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Abstract
Breast masses in children and adolescents are uncommon and most often benign. Occasionally, however, they require surgical intervention for lifestyle limiting symptoms or malignant potential. These masses are best evaluated with physical exam and ultrasound. Breast masses likely to be encountered by the surgeon in the pediatric and adolescent population include intraductal papillomas, phyllodes tumors, primary breast cancer, and metastatic lesions. Unlike adults, pediatric and adolescent breast cancer tends to be of the secretory variety and typically have less metastatic potential. However, cases of inflammatory and medullary breast cancers have also been reported in girls and appear more aggressive. Radiation exposure during breast development is a risk factor to subsequent development of breast cancer. Surgical objective for a concerning pediatric and adolescent breast mass is complete resection while preserving normal breast development, when appropriate. The need for routine axillary dissection for malignant cases in children appears unnecessary from the limited data available, and the authors favor sentinel lymph node sampling and reserve axillary dissection for positive lymph nodes.
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Affiliation(s)
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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52
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Searching for mammary analogue [corrected] secretory carcinoma of salivary gland among its mimics. Mod Pathol 2014; 27:30-7. [PMID: 23807775 DOI: 10.1038/modpathol.2013.84] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/08/2022]
Abstract
Mammary analog secretory carcinoma of salivary gland is a recently described entity with unique morphologic, clinical, and genetic characteristics, including the characteristic t(12;15)(p13;q25) with ETV6-NTRK3 translocation found in secretory carcinomas of the breast. Before their initial description, these salivary gland tumors were generally diagnosed as acinic cell carcinoma or adenocarcinoma. For the purpose of this study, all cases of salivary gland acinic cell carcinoma, cribriform cystadenocarcinoma, and adenocarcinoma, not otherwise specified (NOS), diagnosed over a 10-year period were retrieved from our surgical pathology files. There were a total of 11 cases diagnosed as acinic cell carcinoma, 10 cases of adenocarcinoma, NOS, and 6 cases of cribriform cystadenocarcinoma. All slides were reviewed by two pathologists (AP, CGF) and tumors that show morphologic features of mammary analog secretory carcinoma according to the recent literature were selected. This process narrowed down the initial number to six cases originally diagnosed as acinic cell carcinoma, three cases originally diagnosed as adenocarcinoma, NOS, and one case originally diagnosed as cribriform cystadenocarcinoma. The 10 cases were subjected to immunohistochemistry for S-100, mammaglobin, and ANO1, as well as fluorescence in situ hybridization analysis for t(12;15)(p13;q25) with ETV6-NTRK3 fusion rearrangement. The ETV6-NTRK3 gene rearrangement was detected in three tumors. These three tumors, initially diagnosed as acinic cell carcinomas, stained positive for S-100 and mammaglobin, and negative for ANO1 by immunohistochemistry. Two of the three patients were male (2/3). In summary, mammary analog secretory carcinoma is a newly described diagnostic entity that should be in the differential diagnosis of salivary gland tumors that morphologically mimic other neoplasms, mainly acinic cell carcinomas. They differ from conventional acinic cell tumors immunohistochemically and molecularly. Positivity for mammaglobin and S-100, and negativity for ANO1 are useful screening tools before confirmatory molecular studies.
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53
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Case report: Secretory breast cancer in an 11-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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54
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Osako T, Takeuchi K, Horii R, Iwase T, Akiyama F. Secretory carcinoma of the breast and its histopathological mimics: value of markers for differential diagnosis. Histopathology 2013; 63:509-19. [PMID: 23944930 DOI: 10.1111/his.12172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 04/21/2013] [Indexed: 11/28/2022]
Abstract
AIMS Secretory carcinoma (SC) is a rare histological type of breast cancer, and ETV6-NTRK3 gene fusion is highly specific to it. The differential diagnoses of SC include acinic cell carcinoma (ACCA) and cystic hypersecretory carcinoma (CHC), as well as invasive ductal carcinoma (IDC). For patients with these rare but distinctive histological subtypes, SC and its histopathological mimics should be differentiated from each other. However, differential markers have not yet been assessed systematically, and we aimed to identify and evaluate novel and existing markers. METHODS AND RESULTS We reviewed 19 cases diagnosed initially as SC using integrated diagnostic techniques, including morphology, immunohistochemistry and molecular pathology, and validated promising markers in 445 breast cancers. We reclassified 19 formerly diagnosed 'SCs' into nine SCs, three ACCAs, three CHCs, three IDCs and one microglandular adenosis. We confirmed that ETV6-NTRK3 gene rearrangement and amylase positivity are good diagnostic markers for SC and ACCA, respectively. Vacuolar staining for adipophilin, positivity for α-lactalbumin and negativity for ETV6 rearrangement are diagnostic markers for CHC. CONCLUSIONS In this study, we propose a panel of four markers (ETV6 rearrangement, amylase, α-lactalbumin and adipophilin) for distinguishing SC, ACCA, CHC and IDC. This simple but robust panel will serve pathologists well as a practical guide for reaching an appropriate diagnosis.
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Affiliation(s)
- Tomo Osako
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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55
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Abstract
Invasive breast cancers constitute a heterogeneous group of lesions. Although the most common types are ductal and lobular, this distinction is not meant to indicate the site of origin within the mammary ductal system. The main purpose of the identification of specific types of invasive breast carcinoma is to refine the prediction of likely behavior and response to treatment also offered by the other major prognostic factors, including lymph node stage, histologic grade, tumor size, and lymphovascular invasion.
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Affiliation(s)
- Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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56
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Vincent-Salomon A. [Young secretory carcinoma of the breast]. Ann Pathol 2012; 32:S37-8. [PMID: 23127934 DOI: 10.1016/j.annpat.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
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57
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Sato T, Iwasaki A, Iwama T, Kawai S, Nakagawa T, Sugihara K. A rare case of extensive ductal carcinoma in situ of the breast with secretory features. Rare Tumors 2012; 4:e52. [PMID: 23372916 PMCID: PMC3557566 DOI: 10.4081/rt.2012.e52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/14/2012] [Accepted: 09/17/2012] [Indexed: 11/23/2022] Open
Abstract
We report a very rare case of extensive ductal carcinoma in situ (DCIS) of the breast with secretory features in a 30-year old Japanese woman. The patient presented with a nodule in the lower inner quadrant of the left breast measuring approximately 2-3 cm, accompanied by an irregular tumor shadow with segmental microcalcification on mammography. These findings suggested malignancy, and excisional biopsy was performed following core needle biopsy. Pathological diagnosis was that of DCIS with secretory features. A treatment plan of simple mastectomy and sentinel lymph node biopsy was chosen. Most previous reports have only described invasive secretory carcinoma of the breast. We have only been able to find 2 case reports of non-invasive secretory lesion in the English literature to date. Because the characteristics of this lesion are not widely known, we thought it important to share our findings.
