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Amsiguine N, Essaber H, Elbakkari A, Allioui S, Jerguigue H, Omor Y, Latib R. Neuroendocrine breast carcinoma: The importance of the correlation between histological and radiological findings. Radiol Case Rep 2024; 19:489-492. [PMID: 38046918 PMCID: PMC10692488 DOI: 10.1016/j.radcr.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Neuroendocrine breast carcinoma (NEBC) is an uncommon and malignant breast lesion. The absence of proper testing for this type of breast cancer carcinoma exacerbates this paucity. Additionally, only scant evidence of these tumors is present because of the repeated revisions in their diagnostic criteria throughout time. This case report highlights the importance of the correlation between histological and radiological findings in the diagnosis and treatment of neuroendocrine breast cancer. We describe the clinical, radiological, and histological characteristics of a patient diagnosed with neuroendocrine carcinoma. The breast parenchyma was penetrated by a carcinomatous tumor growth that contained trabeculae and lobules, exhibiting mild cytonuclear atypia, and having a low mitotic index. This report emphasizes the value of a multidisciplinary strategy for precise diagnosis and treatment planning.
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Affiliation(s)
- Najwa Amsiguine
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Hatim Essaber
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Assaad Elbakkari
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Soukaina Allioui
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Hounaida Jerguigue
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Youssef Omor
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Rachida Latib
- Radiology Department, National Institute of Oncology, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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2
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Kawasaki T, Tashima T, Enomoto A, Ichikawa J, Nagai H, Muramatsu C, Nakamura Y, Kaira K. Neuroendocrine neoplasms in the breast oncology field: dilemmas of nature and morphology. Front Endocrinol (Lausanne) 2023; 14:1216424. [PMID: 38027104 PMCID: PMC10646302 DOI: 10.3389/fendo.2023.1216424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
- Comprehensive Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan
- Department of Pathology, Nagoya University Graduate School of Medicine, Aichi, Japan
- Graduate School of Medicine, University of Yamanashi, Chuo, Japan
- Clinical Research Center, Nagoya Medical Center, Aichi, Japan
| | - Tomoaki Tashima
- Comprehensive Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Atsushi Enomoto
- Department of Pathology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jiro Ichikawa
- Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Hirokazu Nagai
- Clinical Research Center, Nagoya Medical Center, Aichi, Japan
| | | | - Yasuhiro Nakamura
- Comprehensive Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kyoichi Kaira
- Comprehensive Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan
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3
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Prognostic relevance of mixed histological subtypes in invasive breast carcinoma: a retrospective analysis. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04443-x. [DOI: 10.1007/s00432-022-04443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
The prognostic and therapeutic power of special histological subtypes in breast cancer in pure form or in combination with other histological subtypes is still not established, and diagnostic guidelines are cautious regarding prognostic power based on the histological subtype alone. Therapy decisions are guided in most cases independently of the histological subtype and are directed by biomarkers and tumor stage. In this study, we analyzed a comprehensive large retrospective breast cancer cohort with a special focus on histological subtype (other than ductal non-special type or lobular carcinoma) and correlated pure or mixed histological forms with pathological tumor stage and overall disease-free survival.
Materials and methods
A total of 827 breast cancer cases with pure or mixed special histological types were retrospectively analyzed. Survival information was available in 645 of 827 cases.
Results
A total of 293 cases had pure forms, and 534 cases had mixed histological subtypes. The most common pure special types were mucinous (23.9%), micropapillary (21.2%), high-grade metaplastic (13%), male breast cancer (8.2%), cribriform (6.8%), metastases (6.1%), apocrine and papillary (each 5.46%), NST with medullary and clear cell pattern (up to 3.4%) and high-grade neuroendocrine carcinomas (2.7%). Mixed forms were most frequently encountered in NST carcinomas with micropapillary components (41.8%), followed by mucinous (9.93%) and cribriform (6.74%) mixed patterns. In univariate analysis, no pure form had prognostic relevance compared with any mixed form with the basic pure element. Pooling pure histological subtypes with tumor stage and age in a linear random-effects model, the cribriform subtype had the most favorable prognosis, while male breast cancer showed the poorest outcome (p < 0.001). All other frequent pure forms had intermediate prognostic power (p < 0.001).
Conclusion
Our results show that the analyzed special histological breast cancer subtypes (other than ductal and lobular carcinomas) do not carry prognostic information alone, either in pure form or in any combination with other subtypes. Prognostic groups including special subtypes, however, can strongly stratify breast cancer if tumor stage, age and biomarkers are included in the prognostic measurements.
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4
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Zhong E, Pareja F, Hanna MG, Jungbluth AA, Rekhtman N, Brogi E. Expression of novel neuroendocrine markers in breast carcinomas: a study of INSM1, ASCL1, and POU2F3. Hum Pathol 2022; 127:102-111. [PMID: 35690220 PMCID: PMC10227884 DOI: 10.1016/j.humpath.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
INSM1, ASCL1, and POU2F3 are novel transcription factors involved in neuroendocrine (NE) differentiation of neoplasms in several organs, but data on their expression in breast carcinomas (BCs) are limited. We retrospectively evaluated the expression of these markers in a series of 97 BCs (58 with NE morphology and 39 with otherwise uncommon morphology) tested prospectively using immunohistochemistry (IHC). Nuclear staining in >50% of the cells was used as the positive cut-off. Thirty-two of the 97 BCs (33%) were INSM1-positive. INSM1-positivity correlated significantly with histologic type and presence of stromal mucin. INSM1 also correlated with synaptophysin and chromogranin, established markers of NE differentiation (P < .0001 and P = .0023, respectively). In BC with NE morphology, the expression of INSM1 supported NE differentiation, and INSM1 was more specific than synaptophysin and more sensitive and specific than chromogranin. INSM1 was the most expressed NE marker in 17 BCs. INSM1-positive BCs included 56% of solid papillary BCs, 88% of BCs with solid papillary features, and 75% of high-grade NE carcinomas. Of 35 BCs tested for POU2F3 and ASCL1, only 1 and 4 cases were positive, respectively. Our results show that INSM1 is a sensitive marker of NE differentiation in BC and should be included with synaptophysin and chromogranin in the IHC panel used to evaluate NE differentiation in BC with NE morphology. ASCL1 and POU2F3 are uncommon in BC and their routine assessment is not warranted.
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Affiliation(s)
- Elaine Zhong
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA.
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5
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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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6
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Chen YQ, Xu XF, Xu JW, Di TY, Wang XL, Huo LQ, Wang L, Gu J, Zhou GH. A high-quality model for predicting the prognosis of breast neuroendocrine carcinoma to help clinicians decide on appropriate treatment methods: A population-based analysis. Transl Oncol 2022; 22:101467. [PMID: 35700595 PMCID: PMC9198476 DOI: 10.1016/j.tranon.2022.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 12/01/2022] Open
Abstract
The incidence of breast neuroendocrine carcinoma (NEC) was approximately 1.96–2.37%. Breast NEC had poor prognosis than breast invasive ductal carcinoma (IDC). Patients with breast NEC may benefit from surgery plus chemotherapy. Efficient models were constructed to guide the treatment of breast NEC.
Background Breast neuroendocrine carcinoma (NEC) is a rare malignancy with unclear treatment options and prognoses. This study aimed to construct a high-quality model to predict overall survival (OS) and breast cancer-specific survival (BCSS) and help clinicians choose appropriate breast NEC treatments. Patients and methods A total of 378 patients with breast NEC and 349,736 patients with breast invasive ductal carcinoma (IDC) were enrolled in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018. Propensity score matching (PSM) was performed to balance the clinical baseline. Prognostic factors determined by multivariate Cox analysis were included in the nomogram. C-index and calibration curves were used to verify the performance of the nomogram. Results Nomograms were constructed for the breast NEC and breast IDC groups after PSM. The C–index of the nomograms ranged from 0.834 to 0.880 in the internal validation and 0.818–0.876 in the external validation, indicating that the nomogram had good discrimination. The risk stratification system showed that patients with breast NEC had worse prognoses than those with breast IDC in the low-risk and intermediate-risk groups but had a similar prognosis that those in the high-risk group. Moreover, patients with breast NEC may have a better prognosis when undergoing surgery plus chemotherapy than when undergoing surgery alone or chemotherapy alone. Conclusions We established nomograms with a risk stratification system to predict OS and BCSS in patients with breast NEC. This model could help clinicians evaluate prognosis and provide individualized treatment recommendations for patients with breast NEC.
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Affiliation(s)
- Yu-Qiu Chen
- Department of Clinical Pharmacy, Affiliated Jinling Hospital, State Key Laboratory of Analytical Chemistry for Life Science and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210002, China; Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Xiao-Fan Xu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jia-Wei Xu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Tian-Yu Di
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Xu-Lin Wang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Li-Qun Huo
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Lu Wang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jun Gu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
| | - Guo-Hua Zhou
- Department of Clinical Pharmacy, Affiliated Jinling Hospital, State Key Laboratory of Analytical Chemistry for Life Science and Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210002, China; Department of Clinical Pharmacy, Affiliated Jinling Hospital, School of Pharmacy, Southern Medical University, Guangzhou 510515, China.
