Needle aspiration cytology, immunocytochemistry, and electron microscopy in a rare case of secretory carcinoma of the breast in an elderly woman

Relato de caso: carcinoma secretório de mama

Neste artigo, os autores apresentam o caso de uma paciente portadora de um carcinoma secretório de mama, tipo raro de carcinoma mamário que ocorre com maior freqüência em pacientes jovens. No caso apresentado, uma paciente do sexo feminino com 38 anos de idade, apresentando nódulo mamário com características clínicas de benignidade, foi abordada inicialmente através de uma punção-biópsia por agulha fina (PAAF), cujo exame citológico foi compatível com uma lesão benigna. A paciente foi, então, submetida a uma tumorectomia simples e, ao exame anatomopatológico, foi constatado tratar-se de um carcinoma secretório da mama. Após o diagnóstico de malignidade, optou-se por uma conduta mais conservadora no caso, uma vez que trata-se de um tumor de bom prognóstico, e foi realizada apenas a ampliação das margens cirúrgicas da primeira ressecção. Os autores fazem, ainda, uma breve revisão da literatura, a qual justifica o tratamento conservador instituído.

Cytological and molecular characterization of secretory breast carcinoma

Secretory breast carcinoma is a rare neoplasm, histologically well-characterized, and secondary to ETV6-NTRK3 gene fusion, whose cytological features are scarcely described in the literature. We report the case of a woman with a history of secretory breast carcinoma 8 years before, who presented a periareolar nodule. A recurrence was diagnosed by fine-needle aspiration based on the cytomorphological features and pan-TRK immunocytochemistry on the cell block, and the patient underwent a mastectomy. The histology and molecular studies performed on the surgical specimen (immunohistochemistry, FISH and NGS) confirmed the diagnosis. Cytological smears showed abundant epithelial cellularity, in groups and single cells. These cells showed moderate atypia, with abundant cytoplasm. We observed intracytoplasmic inclusions and extracellular metachromatic globules. Immunocytochemical and immunohistochemical studies showed a triple negative breast tumour. NTRK overexpression was demonstrated with immunocytochemistry against pan-TRK on the cell block, as well as with immunohistochemistry in the surgical specimen. NTRK3 rearrangement was proved by FISH. In the primary tumour and in the recurrence, we demonstrated ETV6-NTRK3 fusion by NGS. After conducting a literature review, we have found 26 articles describing the cytological features of secretory breast carcinoma in 33 patients. The smears were described as groups of epithelial cells with vacuolated cytoplasm, single signet ring cells and a globular extracellular secretion. In only two cases molecular confirmation of the diagnosis with ETV6-NTRK3 fusion was proven, although not in the cytological specimen, but in the subsequent biopsy. The distinct cytological features of secretory breast carcinoma can help in its diagnosis, thus guiding the molecular studies. This is the first reported case that proves TRK overexpression, as a fusion surrogate, in the cytological sample.

Secretory Carcinoma in a 79- Year-Old Woman: An Exceptionally Rare Type of Breast Carcinoma

Secretory breast carcinoma is an exceptionally rare mammary gland neoplasia described mainly in adult females and children of both sexes, and very rarely in the elderly. It has particular histopathological and immunohistochemical features and a favorable prognosis. We report the case of a 79-year-old Hispanic woman with a palpable breast mass. Currently, the patient is disease free after a followup period of 6 years without local recurrence or axillary lymph-nodes nor distant metastases.

Secretory carcinoma of the male breast: correlation of aspiration cytology and pathology

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.

Carcinoma secretor da mama no adulto: existem parâmetros bem definidos para decisão terapêutica?

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.

Fine needle aspiration cytodiagnosis of secretory carcinoma of the breast

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.