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Affiliation(s)
- Takanobu Sato
- Department of Surgery, Sasaki Institute Kyoundo Hospital, Tokyo; Departments of
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58
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Abstract
The purpose of this review is to discuss the less common variants and mimics of ductal carcinoma in situ (DCIS). DCIS lesions are heterogeneous in clinical presentation and behavior, morphology, biomarker profile, and identified genetic aberrations. DCIS is most easily recognized when presenting with classical features. The diagnosis is more challenging when a lesion displays less common cytologic features and has architectural patterns that overlap with other benign or malignant entities.
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Affiliation(s)
- Nicole B Johnson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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59
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Din NU, Idrees R, Fatima S, Kayani N. Secretory carcinoma of breast: clinicopathologic study of 8 cases. Ann Diagn Pathol 2012; 17:54-7. [PMID: 22832018 DOI: 10.1016/j.anndiagpath.2012.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/01/2012] [Accepted: 06/02/2012] [Indexed: 10/28/2022]
Abstract
Our aim was to describe clinicopathologic features of secretory carcinoma on a cohort of cases. We retrieved reported cases of secretory carcinoma of breast (SCB) in the Section of Histopathology, Department of Pathology & Microbiology, Aga Khan University Hospital Karachi, from May 2004 to December 2011. The slides were reviewed, and clinicopathologic features were noted. A total of 8 cases of SCB were found. The age ranged from 17 to 60 years (median, 41 years) with a female to male ratio of 7:1. Lumpectomy was done in 6 cases, and mastectomy, in 2 cases. The tumor size ranged from 2.5 to 10 cm (mean, 5.5 cm). Histologically, abundant extra- and intracellular secretory material was seen in all cases. Most of the tumors showed mixtures of patterns with dominant microcystic and papillary patterns. In situ component was seen in only 1 case. Lymph node metastases were seen in both cases with lymph node sampling. In conclusion, SCB is a rare type of ductal breast carcinoma. The papillary pattern of SCB is rare according to published data but was seen in most of our cases. In situ secretory carcinoma is even rarer, and to date, we have seen a single case only. Although most occur in women, these can be seen in men as well.
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Affiliation(s)
- Nasir Ud Din
- The Aga Khan University Hospital, Department of Pathology and Microbiology, Karachi, Pakistan.
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60
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Horowitz DP, Sharma CS, Connolly E, Gidea-Addeo D, Deutsch I. Secretory carcinoma of the breast: Results from the survival, epidemiology and end results database. Breast 2012; 21:350-3. [DOI: 10.1016/j.breast.2012.02.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/23/2012] [Accepted: 02/26/2012] [Indexed: 02/09/2023] Open
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61
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Choi J, Kim D, Koo JS. Secretory Carcinoma of Breast Demonstrates Nuclear or Cytoplasmic Expression in p63 Immunohistochemistry. Int J Surg Pathol 2012; 20:367-72. [DOI: 10.1177/1066896912440506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the pattern of p63 expression and its implication in secretory carcinoma of the breast. Immunohistochemical staining for p63, p53, MDM2, and smooth muscle actin was performed in 7 cases of secretory carcinomas. Nuclear expression of p63 was observed in 3 cases, whereas staining against cytoplasmic and intraluminal secretory material were observed in 4 cases. p53 was expressed in 3 cases and MDM2 in 2 cases. The loss of myoepithelial cells was confirmed by immunohistochemical stain for smooth muscle actin in invasive secretory carcinomas. The pattern of expression of p63 in secretory carcinoma of the breast was revealed in nuclei or cytoplasm/secretory materials.
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Affiliation(s)
- Junjeong Choi
- Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dokyung Kim
- Ajou University Medical Center, Suwon, South Korea
| | - Ja Seung Koo
- Yonsei University College of Medicine, Seoul, South Korea
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62
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Secretory breast carcinoma: a clinicopathological and immunophenotypic study of 15 cases with a review of the literature. Mod Pathol 2012; 25:567-75. [PMID: 22157932 DOI: 10.1038/modpathol.2011.190] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Secretory breast carcinoma is a rare breast cancer with indolent clinical behavior. Recent research showed that secretory breast carcinoma belongs to the phenotypic spectrum of basal-like breast carcinomas. In this study, a clinicopathological and immunophenotypic analysis of secretory breast carcinomas from 15 Chinese patients was conducted. This patient group consisted of 2 males and 13 females, with ages ranging from 10 to 67 years old (median, 36 years old). All patients presented with a painless and firm mass. Tumor size ranged from 10 to 55 mm. Most tumors were located in the outer upper quadrant of the breast. Two patients (2 of 13, 15%) displayed positive axillary lymph nodes. At the microscopic level, the presence of intracellular and extracellular secretory material was the most remarkable feature. Most cases showed mild dysplasia cytologically. All cases were negative for estrogen receptor, progesterone receptor and HER2. The expression rate of the basal-like marker (CK5/6 or epidermal growth factor receptor) was 87% (13 of 15). The basal-like phenotype was identified in 13 cases (87%). Follow-up time ranged from 10 to 55 months (median, 19 months). None of the cases had evidence of recurrence and metastasis. Our study reveals that secretory breast carcinoma is a distinct subset of invasive breast carcinoma, with expression of basal-like markers. It should be noted that secretory breast carcinoma is different from conventional basal-like breast carcinomas. Future studies are required to further understand the prognostic significance of the basal-like markers expression in secretory breast carcinomas.
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63
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Abstract
Secretory carcinoma is a rare form of breast carcinoma which has a predilection for juveniles and young adults (usually less than 30 years of age), becoming progressively less common with advancing age. It is a low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma on fine needle aspiration cytology (FNAC) is difficult. We report a case of a 62-year-old woman diagnosed to have secretory carcinoma of breast on FNAC. Histopathological examination confirmed the diagnosis. The recognition of secretory carcinoma is important because the cytological findings can be confused with those of lactating breast. Preoperative diagnosis is essential for appropriate surgical therapy. Secretory carcinoma is reported to have good prognosis, but surgical therapy with an axillary node dissection is recommended, since axillary metastases have been found in approximately 30% of the recorded cases.