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7
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Chai Y, Liu M, Li Z, Chen Y, Qi F, Li Q, Xu B. Retrospective literature review of primary neuroendocrine neoplasms of the breast (BNEN) in 209 Chinese patients: Treatment and prognostic factor analysis. Breast 2022; 62:93-102. [PMID: 35134665 PMCID: PMC8844750 DOI: 10.1016/j.breast.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background The prognostic factors and optimal choice of treatment for primary neuroendocrine neoplasms of the breast (BNEN) remain to be defined. Methods Patients diagnosed with BNEN in China were retrospectively reviewed from the literature following the systematic search of China National Knowledge Infrastructure (CNKI), Chinese biomedical literature service system (sinomed), wanfang medical network, and Pubmed database. The clinical characteristics and different treatment modalities of patients with BNEN were evaluated. Results A total of 209 cases with BNEN were enrolled. There were 204 female and 5 male patients. The median age was 51 years old (range, 17–82). Out of 209 patients with BNEN, 208 (99.5%) patients were treated with surgery (SG), 44 patients (21.1%) had received radiotherapy (RT), 173 patients (82.8%) experienced chemotherapy (CT). A total of 158 patients with hormone receptor (HR) positive (87.8%, 158/180) were treated with endocrine treatment (ET). The median follow-up time was 52.4 months (range, 6–144). The 3-year overall survival (OS) rate and 3-year disease-free survival (DFS) rate for the whole group were 93.7% and 85.3%, respectively. In univariate analyses, Ki67 expression ≥20%, HR negative, neuroendocrine carcinomas (NECs) were associated with decreased OS and DFS (P < 0.05). Patients treated with anthracycline/taxane-containing CT regimens, or taxane-containing CT regimens had superior OS and DFS than patients without those (P < 0.05). Among 69 patients with stage I who received CT had no significant differences in OS or DFS compared to those without CT. Multivariate Cox regression analysis showed that gender, HR expression, pathologic subtype, and CT were independent prognostic factors for DFS but not OS (P > 0.05). Conclusions The best selection of patients to get the most benefit from different treatment modalities warrant further exploration. The clinicopathological parameters including gender, HR expression, ki67 expression, pathologic type, stage, tumor size, and lymph node status may serve as both indicators of diagnosis and prognosis, and guide treatment decisions for BNEN. Surgery is a cornerstone of BNEN. ET may have a long-term superior effect on patients with HR-positive. Low-risk BNEN patients may be spared CT and managed with ET. Many clinicopathological parameters were very important for BNEN.
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Affiliation(s)
- Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Liu
- Department of Medical Oncology, The Second People's Hospital/ Tumor Hospital of Jilin City, Jilin, China
| | - Zhijun Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujie Chen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Fei Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Bejing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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8
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Krawczyk N, Röwer R, Anlauf M, Muntanjohl C, Baldus SE, Neumann M, Banys-Paluchowski M, Otten S, Luczak K, Ruckhäberle E, Mohrmann S, Hoffmann J, Kaleta T, Jaeger B, Esposito I, Fehm T. Invasive Breast Carcinoma with Neuroendocrine Differentiation: A Single-Center Analysis of Clinical Features and Prognosis. Geburtshilfe Frauenheilkd 2022; 82:68-84. [PMID: 35027862 PMCID: PMC8747900 DOI: 10.1055/a-1557-1280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction
Invasive breast cancer with neuroendocrine differentiation is a rare subtype of breast malignancy. Due to frequent changes in the definition of these lesions, the correct diagnosis, estimation of exact prevalence, and clinical behaviour of this entity may be challenging. The aim of this study was to evaluate the prevalence, clinical features, and outcomes in a large cohort of patients with breast cancer with neuroendocrine differentiation.
Patients
Twenty-seven cases of breast cancer with neuroendocrine differentiation have been included in this analysis. Twenty-one cases were identified by systematic immunohistochemical re-evaluation of 465 breast cancer specimens using the neuroendocrine markers chromogranin A and synaptophysin, resulting in a prevalence of 4.5%. A further six cases were identified by a review of clinical records.
Results
Median age at the time of diagnosis was 61 years. 70% of patients had T2 – 4 tumors and 37% were node-positive. The most common immunohistochemical subtype was HR-positive/HER2-negative (85%). 93% were positive for synaptophysin and 48% for chromogranin A. Somatostatin receptor type 2A status was positive in 12 of 24 analyzed tumors (50%). Neuroendocrine-specific treatment with somatostatin analogues was administered in two patients. The 5-year survival rate was 70%.
Conclusions
Breast cancer with neuroendocrine differentiation is mostly HR-positive/HER2-negative and the diagnosis is made at a higher TNM stage than in patients with conventional invasive breast carcinoma. Moreover, breast cancer with neuroendocrine differentiation was found to be associated with impaired prognosis in several retrospective trials. Due to somatostatin receptor 2A expression, somatostatin receptor-based imaging can be used and somatostatin receptor-targeted therapy can be offered in selected cases.
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Affiliation(s)
- Natalia Krawczyk
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Rowena Röwer
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Martin Anlauf
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany.,Institute of Pathology, Cytology and Molecular Pathology, St. Vincenz Hospital, Limburg, Germany
| | - Caja Muntanjohl
- Institute of Pathology, Cytology and Molecular Pathology, St. Vincenz Hospital, Limburg, Germany
| | - Stephan Ernst Baldus
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany.,Institute of Pathology, Cytology and Molecular Pathology, Bergisch Gladbach, Germany
| | - Monika Neumann
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Maggie Banys-Paluchowski
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Sabine Otten
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Katharina Luczak
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Thomas Kaleta
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Bernadette Jaeger
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
| | - Irene Esposito
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynaecology, University of Düsseldorf, Düsseldorf, Germany
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9
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Guzelbey B, Hacihasanoglu E, Talu CK, Cakir Y, Nazli MA. The Effect of the Extent of Neuroendocrine Differentiation on Cytopathological Findings in Primary Neuroendocrine Neoplasms of the Breast. J Cytol 2022; 38:216-224. [PMID: 35002115 PMCID: PMC8670448 DOI: 10.4103/joc.joc_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/02/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: This study aimed to describe the cytological features of neuroendocrine breast tumors and to show the effect of the extent of neuroendocrine differentiation on cytological features. Methods: Breast tumor excision materials showing immunostaining with neuroendocrine markers (Synaptophysin or Chromogranin A) were determined and divided into two groups: cases with focal (10%–50% of tumor cells) staining and cases with diffuse (>50% of tumor cells) staining. A group of cases without neuroendocrine features/staining was used as control group. Fine needle aspiration biopsy specimens of the tumor mass or metastatic lymph nodes were examined and compared. Results: Twenty cases with neuroendocrine differentiation were included. Eleven cases were in the diffuse group, nine cases were in the focal group. Clean background, high cellularity, loosely cohesive cell groups with monotonous appearance, and naked nuclei were more common in the diffuse group. On the contrary, tight cohesive cell groups, the proportion of large cells, nuclear pleomorphism, and nucleolar prominence were higher in the group with focal staining. Plasmocytoid appearance, isolated cell groups, and binucleation were in similar distribution in both groups. Although round-oval nuclei were dominant in both groups, round nuclei were observed to be slightly more in the diffuse group. Only two cases in diffuse group showed cytoplasmic granularity and one case in focal group showed necrosis and mitosis. In the control group, tight cohesive groups, large cell size, pleomorphism, prominent nucleoli, and coarse chromatin were more commonly encountered. Conclusions: Clean background, hypercellularity, loss of cohesion, naked nuclei, monotonous cells with round nucleus, and granular cytoplasm were more prominent in cases showing diffuse staining with neuroendocrine markers. Suspecting neuroendocrine differentiation in tumors that show focal staining with neuroendocrine markers can be challenging in cytological preparations.
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Affiliation(s)
- Burcu Guzelbey
- Department of Pathology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ezgi Hacihasanoglu
- Department of Pathology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Canan Kelten Talu
- Department of Pathology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasemin Cakir
- Department of Pathology, Doc. Dr. Ismail Karakuyu State Hospital, Kutahya, Turkey
| | - Mehmet A Nazli
- Department of Radiology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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10
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Metovic J, Cascardi E, Uccella S, Maragliano R, Querzoli G, Osella-Abate S, Pittaro A, La Rosa S, Bogina G, Cassoni P, Marchiò C, Sapino A, Castellano I, Papotti M. Neuroendocrine neoplasms of the breast: diagnostic agreement and impact on outcome. Virchows Arch 2022; 481:839-846. [PMID: 36243799 PMCID: PMC9734208 DOI: 10.1007/s00428-022-03426-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023]
Abstract
The classification of breast neuroendocrine neoplasms (Br-NENs) was modified many times over the years and is still a matter of discussion. In the present study, we aimed to evaluate the diagnostic reproducibility and impact on patient outcomes of the most recent WHO 2019 edition of breast tumor classification, namely, for neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). This multicentric observational study included 287 breast neoplasms with NE differentiation. The cases were blindly classified by three independent groups of dedicated breast and/or endocrine pathologists following the 2019 guidelines. Diagnostic concordance and clinical impact were assessed. We observed only a moderate overall diagnostic agreement across the three centers (Cohen's kappa 0.4532) in distinguishing NET from solid papillary carcinomas (SPCs) and no special type carcinomas (NST) with NE differentiation. Br-NENs were diagnosed in 122/287 (42.5%) cases, subclassified as 11 NET G1 (3.8%), 84 NET G2 (29.3%), and 27 NEC (9.4%), the latter group consisting of 26 large-cell and 1 small-cell NECs. The remaining 165/287 (57.5%) cases were labeled as non-NEN, including SPC, mucinous, NST, and mixed NE carcinomas. While NET and non-NEN cases had a comparable outcome, the diagnosis of NECs showed negative impact on disease-free interval compared to NETs and non-NENs (p = 0.0109). In conclusion, the current diagnostic classification of Br-NENs needs further adjustments regarding morphological and immunohistochemical criteria to increase the diagnostic reproducibility among pathologists. Our data suggest that, apart from high-grade small- and large-cell NECs, Br-NENs behave like non-NEN breast carcinomas and should be managed similarly.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - Eliano Cascardi
- Candiolo Cancer Institute, Pathology Division, FPO-IRCCS, Candiolo, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Roberta Maragliano
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Giulia Querzoli
- Department of Pathology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Simona Osella-Abate
- Department of Medical Sciences, Pathology Unit, Città Della Salute E Della Scienza Hospital, Turin, Italy
| | - Alessandra Pittaro
- Department of Medical Sciences, Pathology Unit, Città Della Salute E Della Scienza Hospital, Turin, Italy
| | - Stefano La Rosa
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Giuseppe Bogina
- Department of Pathology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Paola Cassoni
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - Caterina Marchiò
- Candiolo Cancer Institute, Pathology Division, FPO-IRCCS, Candiolo, Italy ,Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - Anna Sapino
- Candiolo Cancer Institute, Pathology Division, FPO-IRCCS, Candiolo, Italy ,Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - Isabella Castellano
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy.
