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Yuan M, Chen D, Sun H, Wang X, Wan D. Primary neuroendocrine carcinoma of the breast with leptomeninges metastasis: A case report and literature review. J Int Med Res 2022; 50:3000605221118505. [PMID: 36069002 PMCID: PMC9459456 DOI: 10.1177/03000605221118505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary neuroendocrine carcinoma of the breast (NECB) is a rare tumour with an incident rate of 0.3-0.5%. The most common metastatic sites of NECB are liver, bones, lung, pancreas, soft tissues and brain, while leptomeninges metastasis (LM) is reported rarely. This current case report describes a 50-year-old female patient with NECB and LM whose overall survival was 2 months. The report also presents the current literature regarding the knowledge of this unusual tumour and metastatic type. The current patient was diagnosed with NECB with right cerebellar metastasis, followed by LM. She underwent modified radical mastectomy of the left breast, left whole breast radiation therapy and incomplete adjuvant chemotherapy until the metastasis occurred. Whole-brain radiation therapy and a first-line salvage regimen of etoposide and cis-platinum were then undertaken. The patient died 2 months after their LM diagnosis. Primary NECB with LM is sporadic, devoid of effective treatment and associated with a poor prognosis. Consequently, it is vitally important to identify LM in order to achieve longer patient survival.
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Affiliation(s)
- Mengqi Yuan
- Department of Oncology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Dongmei Chen
- Department of Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiuhong Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Donggui Wan
- Department of Oncology, China-Japan Friendship Hospital, Beijing, China
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Hussain M, Abbott M, Zargham R, Pabani A, Khan OF. Evolution of an invasive ductal carcinoma to a small cell carcinoma of the breast: A case report. Medicine (Baltimore) 2022; 101:e28433. [PMID: 35029184 PMCID: PMC8758025 DOI: 10.1097/md.0000000000028433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Small cell carcinoma (SCC) is a rare subtype of breast cancer and presents a complex diagnostic and treatment challenge, due to paucity of data. To the best of our knowledge, most cases of breast SCC reported in the literature describe a de novo breast primary. Our case is unique as it describes the evolution of an invasive ductal carcinoma after treatment into a SCC of the breast. PATIENT CONCERNS AND DIAGNOSIS We report a case of a 53-year-old female, lifelong non-smoker, who initially presented with breast mass noted on self examination. Breast and axillary lymph node biopsy demonstrated a hormone receptor positive invasive ductal carcinoma with a metastatic T3 lesion. INTERVENTION She was treated with first-line palbociclib/letrozole with initial clinical response, and at progression was switched to capecitabine with no response. Repeat biopsy of the axillary lesion showed evolution of the tumor into a triple negative breast cancer. She was then treated with third-line paclitaxel and radiation therapy with good initial response. She eventually had further disease progression and presented with a new mediastinal lymphadenopathy causing SVC syndrome. Biopsy of this showed a small cell variant of breast neuroendocrine carcinoma. Due to the evolution of histology in this case, a retrospective review of her initial breast specimen as well as the second biopsy from the axilla was conducted which confirmed that the mediastinal lymphadenopathy was metastatic from the original breast tumor. OUTCOMES AND LESSONS We speculate that the initial treatment allowed a minority of treatment-resistant neuroendocrine cells to grow and become the dominant face of the tumor. Our patient had an excellent response to carboplatin/etoposide and consolidative locoregional radiotherapy but presented with an early intracranial recurrence. This is a similar pattern of metastases as seen in lung SCC and highlights a potential role for prophylactic cranial irradiation in breast SCC. Further studies are needed to better understand the biology and treatment of breast SCC which continues to present a challenge for clinicians.