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Affiliation(s)
- Vissa Shanthi
- Department of Pathology, Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
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64
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Yorozuya K, Takahashi E, Kousaka J, Mouri Y, Yoshida M, Fujii K, Akizuki M, Nakano S, Fukutomi T, Umemoto Y, Yokoi T, Imai H. A Case of Estrogen Receptor Positive Secretory Carcinoma in a 9-Year-old Girl With ETV6-NTRK3 Fusion Gene. Jpn J Clin Oncol 2011; 42:208-11. [DOI: 10.1093/jjco/hyr187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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65
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Vasudev P, Onuma K. Secretory Breast Carcinoma: Unique, Triple-Negative Carcinoma With a Favorable Prognosis and Characteristic Molecular Expression. Arch Pathol Lab Med 2011; 135:1606-10. [DOI: 10.5858/arpa.2010-0351-rs] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Secretory carcinoma is a rare but distinct subtype of breast carcinoma, with characteristic histomorphology and generally favorable prognosis. Although it was originally described as a juvenile breast carcinoma, occurring in young children, most cases have been reported in adults of both sexes. As the name implies, the characteristic histomorphology is the presence of a large amount of intracellular and extracellular, eosinophilic secretion material that stains positive for periodic acid–Schiff. Most tumors stain positive for S100 and negative for estrogen receptor, progesterone receptor, and ERBB2 (formerly HER2/neu) (ie, triple negative). In addition, some secretory carcinomas demonstrate a basal-like immunoprofile. Recent studies have shown the characteristic molecular feature: a balanced translocation t(12;15), resulting in an ETS variant 6–neurotrophic tyrosine kinase receptor type 3 (ETV6-NTRK3) fusion gene encoding a chimeric tyrosine kinase. Although rare events of axillary lymph node or distant metastases have been documented, the prognosis is generally excellent. The methods of surgical treatment and the role of adjuvant therapy, particularly for young patients, remain controversial.
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66
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Bhatia A, Malhotra G, Grover P, Singh N. A cytomorphological study of secretions in breast cancer. J Cytol 2011; 28:196-9. [PMID: 22090695 PMCID: PMC3214466 DOI: 10.4103/0970-9371.86347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Secretions are seen in a range of breast cancer that includes invasive ductal carcinoma, mucinous carcinoma and secretory carcinoma. Evaluation of the quantity and location of secretions and the contours of the cell clusters complement cell morphology could improve diagnostic cytopathological criteria. Aim: To identify the range of breast carcinomas with secretions on fine-needle aspiration. Materials and Methods: A retrospective study of 160 patients with breast carcinoma was carried out. The tumors were typed by evaluating the quantity and location of secretions, cellularity and nuclear grade. Results: Secretions were seen in 16 of 160 breast carcinomas. Eleven were invasive ductal carcinoma (IDC), three were mucinous and two were secretory carcinomas. In IDC, minimal intracytoplasmic secretions were seen in 10, nuclear grades of 2 and 3 in 9, cell clusters with irregular margins in 6, and necrosis in 4. All mucinous and secretory carcinomas were nuclear grade 1. Extensive extracellular secretions and cell clusters with rounded contours were seen in mucinous carcinomas. In secretory carcinomas, the secretions were predominantly intracellular; stringy vasculature was a unique feature. Conclusion: Secretions in breast cancer are seen in a range of lesions that include IDC, mucinous, and secretory carcinomas. The quantity and location of secretions in breast cancer offer clues to differentiating these.
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Affiliation(s)
- Arati Bhatia
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
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67
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Cabello C, Alvarenga M, Alvarenga CA, Duarte GM, Pereira PN, Marshall PS. Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up. Breast Cancer Res Treat 2011; 133:813-20. [PMID: 22083230 DOI: 10.1007/s10549-011-1869-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
Abstract
Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.
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Affiliation(s)
- Cesar Cabello
- University of Campinas, Av. Alexander Flemming, 101, Cidade Universitária, Campinas, SP 13083-881, Brazil.
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68
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Gabal S, Talaat S. Secretory carcinoma of male breast: case report and review of the literature. Int J Breast Cancer 2011; 2011:704657. [PMID: 22332016 PMCID: PMC3276072 DOI: 10.4061/2011/704657] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/09/2011] [Indexed: 11/20/2022] Open
Abstract
Secretory carcinoma is a rare low-grade breast carcinoma, initially termed "juvenile breast cancer," but it is now known to occur in adults of both sexes. It is the only epithelial tumor of the breast with a balanced translocation, t(12;15), that creates an ETV6-NTRK3 gene translocation. In this paper, a 19-year-old male patient has had a right breast mass for 9 years which suddenly increased in size with no evidence of palpable axillary lymph nodes. The mass was excised for frozen section and was diagnosed as malignant growth for simple mastectomy. Microscopic examination revealed the classical features of secretory carcinoma. The tumor cells were positive for EMA and S-100 protein and focally positive for cytokeratin and ER but negative for progesterone receptor, CD34, and CEA. Four months later the patient developed ipsilateral axillary lymph node enlargement, with lymph node metastases in five of the dissected 19 lymph nodes. The patient was treated with six courses of chemotherapy and radiotherapy. Conclusion. Though considered an indolent neoplasm, secretory carcinoma does metastasize to lymph nodes. Surgery in the form of mastectomy with axillary clearance is the treatment of choice. This paper includes a rare case report of secretory carcinoma in young male patient, with axillary lymph node metastasis in spite of the indolent nature that this tumor is known to display.
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Affiliation(s)
- S Gabal
- Department of Pathology, Faculty of Medicine, Cairo University, Giza 12655, Egypt. ns
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69
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Dursun N, Feng J, Basturk O, Bandyopadhyay S, Cheng JD, Adsay VN. Vacuolated cell pattern of pancreatobiliary adenocarcinoma: a clinicopathological analysis of 24 cases of a poorly recognized distinctive morphologic variant important in the differential diagnosis. Virchows Arch 2010; 457:643-9. [PMID: 20931225 PMCID: PMC3164262 DOI: 10.1007/s00428-010-0978-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 12/27/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDCA) is characterized by well-defined tubular units in the vast majority of the cases; however, variations in this theme do occur. It is important to recognize the morphologic spectrum of PDCA to avoid misdiagnosis especially in small specimens and also in metastatic foci. Here, we document a morphologic variant of PDCA that is characterized by a distinctive pattern of infiltrating cribriform nests in a distinctive "microcystic" or "secretory" pattern. Twenty-four cases of PDCA have been identified in a review of 505 cases diagnosed with PDCA. Histologically, this pattern was characterized by infiltrating nests of tumor cells with large vacuoles and "signet-ring" like appearance imparting a cribriform growth pattern. The vacuoles were one to five cells in size, often merging to form multilocular spaces separated by a thin rim of cell membrane. Many of these spaces contained CA19.9 positive granular secretory material. The nuclei were often pushed to the periphery and compressed in a pattern resembling adipocytes, although the nuclei were often densely hyperchromatic and displayed significant atypia. Especially in biopsies from the peripancreatic fat and peritoneum, these neoplastic cells had been misdiagnosed as degenerating adipocytes, and in the lymph nodes, they had been misinterpreted as lipogranulomas. Clinical findings of the patients were similar to that of conventional PDCA, except higher incidence of history of smoking (83% vs. 60%; p=0.034). In conclusion, vacuolated cell adenocarcinoma is a distinct morphologic variant of PDCA, and the presence of this peculiar pattern in a metastatic site, although not specific, should raise the suspicion of a PDCA.