| | - Mauro Papotti
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
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11
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Marijanović I, Kraljević M, Buhovac T, Karan Križanac D. Rare Human Epidermal Growth Factor Receptor 2 (HER-2)-Positive Neuroendocrine Carcinoma of the Breast: A Case Report with 9-Year Follow-up. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925895. [PMID: 33067411 PMCID: PMC7579747 DOI: 10.12659/ajcr.925895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neuroendocrine carcinoma of the breast (NECB) is very rare, accounting for 0.1% of all breast tumors and less than 1% of all neuroendocrine tumors. Most NECBs are hormone receptor-positive and human epidermal growth factor receptor 2 (HER-2)-negative and more than 50% are the luminal B subtype. Because prospective studies of NECB are lacking, treatment is the same as for other breast tumors. CASE REPORT A 70-year-old woman was diagnosed with NECB in February 2011. She underwent radical right mastectomy and right axillary node dissection. Final histopathological examination revealed NECB with positive axillary nodes (N1). The tumor cells were 100% positive for estrogen receptors and 10% positive for progesterone receptors. The HER-2 status was 3+. According to the Tumor, Node, Metastasis (TNM) Classification of Malignant Tumors, the pathologic stage was IIB - pT2pN1cM0. The histologic grade was 2 and the Ki-67 proliferation index was 5.7%. The patient received adjuvant chemotherapy, radiation therapy, IV trastuzumab, and endocrine therapy. After 9 years of follow-up, she remains disease-free. CONCLUSIONS As far as we know, this is only the second report describing treatment of HER-2-positive NECB with trastuzumab. A literature review shows that it is the first report of treatment of HER-2-positive primary NECB with adjuvant trastuzumab. In similar cases, long-term follow-up is recommended because of the potential for multiple metastases of NECB even years after completion of adjuvant therapy.
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Affiliation(s)
- Inga Marijanović
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- Department of Oncology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Dragana Karan Križanac
- Department of Pathology, Cytology and Forensic Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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12
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INSM1 is a novel prognostic neuroendocrine marker for luminal B breast cancer. Pathology 2020; 53:170-178. [PMID: 32951906 DOI: 10.1016/j.pathol.2020.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/31/2022]
Abstract
Insulinoma associated protein 1 (INSM1) is a relatively new marker of neuroendocrine differentiation. It has been shown to have a high sensitivity for neuroendocrine tumours arising from different organs. This study evaluated INSM1 as a marker for neuroendocrine differentiation in infiltrating breast cancers (IBC). The expression of INSM1, together with other neuroendocrine markers (synaptophysin, chromogranin and CD56) was assessed in a large IBC cohort using tissue microarray by immunohistochemistry. Overall, 13.1%, 4.6%, 7.0% and 6.5% of the cases were positive for synaptophysin, chromogranin, INSM1 and CD56, respectively. INSM1 expression showed similar clinicopathological and biomarker profiles as chromogranin and synaptophysin. They were associated positively with luminal profile (p<0.001) and hormone receptors expression (p≤0.015), but negatively with HER2 (p≤0.044) and high molecular weight cytokeratins (p≤0.047). Using synaptophysin and/or chromogranin to define neuroendocrine differentiation, INSM1 showed a sensitivity of 37.3%, and was more sensitive than chromogranin (33.5%) and CD56 (16.4%) but less than synaptophysin (94.6%). Interestingly, INSM1 expression segregated IBC with neuroendocrine differentiation into different prognostic subgroups, particularly within luminal B subtype. Among the synaptophysin/chromogranin+ luminal B cancers, INSM1 expression was associated with significantly better survival (DFS: χ2=8.009, p=0.004; BCSS: χ2=3.873, p=0.049). Multivariate analysis showed that synaptophysin/chromogranin+ INSM1- status was an independent adverse factor for DFS (HR=2.282, 95%CI=1.196-4.356, p=0.012) in the luminal B subtype. Our data supported the usefulness of INSM1 in detecting neuroendocrine differentiation in IBC. Furthermore, INSM1 expression suggested a favourable prognostic impact; thus, it could be useful for stratifying neuroendocrine tumours with different prognosis.
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13
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Trevisi E, La Salvia A, Daniele L, Brizzi MP, De Rosa G, Scagliotti GV, Di Maio M. Neuroendocrine breast carcinoma: a rare but challenging entity. Med Oncol 2020; 37:70. [PMID: 32712767 PMCID: PMC7382662 DOI: 10.1007/s12032-020-01396-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022]
Abstract
Breast carcinoma with neuroendocrine differentiation, also known as neuroendocrine breast carcinoma (NEBC), includes a heterogeneous group of rare tumors, which account for 2–5% of all invasive breast carcinomas. Because of their low incidence, most of the current limited knowledge of these tumors derives from anecdotal case reports or small retrospective series. The diagnosis of NEBC is based on the presence of morphological features similar to gastrointestinal and lung NETs and neuroendocrine markers. NEBCs are usually hormone receptors positive and HER2 negative, but despite this luminal phenotype, most recent studies suggested that NEBC could be associated with worse prognosis compared to invasive breast cancer without neuroendocrine differentiation. Due to its rarity and lack of randomized data, there is little evidence to guide the choice of treatment, so NEBC is currently treated as any invasive breast carcinoma not-otherwise specified. Recently, attempts to molecularly characterize NEBC have been made, in order to provide new targets for a more personalized treatment of this uncommon entity.
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Affiliation(s)
- Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Anna La Salvia
- Department of Oncology, University Hospital, 12 de Octubre, Madrid, Spain
| | | | - Maria Pia Brizzi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | | | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
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14
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Erber R, Hartmann A. Histology of Luminal Breast Cancer. Breast Care (Basel) 2020; 15:327-336. [PMID: 32982642 DOI: 10.1159/000509025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background Invasive breast cancer (IBC) can be categorized into prognostic and predictive molecular subtypes (including luminal breast cancer) using gene expression profiling. Luminal IBC comprises a variety of histological subtypes with varying clinical and pathological features. Summary IBC of no special subtype is the most common histological subtype in general and likewise within luminal IBC. Classical invasive lobular breast cancer, typically clustering into luminal subgroup, is characterized by discohesive growth and loss of E-cadherin expression. Infrequent, morphologically distinct luminal IBC subtypes are tubular, invasive cribriform, mucinous, and invasive micropapillary carcinomas. Breast carcinoma with apocrine differentiation, with characteristic expression of androgen receptor (AR), often clusters into the luminal AR category. Rarely, neuroendocrine neoplasms of the breast can be seen. IBC of the male breast usually matches with the luminal subtype. Key Messages Independently from histological subtypes, invasive breast cancer (IBC) can be divided into molecular subtypes based on mRNA gene expression levels. Using this molecular subtyping, risk scores based on gene expression profiling (established for hormone receptor-positive, HER2-negative IBC), grading, and Ki-67 index, prognosis of patients with luminal breast cancer and response to chemotherapy can be predicted. In routine diagnostics, the expression of estrogen receptor (ER) and progesterone receptor (PR), HER2 status, and the proliferation rate (Ki-67) are used to determine a surrogate (molecular-like) subtype. Within luminal(-like) IBC, no special subtype and invasive lobular breast carcinoma are the most common histological subtypes. Other rare histological subtypes (e.g., tubular carcinoma) should be recognized due to their distinct clinical and pathological features.
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Affiliation(s)
- Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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15
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Lai BSW, Tsang JY, Poon IK, Shao Y, Chan SK, Tam FK, Cheung SY, Shea KH, Tse GM. The Clinical Significance of Neuroendocrine Features in Invasive Breast Carcinomas. Oncologist 2020; 25:e1318-e1329. [PMID: 32472950 DOI: 10.1634/theoncologist.2020-0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/06/2020] [Indexed: 01/13/2023] Open
Abstract
The latest World Health Organization (WHO) classification categorized invasive breast carcinomas (IBCs) with neuroendocrine (NE) differentiations into neuroendocrine neoplasms (including well-differentiated neuroendocrine tumor [NET] and poorly differentiated neuroendocrine carcinoma [NEC]) and IBC no special type with NE features (IBC-NST-NE). However, little is documented of the clinical significance of this classification; also the precise thresholds and choices of NE markers were variable. In the current study, a large cohort of patients with IBC with NE differentiation were morphologically classified based on the WHO criteria and the clinical relevance of expression of different NE markers (synaptophysin [SYN], chromogranin [CG], and CD56) was evaluated. Among 1,372 IBCs, 52 NET (3.8%) and 172 IBC-NST-NE (12.5%) were identified. Compared with the IBC-no NE cases, NET and IBC-NST-NE were similarly associated with positive estrogen receptor (ER) expression and lower grade (p < .001). For patient outcome, IBC-NST-NE, but not NET, demonstrated significantly worse survival than the IBC-no NE cases. Based on high (≥50%) and low (<50%) expression for each NE marker, independent poor disease-free survival for SYNlo CGlo and SYNhi CGlo cancers (IBC-no NE cases as references, hazard ratio [HR], ≤1.429; p ≤ .026) was found. Interestingly, SYN and CG expression correlated with each other and they shared similar clinicopathologic characteristics; but not with with CD56. In addition, CD56-only positive cases were associated with hormone receptors negativity and basal markers positivity (p ≤ .019), and patients' outcome was similar to IBC-no NE cancers. Our findings suggested that NE markers expression may provide information to fine tune treatment strategy. The relevance of CD56 as NE marker requires further studies. IMPLICATIONS FOR PRACTICE: Invasive breast carcinomas (IBCs) with neuroendocrine (NE) differentiation are heterogeneous in clinicopathologic parameters, biomarker expression, and prognosis. However, there are no specific therapies targeting NE differentiation, and all carcinomas with any NE differentiation are treated similarly as other IBCs. The results of this study suggest that stratification based on NE marker expression levels may provide added prognostically pertinent information, aiding better treatment strategy. In addition, CD56-only positive carcinomas showed a different clinicopathologic and biomarker expression profile compared with those with chromogranin and synaptophysin expression. Relevance of CD56 as an NE marker requires further studies.