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Affiliation(s)
- Marya Hussain
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marcia Abbott
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Ramin Zargham
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Omar F. Khan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Boutrid H, Kassem M, Tozbikian G, Morgan E, White J, Shah M, Vandeusen J, Sardesai S, Williams N, Stover DG, Lustberg M, Wesolowski R, Pudavalli V, Williams TM, Konda B, Fortier S, Carbone D, Ramaswamy B, Cherian MA. TTF-1 Positive Primary Small Cell Carcinoma of the Breast: A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:228. [PMID: 32411090 PMCID: PMC7201766 DOI: 10.3389/fendo.2020.00228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 01/22/2023] Open
Abstract
Primary small cell carcinoma of the breast (SCCB) is a rare tumor subtype comprising <0.1% of all breast carcinomas. Here we present a case of thyroid transcription factor-1 (TTF-1) positive SCCB that recurred within 3 years of diagnosis in the lung and lymph nodes. Given the small number of cases, no clear guidelines exist on the appropriate management of patients with these aggressive tumors. We present a case study and review the current literature to highlight the knowledge gaps and needs of patients with these rare tumors. A 50-year-old premenopausal woman with no family history, presented with a palpable right breast mass. Biopsy was consistent with primary SCCB that was poorly differentiated, positive for synaptophysin and chromogranin and TTF-1 and presence of ductal carcinoma in situ component showing neuroendocrine differentiation. Imaging with PET, CT, and MRI brain excluded any other sites of primary disease. She underwent a right lumpectomy with axillary lymph node dissection and was treated with adjuvant cisplatin-based chemotherapy and concurrent radiation therapy. Thirty-four months later, routine scans showed a new right lower-lobe lung nodule and an enlarged sub-carinal node that was proven to be poorly differentiated neuroendocrine cancer. This case report sheds light on a rarely described disease and provides a comprehensive approach to diagnosis and management. Primary SCCB is an extremely rare, aggressive form of breast cancer that is molecularly and histologically similar to SCLC. However, a review of the literature highlights recent mutational analyses that show important differences between these two cancer types, including an increase in PIK3CA mutations in primary SCCB. Further studies, including genomic analyses are needed to better define this malignancy and to develop a standard treatment.
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Affiliation(s)
- Hinda Boutrid
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Mahmoud Kassem
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Evan Morgan
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Julia White
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Manisha Shah
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Jeffrey Vandeusen
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Sagar Sardesai
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Nicole Williams
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Daniel G. Stover
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Maryam Lustberg
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Wesolowski
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Vinay Pudavalli
- Department of Neurological Surgery, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Terence M. Williams
- Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Bhavana Konda
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Stephanie Fortier
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - David Carbone
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Bhuvaneswari Ramaswamy
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Mathew A. Cherian
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
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Kanat O, Kilickap S, Korkmaz T, Oven BBU, Canhoroz M, Cubukcu E, Tolunay S, Evrensel T, Manavoglu O. Primary small cell carcinoma of the breast: Report of seven cases and review of the literature. TUMORI JOURNAL 2018; 97:473-8. [DOI: 10.1177/030089161109700410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of the study was to analyze the clinicopathological characteristics, treatment modalities, and clinical outcome of patients with primary small cell carcinoma of the breast. Methods Fifty-three cases of primary small cell carcinoma of the breast were identified; 7 cases in this series and 46 from the English-language medical literature. Results There were 52 females and 1 male. The mean age was 53 years. Tumor size ranged from 1 to 18 cm (mean, 4.53). Axillary node metastasis was present in 61.7%. Only one patient had distant metastases at presentation. The presence of hormone receptors was reported in 24.5% of the tumors. Modified radical mastectomy was the most common surgical procedure and was performed in 50.9% of the patients. Adjuvant radiotherapy was administered to 39.6% of the patients, and 69.8% underwent chemotherapy. Thirteen percent of patients received adjuvant tamoxifen therapy. The mean follow-up was 20.75 months (range, 3–60), and 10 of 53 cases (18.9%) died of metastatic disease. Conclusions The prognosis of primary small cell carcinoma of the breast largely depends on the initial stage of the disease. Multimodality treatment including surgery, radiotherapy and chemotherapy seems to be the most appropriate strategy for early disease. Chemotherapy is usually unsuccessful in treating metastatic disease.