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Affiliation(s)
- Nevra Dursun
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Jining Feng
- Department of Pathology, Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Olca Basturk
- Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | | | - Volkan N. Adsay
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Room H-180B, Atlanta, GA 30322, USA
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70
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Jena M, Shariff S. Cytodiagnosis of secretory carcinoma of the breast: A report on two cases. Diagn Cytopathol 2010; 38:921-4. [DOI: 10.1002/dc.21342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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71
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Abstract
Carcinoma in children differs from that occurring in adults. It is far rarer and represents only a small fraction of all pediatric cancer diagnoses. Pediatric sarcomas were among the first tumors in which recurrent chromosomal aberrations were discovered. Once defined, these recurrent aberrations, many of them translocations, became incorporated into the pathologist's diagnostic armamentarium. In the past several years, defining chromosomal rearrangements have been identified in pediatric carcinomas as well, and this has become a new frontier in pathologic diagnosis. This article provides an overview of pediatric carcinoma as well as a detailed review of selected types of carcinoma that in particular can present diagnostic difficulty to the practicing pathologist and illustrate new and emerging concepts in pediatric carcinoma.
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Affiliation(s)
- Sara O Vargas
- Department of Pathology, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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72
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Iglesias B, Monteagudo B, Rouco JS, Antón I. Secretory breast carcinoma in a 63-year-old man. J Cutan Pathol 2009; 36 Suppl 1:86-8. [DOI: 10.1111/j.1600-0560.2008.01240.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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74
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Mun SH, Ko EY, Han BK, Shin JH, Kim SJ, Cho EY. Secretory carcinoma of the breast: sonographic features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:947-954. [PMID: 18499854 DOI: 10.7863/jum.2008.27.6.947] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this series was to evaluate the sonographic features of secretory carcinoma of the breast. METHODS Between 1994 and 2006, 9 patients had histologically confirmed secretory carcinoma of the breast in our institution, and 6 of them underwent breast sonography. We retrospectively evaluated the sonographic findings of the patients in correlation with other available images and reviewed the clinical records. RESULTS Clinical manifestations were a palpable mass (n=3), a bloody nipple discharge (n=1), and screening-detected abnormalities (n=2). Breast sonograms showed masses with a round or oval (n=5) or tubular (n=1) shape, with relatively well-circumscribed (n=2) or partially microlobulated (n=4) margins, and with a hypoechoic (n=4) or an isoechoic (n=2) internal echo texture. Most lesions were single nodules (n=3) or groups of nodules (n=2) measuring 1 cm or smaller, except 1 mass measuring 3.5 cm with axillary lymph node metastasis. Two cases had associated ductectasia. Sonographic assessments were classified as Breast Imaging Reporting and Data System category 3 in 2 cases, category 4A in 3 cases, and category 4B in 1 case. CONCLUSIONS Secretory carcinoma of the breast is frequently shown as a small benign-looking nodule or group of nodules or sometimes as an intraductal lesion with a low clinical stage on sonography. Although secretory carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the differential diagnosis.
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Affiliation(s)
- Sung Hee Mun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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75
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Vieni S, Cabibi D, Cipolla C, Fricano S, Graceffa G, Latteri MA. Secretory breast carcinoma with metastatic sentinel lymph node. World J Surg Oncol 2006; 4:88. [PMID: 17150092 PMCID: PMC1764883 DOI: 10.1186/1477-7819-4-88] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 12/06/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases. CLINICAL PRESENTATION In this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression. We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma. CONCLUSION After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice.
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Affiliation(s)
- Salvatore Vieni
- Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Daniela Cabibi
- Institute of Pathology, University of Palermo, Palermo, Italy
| | - Calogero Cipolla
- Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Salvatore Fricano
- Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Giuseppa Graceffa
- Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
| | - Mario Adelfio Latteri
- Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy
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76
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Yaqoob N, Kayani N, ul Hasan SH. Painless breast lump in an elderly woman. Secretory breast carcinoma in an elderly woman. Arch Pathol Lab Med 2006; 130:1073-4. [PMID: 16831040 DOI: 10.5858/2006-130-1073-pbliae] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Secretory breast carcinoma is a rare breast cancer. It occurs in all age groups, with the majority of patients being adults. It is a rare occurrence in elderly (>50 years) patients; only 5 cases have been reported in this patient group in the English literature. It is even rarer in males, with only 15 cases reported in the world literature. Ultrasonographic findings may resemble other well-circumscribed breast carcinomas as well as some benign masses, including fibroadenomas. We present a case of a 60-year-old woman who had a painless lump in her right breast. The tumor was ulcerating through the skin. Axillary lymph nodes were also palpable. Simple mastectomy was performed and the histopathologic findings revealed secretory carcinoma of the breast.
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Affiliation(s)
- Nausheen Yaqoob
- Department of Pathology, Faculty of Health Sciences, Medical College, The Aga Khan University, Medical Centre, Karachi-74800, Pakistan.
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77
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Anderson P, Albarracin CT, Resetkova E. A large, fungating breast mass. Secretory carcinoma with apocrine differentiation. Arch Pathol Lab Med 2006; 130:e50-2. [PMID: 16594759 DOI: 10.5858/2006-130-e50-alfbm] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paula Anderson
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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78
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Abstract
This article reviews cytomorphology of rare malignant tumors of the breast: squamous carcinoma, metaplastic carcinoma, adenoid cystic carcinoma, apocrine carcinoma, secretory carcinoma, lipid-rich carcinoma, and carcinoma with choriocarcinomatous features. It is important to bear in mind the cytomorphology and diagnosis of rare malignant tumors of the breast in analysis of breast fine needle aspiration smears. Although rare, these malignant tumors can be diagnosed by the cytomorphological characteristics, and should be included in the differential diagnoses of breast neoplasms.
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Affiliation(s)
- Walid E Khalbuss
- Department of Pathology, University of Florida Health Science Center, Jacksonville, FL 32209, USA.
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79
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Ozguroglu M, Tascilar K, Ilvan S, Soybir G, Celik V. Secretory Carcinoma of the Breast. Oncology 2005; 68:263-8. [PMID: 16015043 DOI: 10.1159/000086782] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 08/01/2004] [Indexed: 11/19/2022]
Abstract
We report an elderly case of an indolent breast tumor in a 66-year-old woman. The patient presented with a locally advanced mass in the right breast that was present for 13 years, accompanied by bleeding and ulceration since the last 5 years. She had a modified radical mastectomy with axillary dissection. She was found to have secretory carcinoma with a tumor size of 8 x 4 x 4 cm in diameter. Two out of the 22 removed lymph nodes were involved. The secretory material stained positive with lactalbumin, as well as showed positivity with PAS. The patient received six cycles of adjuvant chemotherapy followed by chest wall irradiation. She is disease free with a follow-up period of 24 months. Preoperative chemotherapy should be primarily replaced by curative surgery in such indolent cancers, despite locally advanced disease.