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Affiliation(s)
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong
| | - Yan Shao
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong
| | - Siu-Ki Chan
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | - Fiona K Tam
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | | | - Ka-Ho Shea
- Department of Pathology, Tuen Mun Hospital, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong
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16
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Özdirik B, Kayser A, Ullrich A, Savic LJ, Reiss M, Tacke F, Wiedenmann B, Jann H, Roderburg C. Primary Neuroendocrine Neoplasms of the Breast: Case Series and Literature Review. Cancers (Basel) 2020; 12:cancers12030733. [PMID: 32244940 PMCID: PMC7140078 DOI: 10.3390/cancers12030733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
Primary neuroendocrine carcinoma of the breast (NECB) as defined by the World Health Organization (WHO) in 2012 is a rare, but possibly under-diagnosed entity. It is heterogeneous as it entails a wide spectrum of diseases comprising both well-differentiated neuroendocrine tumors of the breast as well as highly aggressive small cell carcinomas. Retrospective screening of hospital charts of 612 patients (2008–2019) from our specialized outpatient unit for neuroendocrine neoplasia revealed five patients diagnosed with NECB. Given the low prevalence of these malignancies, correct diagnosis remains a challenge that requires an interdisciplinary approach. Specifically, NECB may be misclassified as carcinoma of the breast with neuroendocrine differentiation, carcinomas of the breast of no special type/invasive ductal carcinoma, or a metastasis to the breast. Therefore, this study presents multifaceted characteristics as well as the clinical course of these patients and discusses the five cases from our institution in the context of available literature.
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Affiliation(s)
- Burcin Özdirik
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Antonin Kayser
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Andrea Ullrich
- Department of Pathology, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Lynn J. Savic
- Department of Diagnostic and Interventional Radiology, Charité University Medicine Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany;
| | - Markus Reiss
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Frank Tacke
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Bertram Wiedenmann
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Henning Jann
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
| | - Christoph Roderburg
- Department of Gastroenterology/Hepatology, Charité University Medical Center Berlin, Campus Virchow Klinikum and Charité Mitte, Augustenburger Platz 1, 13353 Berlin, Germany; (B.Ö.); (A.K.); (M.R.); (F.T.); (B.W.); (H.J.)
- Correspondence:
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17
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Kawasaki T, Hasebe T, Oiwa M, Sugiyama K, Muramatsu C, Ueda S, Osaki A, Ichikawa J, Teramoto N, Hoshida Y. Invasive carcinoma with neuroendocrine differentiation of the breast showing triple negative, large and basal cell-like features. Pathol Int 2019; 69:502-504. [PMID: 31338942 DOI: 10.1111/pin.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan.,Clinical Research Center, National Hospital Organization (NHO), Nagoya Medical Center, Aichi, Japan
| | - Takahiro Hasebe
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mikinao Oiwa
- Clinical Research Center, National Hospital Organization (NHO), Nagoya Medical Center, Aichi, Japan
| | - Keiji Sugiyama
- Clinical Research Center, National Hospital Organization (NHO), Nagoya Medical Center, Aichi, Japan
| | | | - Shigeto Ueda
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akihiko Osaki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jiro Ichikawa
- Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Norihiro Teramoto
- Department of Pathology, NHO, Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshihiko Hoshida
- Department of Pathology, NHO, Osaka Minami Medical Center, Kawachinagano, Japan
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18
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Kelten Talu C, Savli TC, Huq GE, Leblebici C. Histopathological and Clinical Differences Between Primary Breast Carcinomas With Neuroendocrine Features and Primary Breast Carcinomas Mimicking Neuroendocrine Features. Int J Surg Pathol 2019; 27:744-752. [PMID: 31195855 DOI: 10.1177/1066896919851873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We aimed to determine the histopathological differences between primary breast carcinomas with neuroendocrine features (NEBC) and carcinomas mimicking neuroendocrine features (NEBC-like). Twenty-three cases with NEBC, all showing positive staining for synaptophysin and/or chromogranin-A in ≥50% of tumor cells and 36 cases with NEBC-like (no staining for neuroendocrine [NE] markers but suspicious for NE morphology in terms of solid/trabecular growth patterns) were included in the study. Significant differences were found between the groups in terms of the patients' ages, histologic/nuclear grade of tumor, lymphovascular invasion, comedo-type ductal carcinoma in situ (DCIS), microcalcification, Ki-67 proliferation index, nuclear shape, and level of peritumoral lymphocytic infiltration. The presence of large-size solid cohesive groups of tumor cells; plasmocytoid, spindle, and/or columnar shapes of tumor cells; and eosinophilic-granular appearance of cytoplasm were mostly noted in the NEBC group. The presence of small- to medium-sized solid cohesive groups of tumor cells; high-grade histologic and nuclear features; clear cytoplasm; and round to ovoid nucleus were mostly noted in the NEBC-like group. No significant differences were found in terms of tumor size, ER/PR/HER2 status, as well as the presence of DCIS, elastosis, extracellular/intracellular mucin, signet ring cells, apocrine features, and accompanying papilloma or ductal ectasia. In conclusion, small- to medium-sized solid cohesive groups of tumor cells, high-grade features, clear cytoplasm, round to ovoid shape of nucleus, lymphovascular invasion, comedo-type DCIS, microcalcification, high level of Ki-67 proliferation index (≥20%), and moderate/strong level of peritumoral lymphocytic infiltration might support non-NE features in breast carcinomas.
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Affiliation(s)
- Canan Kelten Talu
- 1 Department of Pathology, University of Health Sciences, Istanbul SUAM, Turkey
| | - Taha Cumhan Savli
- 1 Department of Pathology, University of Health Sciences, Istanbul SUAM, Turkey
| | - Gulben Erdem Huq
- 1 Department of Pathology, University of Health Sciences, Istanbul SUAM, Turkey
| | - Cem Leblebici
- 1 Department of Pathology, University of Health Sciences, Istanbul SUAM, Turkey
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19
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Osamura RY, Matsui N, Okubo M, Chen L, Field AS. Histopathology and Cytopathology of Neuroendocrine Tumors and Carcinomas of the Breast: A Review. Acta Cytol 2019; 63:340-346. [PMID: 31163417 DOI: 10.1159/000500705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
Neuroendocrine tumors (NET) and carcinomas (NEC) of the breast are rare diseases, but NEC has attracted attention in both cytopathology and surgical pathology because of its specific management and prognosis. Fine-needle aspiration biopsy (FNAB) cytology can make the diagnosis in many cases particularly with high-grade NEC, with definitive diagnosis based on histopathology and immunohistochemistry. This review describes the characteristics of the disease based on the WHO classification 2012 and recent literature and -includes discussion related to the International Academy of Cytology Yokohama System of Reporting Breast FNAB -cytology.
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Affiliation(s)
- Robert Y Osamura
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan,
- Division of Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki, Japan,
| | - Naruaki Matsui
- Division of Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki, Japan
| | - Misa Okubo
- Division of Pathology, Yamachika Memorial Hospital Odawara City, Odawara, Japan
| | - Lan Chen
- Department of Pathology, Beijing Hospital and National Center of Gerontology, Beijing, China
| | - Andrew S Field
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
- University of NSW and Notre Dame University Medical Schools, Sydney, New South Wales, Australia
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20
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Tuzlali S, Yavuz E. Pathology of Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Zhu R, Yang X, Xue X, Shen M, Chen F, Chen X, Tsai Y, Keng PC, Chen Y, Lee SO, Chen Y. RETRACTED: Neuroendocrine differentiation contributes to radioresistance development and metastatic potential increase in non-small cell lung cancer. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2018; 1865:1878-1890. [PMID: 30262435 DOI: 10.1016/j.bbamcr.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
This article has been retracted at the request of the authors and their institute. The BBA Editor-in-Chief has agreed to retract the paper.
In this paper, there were two errors identified to the journal by the authors: The first error was in Western blot gel band images of Fig. 4A (p-MAPK, MAPK, p-Erk, and Stat3) and the 8 gel band images of Fig. 4G. The second error was in the cell culture images of Figures 3F, 3J, and 4E.
The authors state that these errors were due to uploading mistakes in the preparation of the manuscript. The authors apologize for these errors and any inconvenience caused.
