathology, 29(8), 788–798. https://doi.org/10.1038/modpathol.2016.69
[11] Kawasaki, T., Bussolati, G., Marchiò, C., Castellano, I., Daniele, L., Molinaro, L., et al. (2014). Well-Differentiated Neuroendocrine Tumour of the Breast Showing Peculiar Endovascular Spread. Histopathology, 64(4), 597–600. https://doi.org/10.1111/his.12276
[12] Marchiò, C., Geyer, F., Ng, C., Piscuoglio, S., De Filippo, M., Cupo, M., et al. (2017). The Genetic Landscape of Breast Carcinomas With Neuroendocrine Differentiation. The Journal of Pathology, 241(4), 405–419. https://doi.org/10.1002/path.4837
[13] Vranic, S., Palazzo, J., Sanati, S., Florento, E., Contreras, E., Xiu, J., et al. (2019). Potential Novel Therapy Targets in Neuroendocrine Carcinomas of the Breast. Clinical Breast Cancer, 19(2), 131–136. https://doi.org/10.1016/j.clbc.2018.09.001
[14] Wei, B., Ding, T., Xing, Y., Wei, W., Tian, Z., Tang, F., et al. (2010). Invasive Neuroendocrine Carcinoma of the Breast: A Distinctive Subtype of Aggressive Mammary Carcinoma. Cancer, 116(19), 4463–4473. https://doi.org/10.1002/cncr.25352
[15] Sanguinetti, A., Santoprete, S., Lucchini, R., Triola, R., Loreti, F., & Avenia, N. (2012). A Rare Breast Tumor: Solid Neuroendocrine Carcinoma. Annali Italiani di Chirurgia, 84(2), 1–5.
[16] Rovera, F., Masciocchi, P., Coglitore, A., La Rosa, S., Dionigi, G., & Marelli, M. (2008). Neuroendocrine Carcinomas of the Breast. International Journal of Surgery, 6(1), S113–S115. https://doi.org/10.1016/j.ijsu.2008.12.007
[17] Lai, B., Tsang, J., Poon, I., Shao, Y., Chan, S., Tam, F., et al. (2020). The Clinical Significance of Neuroendocrine Features in Invasive Breast Carcinomas. The Oncologist, 25(12), e1318–e1329. https://doi.org/10.1634/theoncologist.2020-0081
[18] Park, Y., Wu, Y., Wei, W., Yang, W. (2014). Primary Neuroendocrine Carcinoma of the Breast: Clinical, Imaging, and Histologic Features. AJR American Journal of Roentgenology, 203(2), W221–230. https://doi.org/10.2214/ajr.13.10749
[19] Shanks, A., Choi, J., & Karur, V. (2020). Dramatic Response to Cyclin D-Dependent Kinase 4/6 Inhibitor in Refractory Poorly Differentiated Neuroendocrine Carcinoma of the Breast. Proceedings (Baylor University Medical Center), 33(4), 637–639. https://doi.org/10.1080/08998280.2020.1796738
[20] Kwon, S. Y., Bae, Y. K., Gu, M. J., Choi, J. E., Kang, S. H., Lee, S. J., et al. (2014). Neuroendocrine Differentiation Correlates With Hormone Receptor Expression and Decreased Survival in Patients With Invasive Breast Carcinoma. Histopathology, 64(5), 647–659. DOI: 10.1111/his.12306.
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