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Affiliation(s)
- Mustafa Ozguroglu
- Department of Internal Medicine, Section of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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80
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Arce C, Cortes-Padilla D, Huntsman DG, Miller MA, Dueñnas-Gonzalez A, Alvarado A, Pérez V, Gallardo-Rincón D, Lara-Medina F. Secretory carcinoma of the breast containing the ETV6-NTRK3 fusion gene in a male: case report and review of the literature. World J Surg Oncol 2005; 3:35. [PMID: 15963235 PMCID: PMC1184104 DOI: 10.1186/1477-7819-3-35] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 06/17/2005] [Indexed: 11/19/2022] Open
Abstract
SUMMARY BACKGROUND Secretory carcinoma (SC) of the breast is a rare and indolent tumor. Although originally described in children, it is now known to occur in adults of both sexes. Recently, the tumor was associated with the ETV6-NTRK3 gene translocation. CASE PRESENTATION A 52-year-old male was diagnosed with secretory breast carcinoma and underwent a modified radical mastectomy. At 18 months the tumor recurred at the chest wall and the patient developed lung metastases. He was treated concurrently with radiation and chemotherapy without response. His tumor showed the ETV6-NTRK3 translocation as demonstrated by fluorescent in situ hybridization (FISH). CONCLUSION SC is a rare slow-growing tumor best treated surgically. There are insufficient data to support the use of adjuvant radiation or chemotherapy. Its association with the ETV6-NTRK3 fusion gene gives some clues for the better understanding of this neoplasm and eventually, the development of specific therapies.
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Affiliation(s)
- C Arce
- Division of Clinical Research, Instituto Nacional de Cancerología, Mexico
| | - D Cortes-Padilla
- Division of Internal Medicine, Instituto Nacional de Cancerología, Mexico
| | - DG Huntsman
- Genetic Pathology Evaluation Center of the Departments of Pathology, British Columbia Cancer Agency Vancouver Canada
| | - MA Miller
- General Hospital and University of British Columbia and the Prostate Centre at the Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - A Dueñnas-Gonzalez
- Unidad de Investigacion Biomédica en Cancer, Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico e Instituto Nacional de Cancerología, Mexico
| | - A Alvarado
- Division of Internal Medicine, Instituto Nacional de Cancerología, Mexico
| | - V Pérez
- Division of Pathology, Instituto Nacional de Cancerología, Mexico
| | - D Gallardo-Rincón
- Division of Internal Medicine, Instituto Nacional de Cancerología, Mexico
| | - F Lara-Medina
- Division of Internal Medicine, Instituto Nacional de Cancerología, Mexico
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81
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Lannon CL, Sorensen PHB. ETV6–NTRK3: a chimeric protein tyrosine kinase with transformation activity in multiple cell lineages. Semin Cancer Biol 2005; 15:215-23. [PMID: 15826836 DOI: 10.1016/j.semcancer.2005.01.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The ETV6-NTRK3 (TEL-TRKC) gene fusion was discovered by breakpoint analysis of the t(12;15)(p13;q25) translocation associated with congenital fibrosarcoma, a pediatric soft tissue malignancy. ETV6-NTRK3 (EN) encodes the sterile alpha motif oligomerization domain of the ETV6 (TEL) transcription factor linked to the protein tyrosine kinase domain of the neurotrophin-3 receptor NTRK3 (TRKC). The EN chimeric oncoprotein links to multiple signaling cascades including Ras-MAP kinase and PI3K-AKT through the IRS-1 adapter protein. Recent evidence indicates that a functional insulin-like growth factor 1 receptor axis and higher order polymer formation are essential for EN oncogenesis. EN has been detected in other malignancies, including secretory breast carcinoma. This chimeric oncoprotein is therefore unique in being expressed in tumors derived from multiple cell lineages.
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Affiliation(s)
- Chris L Lannon
- Johal Program in Pediatric Oncology Basic and Translational Research, Departments of Pathology and Pediatrics, BC Research Institute for Children's and Women's Health, and the University of British Columbia, Vancouver, BC, Canada V5Z4H4
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82
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Alenda C, Aranda FI, Seguí FJ, Laforga J. Secretory carcinoma of the male breast: correlation of aspiration cytology and pathology. Diagn Cytopathol 2005; 32:47-50. [PMID: 15584046 DOI: 10.1002/dc.20157] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Secretory carcinoma (SC) is a rare variant of breast carcinoma, which was first described in children and adolescents but it can occur at all ages. Very few cases have been reported in male patients. We describe the cytological and histopathological features of SC in a 79-yr-old man. Cytological findings demonstrated cohesive sheets of monotonous cells with round nuclei and small nucleoli. Most cells contained intracytoplasmic vacuoles, which are the key feature of an accurate diagnosis. Differential diagnosis with other tumors is discussed briefly.
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Affiliation(s)
- Cristina Alenda
- Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain.
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83
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Woto-Gaye G, Kasse AA, Dieye Y, Toure P, Demba Ndiaye P. [Secretory breast carcinoma in a man. A case report with rapid evolution unfavorable]. Ann Pathol 2005; 24:432-5; quiz 393. [PMID: 15738869 DOI: 10.1016/s0242-6498(04)93999-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Secretory carcinoma or juvenile carcinoma of the breast is a very rare tumor of male adults. Generally, it has a good prognosis after locoregional treatment. The authors report an observation of a secretory carcinoma occurring in a 20 year old man. The lesion presented as a voluminous tumor 12 cm in diameter with 3 positive lymph nodes; it was treated by mastectomy and axillary dissection. Tumor developed in a few months, with visceral metastasis and fatal issue. The cytological, histological and immuno-histochemical features necessary to the diagnosis are described. The rapid development of this case of secretory carcinoma is unusual. This leads the authors to propose the use of an additional treatment for adult secretory breast carcinoma with more than 3 positive lymph nodes.
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Affiliation(s)
- Gisèle Woto-Gaye
- Laboratoire d'Anatomie et de Cytologie Pathologiques, Faculté de Médecine et de Pharmacie, U.C.A.D., Dakar, Sénégal
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84
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Celik A, Kutun S, Pak I, Seki A, Cetin A. Secretory breast carcinoma with extensive intraductal component: case report. Ultrastruct Pathol 2005; 28:361-3. [PMID: 15764584 DOI: 10.1080/019131290882367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.
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Affiliation(s)
- Alper Celik
- Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey.