The Editor-in-Chief initially agreed to retract the paper based on the identification of these two errors. Readers are able to see further discussion of the paper on the PubPeer site here: https://pubpeer.com/publications/569EB2CE7A7335D7F3F8F3FF310936
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Affiliation(s)
- Rongying Zhu
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, PR China
| | - Xiaodong Yang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, PR China
| | - Xiang Xue
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, PR China
| | - Mingjing Shen
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, PR China
| | - Feng Chen
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Xiaodong Chen
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Ying Tsai
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Peter C Keng
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Yongbing Chen
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, PR China
| | - Soo Ok Lee
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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22
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Vranic S, Palazzo J, Sanati S, Florento E, Contreras E, Xiu J, Swensen J, Gatalica Z. Potential Novel Therapy Targets in Neuroendocrine Carcinomas of the Breast. Clin Breast Cancer 2018; 19:131-136. [PMID: 30268765 DOI: 10.1016/j.clbc.2018.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Neuroendocrine carcinoma (NEC) of the breast is a rare, special type of breast cancer, reportedly constituting 2% to 5% of all breast cancers. Although breast NEC does not have a specific targeted therapy, several new targeted therapies based on specific biomarkers were recently investigated in the NEC of lung and in other types of breast carcinoma, which may provide guidance to their feasibility in breast NEC. MATERIALS AND METHODS Twenty breast NECs were profiled for biomarkers of therapy including antibody-drug conjugates (DLL3, TROP-2, and FOLR1), histone deacetylase (H3K36Me3) inhibitors, tropomyosin receptor kinases (NTRK1/2/3 gene fusions) targeted inhibitors, alkylating agents (MGMT), and immune checkpoint inhibitors (PD-L1, TMB, and MSI) using immunohistochemistry and DNA/RNA next-generation sequencing assays. RESULTS Predictive expression of TROP-2, FOLR1, and H3K36Me3 were detected in different subsets of tumors and may pave the way for development of novel targeted therapies in some patients with breast NECs. There was no evidence of DLL3 expression, NTRK gene fusions, or MGMT hypermethylation. No biomarkers predictive of immune checkpoint inhibitor efficacy (programmed death-ligand 1 expression, tumor mutational burden, microsatellite instability) were identified. FGFR and CCND1 gene amplifications were detected in isolated cases. CONCLUSIONS This study identified several potential targets for novel therapies in breast NEC, including farletuzumab and mirvetuximab soravtansine (FOLR1), sacituzumab govitecan (TROP-2), and HDAC inhibitors (H3K36Me3). In some cases, CCND1 gene amplification may indicate the usefulness of investigational therapies. The reported results should serve as an early indication of potential clinical relevance in selected patients with breast NEC.
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Affiliation(s)
- Semir Vranic
- College of Medicine, Qatar University, Doha, Qatar
| | - Juan Palazzo
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Souzan Sanati
- Division of Anatomic and Molecular Pathology, Washington University School of Medicine, Saint Louis, MO
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23
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Cloutier J, Thompson ED, Cimino-Mathews A, Rooper LM, Matoso A, Argani P. Metastatic breast cancer simulating well-differentiated neuroendocrine neoplasms of visceral organs. Hum Pathol 2018; 82:76-86. [PMID: 30031098 DOI: 10.1016/j.humpath.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 01/06/2023]
Abstract
A series of metastatic breast carcinoma (MBC) mimicking visceral well-differentiated neuroendocrine neoplasms has not previously been reported. We identified 5 consultation cases originally submitted as neuroendocrine neoplasms in women but that were found to be MBC on subsequent review. All 5 neoplasms demonstrated nested architecture and relatively uniform nuclei. Four patients had a known history of breast cancer (remote in 3 and concurrent in 1), but the metastases (3 liver, 1 lung) labeled for chromogranin and/or synaptophysin, prompting misdiagnosis as neuroendocrine neoplasm. In a fifth case, a liver metastasis in a patient with a known pancreatic endocrine neoplasm was originally thought to be of pancreatic origin; an occult concurrent primary breast cancer (PBC) was subsequently identified as the source. On further immunohistochemistry (IHC), all metastases evaluated were diffusely, strongly positive for estrogen receptor (5/5 cases) and GATA3 (4/4 cases). Three patients had previously received ineffective treatment for neuroendocrine carcinoma. Based on the consultation diagnosis, all 4 patients with follow-up received hormone therapy, which was effective in 3. In a separate tissue microarray cohort of paired PBCs and hematogenous MBCs, chromogranin and/or synaptophysin IHC labeling was typically negative and increased from the PBC to the MBC in only 5% of cases. In conclusion, although neuroendocrine differentiation is uncommon in breast cancer and does not commonly increase in metastases, MBC with neuroendocrine differentiation should be considered in patients with visceral neuroendocrine neoplasms of unknown primary site. Diffuse IHC labeling for estrogen receptor and GATA3 helps establish the correct diagnosis.
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Affiliation(s)
- Jeffrey Cloutier
- Department of Pathology, Stanford University, Stanford 94305, CA, USA
| | - Elizabeth D Thompson
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA
| | - Pedram Argani
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore 21231-2410, MD, USA.
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24
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Primary breast carcinomas with neuroendocrine features: Clinicopathological features and analysis of tumor growth patterns in 36 cases. Ann Diagn Pathol 2018; 34:122-130. [PMID: 29661717 DOI: 10.1016/j.anndiagpath.2018.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/30/2018] [Indexed: 12/17/2022]
Abstract
Primary breast carcinoma with neuroendocrine features (NEBC) is an uncommon tumor. In the classification of WHO 2012, these tumors were categorized as: 1- neuroendocrine tumor, well-differentiated; 2- neuroendocrine carcinoma, poorly differentiated/small cell carcinoma; and 3- invasive breast carcinoma with neuroendocrine differentiation. In this study, we reviewed NEBC except poorly differentiated/small cell carcinoma variant in order to define the morphological growth patterns and cytonuclear details of these tumors. All breast surgical excision materials between 2007 and 2016 were re-evaluated in terms of neuroendocrine differentiation. Thirty-six cases showing positive staining for synaptophysin and/or chromogranin A in ≥50% of tumor cells were included in the study. All cases were female with a mean age of 67.4. Mean tumor diameter was 26 mm. Multifocality was noted in 5 cases. Grossly, they were mostly infiltrative mass lesions. T stages, identified in 34 cases, were as follows: 13 cases with pT1; 19 pT2 and 2 pT3. We described schematically 4 types of patterns depending on predominant growth pattern, except one case: 1) Large-sized solid cohesive groups (6 cases), 2) Small- to medium-sized solid cohesive groups with trabeculae/ribbons and glandular structures (6 cases), 3) Mixed growth patterns (20 cases), 4) Invasive tumor with prominent extracellular and/or intracellular mucin (3 cases). The tumor cells were mostly polygonal-oval with eosinophilic/eosinophilic-granular cytoplasm. The nuclei of tumor cells were mostly round to oval with evenly distributed chromatin. Only 5 cases showed high grade nuclear and histological features. Molecular subtypes of the cases were as follows: 33 luminal A, 2 luminal B, and 1 triple negative. NEBC should come to mind when a tumor display one of the morphological patterns described above, composed of monotonous cells with mild to moderate nuclear pleomorphism and abundant eosinophilic/eosinophilic granular or clear cytoplasm, especially in elderly patients.
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25
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Cheymol C, Abramovici O, Do Cao C, Dumont A, Robin YM, El Hajbi F, Dansin E, Bonneterre J, Lauridant G. [Neuroendocrine tumors of the breast: Myth or reality? A systematic review]. Bull Cancer 2018; 105:431-439. [PMID: 29567279 DOI: 10.1016/j.bulcan.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
Abstract
Primary neuroendocrine breast carcinomas are rare and little-known tumors. Only a limited number of studies on neuroendocrine breast carcinomas have been reported in the literature, and the vast majority of them are small retrospective series or case reports. According to the World Health Organization (WHO), they account for only 2 % to 5 % of breast cancers. Their diagnosis relies on the presence of a neuroendocrine architecture and the expression of neuroendocrine markers (chromogranin A and/or synaptophysin). The revised 2012 WHO classification subdivides them into three categories: (i) well-differentiated neuroendocrine carcinomas, (ii) poorly differentiated neuroendocrine carcinomas or small-cell carcinomas, and (iii) invasive breast carcinomas with neuroendocrine differentiation. Their clinical features and radiological characteristics are not different from those of other types of breast cancer. Because of discordant results, their clinical outcome is still poorly defined. So far, no standard treatment has been established, and most clinicians draw on their experience of invasive ductal cancer. The role of specific treatments like platinum-based chemotherapy, somatostatin analogues, peptide receptor radionucleide therapy or temozolomide remains unclear. A better knowledge of the molecular pathways involved in their carcinogenesis could help to identify new potential therapeutic targets. The efficacy of targeted therapies has to be studied.
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Affiliation(s)
- Claire Cheymol
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département de sénologie, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Olivia Abramovici
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département d'anatomie et cytopathologie, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Christine Do Cao
- Centre hospitalo-universitaire régional de Lille 2, service d'endocrinologie, diabétologie et maladies métaboliques, avenue Oscar-Lambret, 59000 Lille, France
| | - Aurélie Dumont
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, unité d'oncologie moléculaire humaine, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Yves-Marie Robin
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département d'anatomie et cytopathologie, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Farid El Hajbi
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département d'oncologie urodigestive, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Eric Dansin
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département de cancérologie cervicofaciale et thoracique, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Jacques Bonneterre
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département de sénologie, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Géraldine Lauridant
- Centre régional de lutte contre le cancer des Hauts de France, centre Oscar-Lambret, département de sénologie, 3, rue Frédéric-Combemale, 59000 Lille, France.