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Affiliation(s)
- Ozkan Kanat
- Uludag University Faculty of Medicine Department of Medical Oncology, Gorukle, Bursa
| | - Saadetin Kilickap
- Cumhuriyet University Faculty of Medicine Department of Medical Oncology, Sivas
| | - Taner Korkmaz
- Marmara University Faculty of Medicine Department of Medical Oncology, Istanbul
| | | | - Mustafa Canhoroz
- Uludag University Faculty of Medicine Department of Medical Oncology, Gorukle, Bursa
| | - Erdem Cubukcu
- Uludag University Faculty of Medicine Department of Medical Oncology, Gorukle, Bursa
| | - Sahsine Tolunay
- Uludag University Faculty of Medicine Department of Pathology, Gorukle, Bursa, Turkey
| | - Turkkan Evrensel
- Uludag University Faculty of Medicine Department of Medical Oncology, Gorukle, Bursa
| | - Osman Manavoglu
- Uludag University Faculty of Medicine Department of Medical Oncology, Gorukle, Bursa
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Tremelling A, Samuel S, Murray M. Primary small cell neuroendocrine carcinoma of the breast - A case report and review of the literature. Int J Surg Case Rep 2017; 38:29-31. [PMID: 28734185 PMCID: PMC5521029 DOI: 10.1016/j.ijscr.2017.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Primary small cell neuroendocrine carcinoma of the breast is a very rare diagnosis. It has similar features to small cell neuroendocrine carcinoma of the lung. Diagnostic workup must exclude metastasis from another primary site. Treatment combines approaches for more common types of lung and breast cancer. Further studies are needed to standardized the treatment for primary SCNCB.
Introduction Primary small cell neuroendocrine carcinoma of the breast (SCNCB) is a very uncommon type of breast cancer. Histology and morphology are virtually indistinguishable from small cell neuroendocrine carcinomas of the lung (SCNCL), mandating a search for a primary site elsewhere in the body. There is no standard approach to treatment as there are only a limited number of cases reported in the literature. This report summarizes a case of primary SCNCB and presents a review of the literature. Presentation of case A 65-year-old female presented to her gynecologist with a right breast mass. After biopsy, she was diagnosed with a primary SCNCB with regional lymph node involvement. She was treated with chemotherapy and radiation therapy with a good clinical response. Discussion Due to the rare nature of this tumor, no standard treatment exits. Case reports have described breast conserving therapy combined with neoadjuvant or adjuvant chemotherapy as well as chemoradiation therapy alone for metastatic disease. Both chemotherapy regimens, those used to treat SCNCL and invasive breast cancer, have been described in these reports. Conclusion Primary SCNCB is a very rare type of breast cancer with no standard treatment. Further research is needed to better understand the behavior of this rare tumor in order to develop a standard approach to treatment.
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Affiliation(s)
- Abigail Tremelling
- Cleveland Clinic Akron General, Department of General Surgery, United States.
| | - Selyne Samuel
- Cleveland Clinic Akron General, Department of General Surgery, Breast Surgery Oncology Fellowship, United States
| | - Mary Murray
- Cleveland Clinic Akron General, Department of General Surgery, Breast Surgery Oncology Fellowship, United States
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Abstract
OBJECTIVES Limited data are available to guide the management of very rare exocrine neoplasms of the pancreas (VREP). Available evidence suggests that VREP have different risk factors and prognoses from those of adenocarcinoma of the pancreas. The primary objectives for this study were to determine the survival, comorbidities, and response to treatment of patients seen at Mayo Clinic with VREP. METHODS We reviewed patients from 1975 to 2005 who had VREP and compared them to patients with adenocarcinomas that were matched for TNM, grade, and decade of treatment. RESULTS Sixty-six patients with VREP were identified. The most commonly identified neoplasms were acinar cell carcinoma (n = 15), small cell carcinoma (n = 12), and squamous cell carcinoma (n = 8). Abdominal discomfort and jaundice were the most common presenting symptoms. The median overall survival for patients with VREP, 10.4 months (range, 3.7-23 months), was better than that for matched controls, 8.2 months (range, 4-15.4 months) (P = 0.01). There was no difference in the survival of patients with stage 4 disease between cases, 8 months (range, 2.3-21.8 months), and controls, 6.7 months (range, 2.3-10.8 months) (P = 0.17). CONCLUSIONS We present one of the largest series of VREP to date. The overall survival of all patients with VREP was better than matched controls, but no statistical difference was seen between the groups with stage 4 disease.
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