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85
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Grabellus F, Worm K, Willruth A, Schmitz KJ, Otterbach F, Baba HA, Kimmig R, Metz KA. ETV6–NTRK3 gene fusion in a secretory carcinoma of the breast of a male-to-female transsexual. Breast 2005; 14:71-4. [PMID: 15695086 DOI: 10.1016/j.breast.2004.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 03/25/2004] [Accepted: 04/15/2004] [Indexed: 10/26/2022] Open
Abstract
Secretory carcinomas of the breast were first described as "juvenile carcinoma" by McDivitt and Stewart in a cohort of children. This term has been replaced by the term "secretory breast carcinoma", because the entity can occur at any time of life. Carcinoma of the male breast is uncommon and accounts for approximately 1% of all cancers in men. Recently, it has been reported that human secretory breast carcinoma expresses the ETV6-NTRK3 gene fusion that was previously cloned in pediatric mesenchymal cancers. We present the case of a 46-year-old male-to-female transsexual in whom a secretory breast carcinoma was an incidental finding. As confirmation of the histopathological diagnosis we detected the novel ETV6-NTRK3 gene fusion in this tumor.
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Affiliation(s)
- F Grabellus
- Institute of Pathology, University Hospital of Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
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86
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Srinivas V, Subramanya H, Rajaram T, Vincent PJ, Rai R. Signet Ring Carcinoma of the Breast : An Uncommon Type of Breast Carcinoma. Med J Armed Forces India 2005; 61:84-5. [PMID: 27407713 DOI: 10.1016/s0377-1237(05)80130-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2002] [Accepted: 07/17/2003] [Indexed: 10/18/2022] Open
Affiliation(s)
- V Srinivas
- Classified Specialist (Pathology), Command Hospital (Eastern Command), Kolkata
| | | | - T Rajaram
- Commandant, 158 Base Hospital, C/o 99 APO
| | - P J Vincent
- Principal Medical Officer, HQ Southern Air Command, Trivandrum
| | - Ramji Rai
- Director General Medical Services (Army), Delhi
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87
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Szántó J, András C, Tsakiris J, Gomba S, Szentirmay Z, Bánlaki S, Szilágyi I, Kiss C, Antall P, Horváth A, Lengyel L, Castiglione-Gertsch M. Secretory breast cancer in a 7.5-year old boy. Breast 2004; 13:439-42. [PMID: 15454204 DOI: 10.1016/j.breast.2004.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Revised: 11/10/2003] [Accepted: 02/16/2004] [Indexed: 10/26/2022] Open
Abstract
Breast cancer is extremely rare in children, and consequently no consensus has been reached on the optimal treatment modalities. The medical history and treatment plan for a 7.5-year old male breast cancer patient is described. Radical mastectomy with sentinel node biopsy was performed in October 2002. As no malignant cells were detected in the sentinel node, and no BRCA1-2 mutations were detected, no further radio- or chemotherapy was performed. A "wait-and-see" policy was decided on. Further treatment will be given if this becomes necessary with the development of metastases.
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Affiliation(s)
- J Szántó
- Department of Medical Oncology, Medical and Health Science Centre, University of Debrecen, Nagyerdei Krt 98, Debrecen 4012, Hungary.
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88
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Kavalakat AJ, Covilakam RK, Culas TB. Secretory carcinoma of breast in a 17-year-old male. World J Surg Oncol 2004; 2:17. [PMID: 15175103 PMCID: PMC425597 DOI: 10.1186/1477-7819-2-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2003] [Accepted: 06/02/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Secretory carcinoma of the male breast (juvenile carcinoma) is a rare neoplasm. Only a few cases have been reported in the literature. CASE REPORT We report here a case in a 17-year old male presenting with recurrent breast swelling. CONCLUSIONS Though considered an indolent neoplasm, secretory carcinoma does metastasise to lymph nodes and recur after local excision. Surgery in form of mastectomy with axillary clearance is the treatment of choice.
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Affiliation(s)
- Alfie J Kavalakat
- Department of Surgery, Medical College Hospital, Thrissur, Kerala, India
| | - Ramani K Covilakam
- Department of Pathology, Medical College Hospital, Thrissur, Kerala, India
| | - Terence B Culas
- Department of Surgery, Medical College Hospital, Thrissur, Kerala, India
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89
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Abstract
A 9-year-old girl presented with a 3-year history of a right breast mass. Excisional biopsy showed a secretory carcinoma. A treatment plan of simple mastectomy and axillary sentinel lymph node biopsy was chosen. She remains free of disease at 3-year follow-up. Sentinel lymph node biopsy offers an approach to stage the axillary lymphatic basin with a lower complication rate than formal dissection. The authors advocate its use in the treatment of pediatric breast cancer.
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Affiliation(s)
- Sheldon J Bond
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, KY 40202, USA
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90
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Diallo R, Schaefer KL, Bankfalvi A, Decker T, Ruhnke M, Wülfing P, Jackisch C, Luttges J, Sorensen PHB, Singh M, Poremba C. Secretory carcinoma of the breast: a distinct variant of invasive ductal carcinoma assessed by comparative genomic hybridization and immunohistochemistry. Hum Pathol 2003; 34:1299-305. [PMID: 14691916 DOI: 10.1016/s0046-8177(03)00423-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Secretory carcinomas (SCA) are distinguished from infiltrating ductal carcinomas (IDC) of the breast by their characteristic histomorphology and more favorable prognosis and by the expression of a chimeric tyrosine kinase that is encoded by the ETV6-NTRK3 fusion gene. On this basis, we evaluated 13 SCAs (12 of them with ETV6-NTRK3 gene fusion) by molecular and immunohistochemical (IHC) methods. DNA was obtained from 8 of 13 microdissected SCAs and was analyzed for genetic alterations (GA) by comparative genomic hybridization (CGH). IHC staining was performed for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and Ki-67 (MIB1) in all 13 cases. Molecular and immunohistochemical results in SCAs were compared with previous data regarding immunohistochemical and molecular characteristics of IDCs. An average of 2.0 GAs (range: 0 to 6) were detected, including recurrent gains of chromosome 8q (37.5%) and 1q (25%) and losses of 22q (25%). Four of 13 (31%) SCAs were positive for ER, and 2 were positive for PR. The mean MIB1-labeling index was 11.4% (range: <1 to 34%). Her-2/neu protein overexpression was detected in 2 cases, including 1 with strong (score 3+) and 1 with weak HER2/neu expression (score 2+). Fluorescence in situ hybridization analysis of the latter case showed no evidence of HER-2/neu-gene amplification. Compared with previous findings in IDCs, SCAs are characterized by a relatively low number of GAs, a low proliferative rate, infrequent HER2/neu protein overexpression, decreased steroid hormone receptor expression, and expression of ETV6-NTRK3 fusion gene. These results support the hypothesis that SCAs have immunohistochemical and genetic features that distinguish them from IDCs of the usual type.