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26
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Tsai TH, Hsieh PP, Hong YC, Yeh CH, Yu LHL, Yu MS. Metastatic primary neuroendocrine carcinoma of the breast (NECB). JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Vats M, Sachan V, Prajapati S, Mandal S. Triple receptor-positive primary neuroendocrine carcinoma of breast in a young patient. BMJ Case Rep 2018; 2018:bcr-2017-223280. [PMID: 29301815 DOI: 10.1136/bcr-2017-223280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary neuroendocrine carcinoma of breast is a very rare malignancy and preoperative diagnosis is difficult by clinical examination alone.Most oftenly, histopathological examination (HPE) and immunohistochemistry (IHC) studies are required to establish the diagnosis. We describe here a case of a primary neuroendocrine carcinoma of right breast in a 32-year-old woman. The patient underwent a right modified radical mastectomy, and the diagnosis was conclusively established postoperatively by the HPE and IHC reports. The IHC report revealed positive status of oestrogen, progesterone and Herceptin receptors.
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Affiliation(s)
- Manu Vats
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Vivek Sachan
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Sahaj Prajapati
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Shramana Mandal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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28
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Comprehensive clinical and molecular analyses of neuroendocrine carcinomas of the breast. Mod Pathol 2018; 31:68-82. [PMID: 28884749 DOI: 10.1038/modpathol.2017.107] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 12/20/2022]
Abstract
Neuroendocrine breast carcinomas represent a rare subtype of breast cancer. Their definition, prevalence, and prognosis remain controversial in the literature. The 2012 WHO classification of breast cancer categorizes neuroendocrine carcinomas into three morphologically distinct subtypes: well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinomas, and invasive breast carcinomas with neuroendocrine differentiation. We aimed to gain insight into the clinical, morphologic, phenotypic, and molecular features of 47 neuroendocrine breast carcinomas. Targeted next-generation sequencing by an AmpliSeq 22 cancer gene hotspot panel and the Prosigna assay were performed on 42/47 and 35/47 cases, respectively. Average age at diagnosis was 69 years. All tumors were estrogen receptor-positive and the large majority expressed progesterone receptor (89%), GATA3 (98%), FOXA1 (96%), and CK8/18 (98%). There was an almost equal distribution of luminal A (52%) and B (48%) carcinomas. Almost half of the cohort (49%) displayed a high risk of recurrence score with the Prosigna test. Patients with a neuroendocrine carcinoma had a shorter disease-free survival compared with those affected by carcinomas of no special type matched for age, size, grade, and estrogen receptor status. No significant differences were observed in terms of overall survival. Stratification of neuroendocrine carcinomas using the 2012 WHO criteria did not reveal statistically significant differences among the distinct categories (well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinomas, and invasive breast carcinomas with neuroendocrine differentiation), in terms of either progression-free or overall survival. Our targeted sequencing analysis found three cases (7%) harboring a PIK3CA mutation, and in three other cases (7%) TP53 mutations were detected. This study showed that neuroendocrine breast carcinoma is a distinct subtype of luminal carcinoma with a low rate of PIK3CA mutations and with an aggressive clinical behavior. An accurate identification of neuroendocrine differentiation may be useful to better tailor patient adjuvant therapy within luminal carcinomas.
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29
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Abstract
Primary neuroendocrine tumors of the breast are a rare and underrecognized subtype of mammary carcinoma. Neuroendocrine tumors of the breast occur predominately in postmenopausal women. The tumors are subclassified into well-differentiated and poorly differentiated neuroendocrine tumors, and invasive breast carcinoma with neuroendocrine features. Well-differentiated tumors show architectural similarity to carcinoids of other sites but lack characteristic neuroendocrine nuclei. Poorly differentiated neuroendocrine tumors are morphologically identical to small cell carcinoma of the lung. Neuroendocrine differentiation, seen in up to 30% of invasive breast carcinomas, is most commonly associated with mucinous and solid papillary carcinomas. The diagnosis of neuroendocrine differentiation requires expression of the neuroendocrine markers synaptophysin or chromogranin. The main differential diagnosis is a metastatic neuroendocrine tumor from an extramammary site. Neuroendocrine tumors of the breast are treated similarly to other invasive breast carcinomas. Although no consensus has been reached on the prognosis, most studies suggest a poor outcome.
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Affiliation(s)
- Lauren Elizabeth Rosen
- From the Department of Pathology, The University of Chicago Medicine, Chicago, Illinois (Dr Rosen); and the Department of Pathology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois (Dr Gattuso)
| | - Paolo Gattuso
- From the Department of Pathology, The University of Chicago Medicine, Chicago, Illinois (Dr Rosen); and the Department of Pathology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois (Dr Gattuso)
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30
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Mjønes P, Sagatun L, Nordrum IS, Waldum HL. Neuron-Specific Enolase as an Immunohistochemical Marker Is Better Than Its Reputation. J Histochem Cytochem 2017; 65:687-703. [PMID: 28972818 PMCID: PMC5714096 DOI: 10.1369/0022155417733676] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The diagnosis of neuroendocrine neoplasms (NENs) may be challenging and is based on typical morphological features and positive staining for antibodies of neuroendocrine differentiation. Neuron-specific enolase (NSE) being a cytosolic marker may be useful in this setting. NSE is by many considered nonspecific, due to the finding of this marker in tumors considered not to be of neuroendocrine origin. Our aim was to determine whether this is true and whether NSE is more specific than previously realized. We examined 178 tumors (carcinomas and NENs) from breast, lung, stomach, and kidney using immunohistochemistry with the following markers: chromogranin A, synaptophysin, CD56, secretagogin, and NSE. Expression of NSE was compared with that of the other markers. NSE was expressed in 138 (78%) of all tumors. Of the NSE-expressing tumors, 95 (68%) cases expressed one or more additional neuroendocrine markers. The staining intensity and number of NSE-expressing tumor cells were highest among tumors of neuroendocrine origin and clear cell renal cell carcinomas. A positive association was found between NSE expression and the number of additional neuroendocrine markers expressed in each of the tumors. Practically all tumors positive for an accepted neuroendocrine marker also expressed NSE.
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Affiliation(s)
- Patricia Mjønes
- Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Woman's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Liv Sagatun
- Department of Gastroenterology and Hepatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ivar S Nordrum
- Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Woman's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helge L Waldum
- Department of Gastroenterology and Hepatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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31
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A challenging breast cancer type; Differentiation to neuroendocrine tumors. JOURNAL OF SURGERY AND MEDICINE 2017. [DOI: 10.28982/josam.342305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Munoz-Zuluaga CA, Kotiah S, Studeman KD. High-grade poorly differentiated neuroendocrine carcinoma of the breast with low oncotype Dx recurrence score: A case report. Breast Dis 2017; 37:99-103. [PMID: 28655121 DOI: 10.3233/bd-170283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary neuroendocrine carcinoma of the breast (NECB) is a rare malignant tumor with controversial biological behavior and a lack of data guiding treatment decisions due to its scarcity. Cancer gene-expression profiling tests provide a better indication of clinical prognosis and help determine the best clinical management versus the traditional clinical and pathological parameters. This is a report of a NECB with a genetic assay that showed a low-risk tumor despite high-grade and poorly differentiated histopathological features. Patient outcomes correlate with the low risk classification without the need for adjuvant chemotherapy despite the standard clinical-pathologic approach. Analysis of cancer related genes expression and outcomes in historical NECB may elucidate new insight of this rare disease.
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Affiliation(s)
| | - Sandy Kotiah
- The Neuroendocrine Tumor Center, Mercy Medical Center, Baltimore, MD, USA
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33
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Liu YH, Tsang JYS, Ni YB, Hlaing T, Chan SK, Chan KF, Ko CW, Mujtaba SS, Tse GM. Doublecortin-like kinase 1 expression associates with breast cancer with neuroendocrine differentiation. Oncotarget 2016; 7:1464-76. [PMID: 26621833 PMCID: PMC4811473 DOI: 10.18632/oncotarget.6386] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/15/2015] [Indexed: 02/07/2023] Open
Abstract
Doublecortin-like kinase 1 (DCLK1), a microtubule associated kinase, has recently been proposed to be a putative marker for stemness and adverse prognosis in gastrointestinal cancers. However, it is not clear whether the protein also plays similar roles in breast cancer. Here, the expression of DCLK1 was analyzed in a large cohort of invasive breast cancers (IBC) by immunohistochemistry. DCKL1 was associated with favorable clinico-pathologic features, namely lower histologic grade, absence of lymphovascular invasion, fibrotic focus, necrosis and lower pN stage (p≤0.045). Additionally, independent significant correlations were found with estrogen receptor and neuroendocrine markers (p ≤0.019), implicating its relationship with IBC with neuroendocrine differentiation (IBC-NED). In the current cohort, IBC-NED showed worse outcome than luminal cancers without NED (hazard ratio=1.756, p=0.041). Interestingly, within the IBC-NED group, DCLK1 was found to be a good prognostic factor (hazard ratio =0.288, p=0.011). These findings were in contrast to those in gastrointestinal cancers, suggesting different functional roles of DCLK1 in different types of cancers. In clinical practice, NED is not routinely assessed; thus IBC-NED are not well studied. Its poor outcome and significant heterogeneity warrants more attention. DCLK1 expression could aid in the prognostication and management of this special cancer subtype.