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Affiliation(s)
- Raihanatou Diallo
- Institute of Pathology, Heinrich-Heine-University, Düsseldorf, Germany
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91
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Abstract
Salivary-type tumors occur in multiple sites in the human body, likely related to a basic structural homology between exocrine glands in these different anatomic areas. This paper reviews these salivary gland tumor types in breast tissue and lung. Salivary-type tumors of both breast and lung are relatively uncommon in comparison to their salivary gland counterparts. This may be attributable in part to lack of familiarity with these tumors in extra-salivary sites, and in part to histologic overlap with other primary and metastatic tumor types. Recognition of these entities is improving as the clinical and pathologic features are better delineated, and tumors are more accurately classified. Prediction of malignant behavior is not always possible in these unusual sites. In some instances, such as adenoid cystic carcinoma, behavior is known to differ considerably from that of analogous primary salivary gland tumors and in other instances there are simply too few reported cases to allow for adequate prognostication. In fact, more recent papers discuss the need to consider a spectrum encompassing benign and malignant lesions, in both breast and lung. Of course, some entities show clear-cut evidence of malignancy with documented potential for metastasis, others show bland features and well-reported benign behavior, and the less well-defined entities reside between these two extremes. The molecular pathology of salivary gland tumors has been reasonably well investigated in that location; however; there are few molecular studies devoted to salivary-type tumors of the breast and lung. This represents a potential area for future growth in further clarifying these tumors and their behavior.
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Affiliation(s)
- Audrey K Bennett
- Robert E. Fecuhner Division of Surgical Pathology, Department of Pathology, University of Virginia Medical Center, Charlottesville, VA 22908, USA
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92
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Paeng MH, Choi HY, Sung SH, Moon BI, Shim SS. Secretory carcinoma of the breast. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:425-429. [PMID: 14528441 DOI: 10.1002/jcu.10198] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Secretory carcinoma of the breast is a rare but histologically distinct variant of invasive ductal carcinoma that has an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. We present the imaging and histopathologic findings of a case of this tumor that initially manifested as a palpable mass in the left breast of a 31-year-old woman. It appeared sonographically as a round, well-circumscribed but microlobulated hypoechoic solid mass. Secretory carcinoma of the breast may resemble other well-circumscribed breast carcinomas as well as some benign masses, including fibroadenomas. Breast imagers should be aware of this rare tumor's nonspecific imaging features and clinical implications when making a differential diagnosis of solid breast masses.
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Affiliation(s)
- Mi Hye Paeng
- Department of Radiology, Mok-dong Hospital, Ewha Womans University, 911-1 Mok-dong, Yangcheon-Ku, Seoul 158-710, South Korea
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93
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Tognon C, Knezevich SR, Huntsman D, Roskelley CD, Melnyk N, Mathers JA, Becker L, Carneiro F, MacPherson N, Horsman D, Poremba C, Sorensen PHB. Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma. Cancer Cell 2002; 2:367-76. [PMID: 12450792 DOI: 10.1016/s1535-6108(02)00180-0] [Citation(s) in RCA: 656] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report that human secretory breast carcinoma (SBC), a rare subtype of infiltrating ductal carcinoma, expresses the ETV6-NTRK3 gene fusion previously cloned in pediatric mesenchymal cancers. This gene fusion encodes a chimeric tyrosine kinase with potent transforming activity in fibroblasts. ETV6-NTRK3 expression was confirmed in 12 (92%) of 13 SBC cases, but not in other ductal carcinomas. Retroviral transfer of ETV6-NTRK3 (EN) into murine mammary epithelial cells resulted in transformed cells that readily formed tumors in nude mice. Phenotypically, tumors produced glands and expressed epithelial antigens, confirming that EN transformation is compatible with epithelial differentiation. This represents a recurrent chromosomal rearrangement and expression of a dominantly acting oncogene as a primary event in human breast carcinoma.
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MESH Headings
- 3T3 Cells
- Adolescent
- Adult
- Aged
- Animals
- Artificial Gene Fusion
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Child
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 15
- DNA-Binding Proteins/chemistry
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Female
- Humans
- Male
- Mice
- Mice, Nude
- Middle Aged
- Proto-Oncogene Proteins c-ets
- Receptor, trkC/chemistry
- Receptor, trkC/genetics
- Receptor, trkC/metabolism
- Recombinant Fusion Proteins/metabolism
- Repressor Proteins/chemistry
- Repressor Proteins/genetics
- Repressor Proteins/metabolism
- Retroviridae/genetics
- Translocation, Genetic
- ETS Translocation Variant 6 Protein
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Affiliation(s)
- Cristina Tognon
- Department of Pathology & Laboratory Medicine, Children's and Women's Health Centre of British Columbia, 950 West 28th Avenue, Vancouver, British Columbia, Canada V5Z4H4
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94
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Lu D, Masood S, Khalbuss WE, Bui M. A subset of breast invasive ductal carcinoma with distinctive cytomorphology, aggressive clinical behavior, and unique immunologic profiles. Cancer 2002; 96:294-300. [PMID: 12378597 DOI: 10.1002/cncr.10745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Invasive ductal carcinoma of the breast is a heterogeneous collection of divergent types of carcinomas. Some subtypes have been characterized by histologic observations. This study describes a distinctive subset recognized through cytomorphologic examination of breast carcinoma specimens obtained by fine-needle aspiration biopsies (FNAB). Identification of this subset is established further by analyses of its clinical and immunologic characteristics. METHODS One hundred patients underwent FNAB and were diagnosed with breast ductal carcinoma. These diagnoses were followed by surgical resections and histologic evaluation of tumors. Immunohistochemical analyses of estrogen receptor, progesterone receptor, Her2/neu, p53 protein, and Ki-67 were performed. Patient's age, race, and family history of breast carcinoma were obtained. The objective of the study is to identify a cytomorphologically distinctive, clinically relevant, subset of breast carcinomas. RESULTS A subset carcinoma was recognized by cytomorphologic examination of Pap-stained FNAB slides. This subset consisted of seven patients with a median age of 37 years. At the time of surgical resection, all patients had axillary lymph node metastases. Six of seven patients had distant metastases. Immunohistochemical studies revealed that all tumors are positive for p53 protein and negative for estrogen and progesterone receptors. CONCLUSION This study presented a unique subset of breast ductal carcinomas that involved young patients and had aggressive growth behavior. These tumors expressed p53 protein but not estrogen and progesterone receptors.
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Affiliation(s)
- Di Lu
- Department of Pathology, The University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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95
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Rivera-Hueto F, Hevia-Vázquez A, Utrilla-Alcolea JC, Galera-Davidson H. Long-term prognosis of teenagers with breast cancer. Int J Surg Pathol 2002; 10:273-9. [PMID: 12490977 DOI: 10.1177/106689690201000405] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report 4 new cases of breast carcinoma in teenage girls diagnosed by use of histochemical and immunohistochemical methods. These cases of breast carcinoma in women under 20 years of age were found in the files of our department in the last 24 years (1976-2000). The patients had operable breast carcinomas corresponding to various histologic types (1 invasive ductal carcinoma associated with fibroadenoma, 2 secretory carcinomas, and 1 invasive lobular-type carcinoma). Simple mastectomy with low axillary lymph node dissection was performed in 2 postpubertal patients. Only 1 patient received adjuvant chemotherapy (case 4). After follow-up ranging from 76 to 126 months, 3 patients are alive and disease-free and 1 has disseminated metastatic disease. The correlations with prognosis-related risk factors (stage, age, previous benign lesions, family history, histologic types, hormonal receptors, and pregnancy) were examined.
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96
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de Bree E, Askoxylakis J, Giannikaki E, Chroniaris N, Sanidas E, Tsiftsis DD. Secretory carcinoma of the male breast. Ann Surg Oncol 2002; 9:663-7. [PMID: 12167580 DOI: 10.1007/bf02574482] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Secretory carcinoma is a distinctive and rare variant of breast carcinoma with a favorable prognosis because these tumors usually behave in an indolent manner. The occurrence of this type of breast cancer in males was studied. METHODS An extensive literature survey concerning secretory breast cancer in males was performed. Data of one case treated in our institute were added. RESULTS A total of 14 cases were identified, and our case was added to this series. The median age was 17 years. The duration of symptoms varied from 1 month to 21 years, and the tumor size was 1.2 to 4 cm. Surgical treatment varied from local excision only to modified radical mastectomy. Three patients received adjuvant treatment. Lymph nodes were involved in 3 of the 10 cases undergoing axillary lymph node dissection. The primary tumor was only 1.5 cm in diameter in two of those cases. None of the patients presented with systemic metastases. Only one male was reported to develop recurrence and consequently died of systemic disease. CONCLUSIONS Secretory breast cancer is very rare in males and seems to occur at a younger age in males than in females. A sufficient number of female cases have been reported with recurrence after local excision. Although in females lymph node metastases are rarely observed in secretory breast carcinoma smaller than 2 cm, in male patients nodal metastases might occur more frequently in smaller tumors. Therefore, mastectomy with sentinel lymph node biopsy or axillary lymph node dissection is recommended in any male case. Biological behavior seems to be similarly favorable in either sex.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, University Hospital, Medical School of Crete, 711 10 Herakleion, Greece.
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97
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Gouveia AMF, Lopes JM, Pimenta APA. Carcinoma secretor da mama no adulto: existem parâmetros bem definidos para decisão terapêutica? Acta Cir Bras 2002. [DOI: 10.1590/s0102-86502002000200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O carcinoma secretor (CS) da mama é uma neoplasia muito rara. O CS da mama foi inicialmente descrito em crianças e adolescentes, mas a maioria dos casos é descrito em doentes adultos. É muitas vezes associado a um prognóstico particularmente favorável, mas em doentes adultos com tumores de maiores dimensões pode apresentar um comportamento mais agressivo. Apresenta-se um caso de uma doente com 62 anos de idade, que apresentava uma volumosa tumefacção da mama com 16 anos de evolução. O exame objetivo revelou extensa fixação da lesão à pele, com sinais inflamatórios acentuados e áreas de necrose cutânea. O tratamento inicial consistiu numa mastectomia simples, com intenção paliativa. O diagnóstico anatomopatológico de carcinoma secretor (3,5 cm), sem invasão cutânea, motivou a posterior realização de esvaziamento ganglionar axilar, que revelou metástases em 2 dos 13 gânglios isolados. A doente faleceu 24 meses depois, por disseminação da doença, comprovando a maior agressividade do CS em doentes adultos com tumores de maiores dimensões (T2) e com metastização ganglionar (N1). Os autores revêem a literatura com particular ênfase nos factores de prognóstico importantes para decisão terapêutica deste tipo raro de carcinoma da mama, em doentes adultos.
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98
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Affiliation(s)
- Jeong Mi Park
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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99
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Gupta RK, Kenwright D, Naran S, Lallu S, Fauck R. Fine needle aspiration cytodiagnosis of secretory carcinoma of the breast. Cytopathology 2000; 11:496-502. [PMID: 11194081 DOI: 10.1046/j.1365-2303.2000.00283.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Secretory carcinoma (SC) of the breast is a rare variant of breast malignancy and its cytological features in fine needle aspirates have only recently been described. In this communication, our experience with four cases of SC of the breast is presented in which the diagnosis was established on fine needle aspiration cytology (FNAC). In all cases, the samples were cellular and featured diffuse, prominent, intracytoplasmic vacuoles and secretion in malignant cells and occasional signet-ring like forms. The cytodiagnosis of SC in all the cases correlated with subsequent examination of cell blocks of the aspirate and tissue. Cytochemical stains showed diffuse positivity for mucin by alcian blue stain in the vacuolated cells which was periodic acid-Schiff positive and resistant to diastase digestion. Oil-red O staining was negative. Immunopositivity to carcinoembryonic antigen, cytokeratin (CAM 5.2), B72.3 and epithelial membrane antigen was found in malignant cells. The cytodiagnostic criteria for SC of the breast, characteristic cytological features which are useful in a correct FNAC diagnosis and differentiation from other pertinent breast carcinomas, are discussed.
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Affiliation(s)
- R K Gupta
- Departments of Cytology, Wellington Hospital and School of Medicine, New Zealand
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100
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Herz H, Cooke B, Goldstein D. Metastatic secretory breast cancer. Non-responsiveness to chemotherapy: case report and review of the literature. Ann Oncol 2000; 11:1343-7. [PMID: 11106125 DOI: 10.1023/a:1008387800525] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Secretory carcinoma of the breast is a rare and indolent tumour originally described in children but occurring equally in the adult population. The principal management problems following primary surgical treatment are local recurrence and axillary lymph node metastases. Distant metastases are extremely rare. We present the case of a 27-year-old woman with pulmonary metastases from a secretory breast cancer treated by mastectomy and axillary lymph node dissection 12 years previously. There was no response to chemotherapy; however, the patient remained alive and active two years from presentation with metastatic disease and one year from cessation of all cytotoxic chemotherapy. She eventually died of respiratory failure two and a half years after presentation. To our knowledge, this is only the fourth reported case of distant metastases from secretory breast cancer and the second reported case in which current active chemotherapy has been used. We review the literature and discuss the apparent chemoresistance of this tumour including the lack of membrane staining for Her2/neu. In the absence of any proven effective chemotherapy we believe that symptom control becomes the focus of management and offers patients with metastatic secretory breast cancer the greatest chance of a functional and good quality existence.
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Affiliation(s)
- H Herz
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
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