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Affiliation(s)
- Yu-Hong Liu
- Department of Pathology, The Affiliated Baoan Hospital of Southern Medical University, Shenzhen, China
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Thazin Hlaing
- Department of Anatomic Pathology, Centro Hospitalar Conde de Sao Januario, Macao, SAR, China
| | - Siu-Ki Chan
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | - Kui-Fat Chan
- Department of Pathology, Tuen Mun Hospital, Hong Kong
| | - Chun-Wai Ko
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - S Shafaq Mujtaba
- Histopathology Section, Laboratory Department, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
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34
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Mečiarová I, Sojáková M, Mego M, Mardiak J, Pohlodek K. High-Grade Neuroendocrine Carcinoma of the Breast With Focal Squamous Differentiation. Int J Surg Pathol 2016; 24:738-742. [PMID: 27353078 DOI: 10.1177/1066896916656444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Primary neuroendocrine carcinoma of the breast is a rare tumor that comprises less than 1% of breast carcinomas, with most patients being in the sixth or seventh decade of their life. In this article, the authors present the case report of a 42-year-old woman with a rapidly growing tumor in her right breast. After clinical staging by physical examination, breast imaging, and thoracoabdominal computed tomography the patient underwent breast-conserving surgery. The histologic results showed a unique type of high-grade, predominantly large-cell neuroendocrine carcinoma with focal abrupt squamous differentiation. The authors also discuss the clinical and morphological characteristics of the tumor as well as treatment options.
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Affiliation(s)
| | - Michaela Sojáková
- Comenius University of Bratislava, Faculty of Medicine, Bratislava, Slovakia.,National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- Comenius University of Bratislava, Faculty of Medicine, Bratislava, Slovakia.,National Cancer Institute, Bratislava, Slovakia
| | - Jozef Mardiak
- Comenius University of Bratislava, Faculty of Medicine, Bratislava, Slovakia.,National Cancer Institute, Bratislava, Slovakia
| | - Kamil Pohlodek
- Comenius University of Bratislava, Faculty of Medicine, Bratislava, Slovakia
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35
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D'Antonio A, Addesso M, Memoli D, Cascone A, Cremone L. A case of multicentric low-grade neuroendocrine breast tumor with an unusual histological pattern. Breast Dis 2016; 36:161-164. [PMID: 27802189 DOI: 10.3233/bd-160226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuroendocrine features are detectable in carcinomas of the breast either as scattered cells, that are recognized by their expression of neuroendocrine cell markers. Instead, pure breast carcinomas with neuroendocrine features (NEBC) are very rare and represent <1% of all breast cancer. Usually NEBC may be well or poorly differentiated and more frequent in older woman. These tumors showed variable histological pattern but a common feature is represented by expression of neuroendocrine markers. Here we report a case of a primary multicentric low-grade neuroendocrine carcinoma of the breast presented because of its rarity and for the unusual tubular and cribriform pattern resembling a well-differentiated conventional breast carcinoma. The tumor was treated with left quadrantectomy with concomitant wide excisional biopsy of other two nodules and lymph node sentinel biopsy. No recurrence was observed during 1-year follow-up. Because of its rarity and variability of morphologic features, there exist diagnostic challenges for pathologists to differentiate primary NEBC to some conventional breast carcinomas and to the breast metastasis from neuroendocrine tumor of the lung or gastrointestinal tract. It is important to be able recognize this tumor in order to avoid potential misdiagnosis and improper management of afflicted patients.
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Affiliation(s)
- Antonio D'Antonio
- Department of Pathologic Anatomy A.O.U. S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Maria Addesso
- Unit of Pathologic Anatomy, ASL Salerno, Hospital Tortora, Pagani (SA), Italy
| | - Domenico Memoli
- Department of Pathologic Anatomy A.O.U. S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Annamaria Cascone
- Department of Pathologic Anatomy A.O.U. S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Luigi Cremone
- Breast Unit, Salerno, Italy, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
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37
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Abstract
Neuroendocrine neoplasms (NEN) of the breast are specific tumor entities. According to the literature up to 5% of breast neoplasms are malignant epithelial neoplasms of the breast. They are defined by a neuroendocrine (NE) architecture and cytology combined with an expression of the neuroendocrine vesicle markers chromogranin A and/or synaptophysin. The diagnosis is supplemented by the receptor status and the proliferative activity. According to the World Health Organization (WHO) classification of 2012 the following groups of NEN are distinguished: (1) invasive breast carcinoma with NE differentiation, (2) well-differentiated neuroendocrine tumor (NET) and (3) poorly differentiated small cell carcinoma (NEC). This review article focuses on (1) the definition and basic principles of diagnostics, (2) the history, nomenclature and WHO classification from 2003 and 2012, (3) the frequency of breast NEN, (4) the hereditary background and functional activity, (5) the expression of receptors and (6) the possible clinical implications. In addition, the first results of a retrospective single center study (n = 465 patients with breast cancer over a time period of 4 years) on the frequency of NEN of the breast at the Breast Center of the University Hospital Düsseldorf are presented. In this study a frequency of 4.5% of NEN was found based on a diagnostic cut-off of > 50% Chromogranin A and/or synaptophysin positive tumor cells.
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38
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Christensen L, Mortensen MB, Detlefsen S. Breast Carcinoma With Unrecognized Neuroendocrine Differentiation Metastasizing to the Pancreas: A Potential Diagnostic Pitfall. Int J Surg Pathol 2016; 24:463-7. [PMID: 26912472 DOI: 10.1177/1066896916632909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The current World Health Organization classification recognizes 3 subtypes of breast carcinomas with neuroendocrine features. Their reported prevalence is highly variable, ranging from <1% to up to 20% of all breast carcinomas. We report the case of a 73-year-old woman who underwent lumpectomy with a postoperative diagnosis of invasive ductal breast carcinoma. Six weeks after lumpectomy, pancreatic biopsies showed tumor cells with neuroendocrine features. The first immunohistochemical panel showed positivity for synaptophysin and cytokeratins, raising suspicion of a pancreatic neuroendocrine tumor. However, a second panel revealed positivity for estrogen receptors and GATA3. On review of the lumpectomy specimen, a significant neuroendocrine component was found, leading to the final diagnosis of breast carcinoma with neuroendocrine features metastasizing to the pancreas. Neuroendocrine markers are not routinely analyzed in breast tumors. Hence, metastases from breast carcinomas with unrecognized neuroendocrine features may lead to false diagnoses of primary neuroendocrine tumors at different metastatic sites, such as the pancreas.
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Affiliation(s)
- Lene Christensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
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39
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Weissferdt A, Moran CA. Neuroendocrine Differentiation in Thymic Carcinomas: A Diagnostic Pitfall: An Immunohistochemical Analysis of 27 Cases. Am J Clin Pathol 2016; 145:393-400. [PMID: 27124922 DOI: 10.1093/ajcp/aqv095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Neuroendocrine differentiation in carcinomas of the nonneuroendocrine type has been observed in various organ systems. Awareness of this phenomenon is important since such tumors need to be separated from true neuroendocrine neoplasms because of therapeutic and prognostic consequences. To investigate this occurrence in thymic carcinomas, 27 cases of different histologies were analyzed using neuroendocrine immunohistochemical markers. METHODS Twenty-seven conventional thymic carcinomas from thymectomies were studied immunohistochemically with antibodies directed against synaptophysin, chromogranin A, and CD56 in addition to the standard markers for these tumors. RESULTS Focal expression of at least one neuroendocrine marker was identified in a total of 12 (44%) cases. Chromogranin A was positive in five (19%) cases, synaptophysin in eight (30%), and CD56 in 10 (37%). All three markers were coexpressed in four (15%) cases. CONCLUSIONS Neuroendocrine differentiation in conventional thymic carcinomas is a common occurrence. It is imperative to separate these tumors from true neuroendocrine neoplasms of the thymus-especially large cell neuroendocrine carcinoma-since both entities require different treatment modalities and likely show different biologic behavior. Contrary to prior suggestions, neuroendocrine differentiation should not be used to distinguish thymic carcinomas from thymomas, and these tumors should not be regarded as "mixed carcinomas."
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Affiliation(s)
- Annikka Weissferdt
- From the Department of Pathology, MD Anderson Cancer Center, Houston, TX.
| | - Cesar A Moran
- From the Department of Pathology, MD Anderson Cancer Center, Houston, TX
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40
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Ohashi R, Sakatani T, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya S, Takei H, Naito Z. Mucinous carcinoma of the breast: a comparative study on cytohistological findings associated with neuroendocrine differentiation. Cytopathology 2016; 27:193-200. [PMID: 26804749 DOI: 10.1111/cyt.12298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Mucinous carcinoma (MCA) may show neuroendocrine differentiation (ND), but the cytological features characteristic of ND remains elusive. We compared fine needle aspiration (FNA) findings of MCA between cases with high and low degrees of ND. METHODS Histological sections of 37 MCA cases were immunohistochemically evaluated for expression of chromogranin A and synaptophysin, and were graded as 0 to 3+ degrees of ND. They were divided into low ND (grade 0 and 1+) and high ND (grade 2+ and 3+) groups. Pre-operative FNA samples of each group were assessed for cytological features. RESULTS The mean age of the high ND group (n = 18) was higher than the low ND group (n = 19, P = 0.01). In FNA samples of the high ND group, 17 cases showed moderate to severe degrees of discohesiveness, but low ND cases mainly showed no or only mild discohesiveness (P < 0.001). Nine of the low ND cases displayed overlapped, cohesive cell clusters, whereas, in the high ND cases, the cells were arranged in a loose, flat and monolayered pattern (P = 0.045). Fourteen of the high ND cases had round nuclei, but oval nuclei were predominant in the low ND cases (P = 0.027). The nuclei were eccentrically located in 12 of the high ND cases but were centrally located in 14 of the low ND cases (P = 0.01). CONCLUSIONS Mucinous carcinoma with high ND may be diagnosed by the presence of discohesiveness, a flat, monolayered pattern, and round or eccentrically located nuclei. Features of ND in carcinomas in other organs, such as intracytoplasmic granules and coarse chromatin, may not be reliable cytological features of ND in MCA.
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Affiliation(s)
- R Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - T Sakatani
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
| | - M Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Y Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yanagihara
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yamashita
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - S Tsuchiya
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Iida Hospital, Nagano, Japan
| | - H Takei
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Z Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
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41
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Abstract
Advances in basic science, technology and translational research have created a revolution in breast cancer diagnosis and therapy. Researchers' discoveries of genes defining variability in response to therapy and heterogeneity in clinical presentations and tumor biology are the foundation of the path to personalized medicine. The success of personalized breast cancer care depends on access to pertinent clinical information and risk factors, optimal imaging findings, well-established morphologic features, and traditional and contemporary prognostic/predictive testing. The integration of these entities provides an opportunity to identify patients who can benefit from specific therapies, and demonstrates the link between breast cancer subtypes and their association with different tumor biology. It is critical to recognize specific types of breast cancer in individual patients and design optimal personalized therapy. This article will highlight the roles of morphologic features and established tumor biomarkers on patient outcome.
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Affiliation(s)
- Shahla Masood
- Department of Pathology & Laboratory Medicine, University of Florida College of Medicine - Jacksonville, UF Health Breast Center, UF Health Jacksonville, 655 W. 8th Street, Box C-505, Jacksonville, FL 32209, USA
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42
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Inno A, Bogina G, Turazza M, Bortesi L, Duranti S, Massocco A, Zamboni G, Carbognin G, Alongi F, Salgarello M, Gori S. Neuroendocrine Carcinoma of the Breast: Current Evidence and Future Perspectives. Oncologist 2015; 21:28-32. [PMID: 26659223 DOI: 10.1634/theoncologist.2015-0309] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/27/2015] [Indexed: 01/30/2023] Open
Abstract
UNLABELLED : Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management. Early stage tumors are usually treated with the same strategy used for the other types of invasive breast cancer. Anthracycline- and taxane-based regimens represent the most frequently administered chemotherapy in neoadjuvant and adjuvant setting, as well as for metastatic disease, although combinations of platinum compounds and etoposide have been widely used, in particular for small-cell histology and tumors with a high proliferation index. For metastatic disease, a multimodality therapeutic strategy can be considered on an individual basis, with chemotherapy, endocrine therapy, peptide receptor radionuclide therapy, radiation therapy, surgery, or a combination of the above. In the near future, a better knowledge of the biology of these tumors will hopefully provide new therapeutic targets for personalized treatment. In this review, we discuss the current evidence and the future perspectives on diagnosis and treatment of neuroendocrine carcinoma of the breast. IMPLICATIONS FOR PRACTICE Neuroendocrine carcinoma of the breast (NECB) is a distinct entity of breast cancer. Clinical features and morphology are not helpful to distinguish NECB from other subtypes of breast cancer; therefore, immunohistochemistry markers for neuroendocrine differentiation, mainly chromogranin and synaptophysin, should be routinely used to confirm the diagnosis, especially in cases of mucinous or solid papillary carcinoma in which the suspicion of NECB may be relevant. Adjuvant treatment should be offered according to the same recommendations given for the other types of invasive breast cancer. An accurate diagnosis of NECB is also important in the metastatic setting, in which a multimodality approach including specific therapies such as peptide receptor radionuclide therapy can be considered.
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Affiliation(s)
- Alessandro Inno
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Bogina
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Monica Turazza
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Laura Bortesi
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Simona Duranti
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Alberto Massocco
- Department of Surgery, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Zamboni
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giovanni Carbognin
- Department of Radiology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Filippo Alongi
- Department of Radiotherapy, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Stefania Gori
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
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43
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Novel mutations in neuroendocrine carcinoma of the breast: possible therapeutic targets. Appl Immunohistochem Mol Morphol 2015; 23:97-103. [PMID: 25679062 DOI: 10.1097/pdm.0b013e3182a40fd1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary neuroendocrine carcinoma of the breast is a rare variant, accounting for only 2% to 5% of diagnosed breast cancers, and may have relatively aggressive behavior. Mutational profiling of invasive ductal breast cancers has yielded potential targets for directed cancer therapy, yet most studies have not included neuroendocrine carcinomas. In a tissue microarray screen, we found a 2.4% prevalence (9/372) of neuroendocrine breast carcinoma, including several with lobular morphology. We then screened primary or metastatic neuroendocrine breast carcinomas (excluding papillary and mucinous) for mutations in common cancer genes using polymerase chain reaction-mass spectroscopy (643 hotspot mutations across 53 genes), or semiconductor-based next-generation sequencing analysis (37 genes). Mutations were identified in 5 of 15 tumors, including 3 with PIK3CA exon 9 E542K mutations, 2 of which also harbored point mutations in FGFR family members (FGFR1 P126S, FGFR4 V550M). Single mutations were found in each of KDR (A1065T) and HRAS (G12A). PIK3CA mutations are common in other types of breast carcinoma. However, FGFR and RAS family mutations are exceedingly rare in the breast cancer literature. Likewise, activating mutations in the receptor tyrosine kinase KDR (VEGFR2) have been reported in angiosarcomas and non-small cell lung cancers; the KDR A1065T mutation is reported to be sensitive to VEGFR kinase inhibitors, and fibroblast growth factor receptor inhibitors are in trials. Our findings demonstrate the utility of broad-based genotyping in the study of rare tumors such as neuroendocrine breast cancer.
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44
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Bogina G, Munari E, Brunelli M, Bortesi L, Marconi M, Sommaggio M, Lunardi G, Gori S, Massocco A, Pegoraro MC, Zamboni G. Neuroendocrine differentiation in breast carcinoma: clinicopathological features and outcome. Histopathology 2015; 68:422-32. [PMID: 26114478 DOI: 10.1111/his.12766] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/22/2015] [Indexed: 12/27/2022]
Abstract
AIMS Primary neuroendocrine (NE) breast carcinoma (BC) is an entity with a wide range of prevalence and poorly defined clinical behaviour. We evaluated the prevalence, clinicopathological features and clinical outcome of NEBC. METHODS AND RESULTS Immunohistochemical staining for synaptophysin and chromogranin A was performed on whole sections from 1232 consecutive cases of invasive BC. We divided NEBC into focal (10-49% positive cells) and diffuse (≥50% positive cells) and compared the outcome of patients with NEBC with strictly matched non-NEBC. A total of 128 BC showed NE differentiation (10.4%): 84 diffuse (6.8%) and 44 focal (3.6%). NE differentiation showed a significant association with T4 stage (P = 0.001), solid-papillary and mucinous histotype (P < 0.0001), G2 grading (P = 0.002), positive oestrogen receptor (ER) (P = 0.003) and progesterone receptor (PR) (P = 0.002). Almost 90% of NEBC were ER(+) /HER2(-) and more than half ER(+) /HER2(-) /Ki67≥14%. Kaplan-Meier analysis revealed that patients with NEBC showed worse disease-free survival (DFS) (P = 0.04) compared to matched non-NEBC. We did not find significant differences regarding clinicopathological features, DFS and CSS between diffuse and focal neuroendocrine BC. CONCLUSIONS This study demonstrates that NEBC represents 7-10% of invasive BC and that NE differentiation does not affect the prognosis of BC in terms of CSS.
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Affiliation(s)
- Giuseppe Bogina
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Enrico Munari
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy.,Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Laura Bortesi
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Marcella Marconi
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Marco Sommaggio
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Gianluigi Lunardi
- Department of Oncology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Stefania Gori
- Department of Oncology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Alberto Massocco
- Department of Surgery, Sacro Cuore Hospital of Negrar, Verona, Italy
| | | | - Giuseppe Zamboni
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
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45
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Tan PH, Schnitt SJ, van de Vijver MJ, Ellis IO, Lakhani SR. Papillary and neuroendocrine breast lesions: the WHO stance. Histopathology 2015; 66:761-70. [PMID: 24845113 DOI: 10.1111/his.12463] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this review, we highlight adaptations in the WHO 2012 classification of papillary and neuroendocrine breast lesions as compared with the previous 2003 version. Consensus criteria for distinguishing atypical ductal hyperplasia from ductal carcinoma in situ within an intraductal papilloma are proposed. The absence of myoepithelial cells around the wall of an encapsulated papillary carcinoma, although raising consideration of an indolent tumour with minimal invasion, is currently regarded as in-situ disease for staging purposes. The majority of solid papillary carcinomas are classified as in-situ tumours, but lesions with irregular tumour islands within desmoplastic stroma may be considered to be invasive. The diagnosis of solid papillary carcinoma without further qualification as either in-situ or invasive disease is discouraged. When invasive papillary carcinoma is seen in the breast, metastatic papillary carcinoma from other organ sites needs to be excluded. WHO 2012 classifies neuroendocrine breast tumours as well-differentiated neuroendocrine tumour, small-cell carcinoma, and invasive breast carcinoma with neuroendocrine differentiation. There is currently no clinical impact of identifying neuroendocrine differentiation in conventional invasive breast carcinomas, apart from acknowledging its frequent occurrence in subtypes such as the hypercellular variant of mucinous carcinoma and solid papillary carcinoma.
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Affiliation(s)
- Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
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46
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Cloyd JM, Yang RL, Allison KH, Norton JA, Hernandez-Boussard T, Wapnir IL. Impact of histological subtype on long-term outcomes of neuroendocrine carcinoma of the breast. Breast Cancer Res Treat 2014; 148:637-44. [PMID: 25399232 DOI: 10.1007/s10549-014-3207-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/09/2014] [Indexed: 12/31/2022]
Abstract
Although rare, neuroendocrine carcinoma of the breast (NECB) is becoming an increasingly recognized entity. The current literature is limited to case reports and small series and therefore a comprehensive population-based analysis was conducted to investigate the clinicopathologic features and long-term outcomes associated with NECB. We included all patients in the SEER Database from 2003 to 2010 with a diagnosis of NECB. The 2012 WHO classification system was used to categorize patients based on histopathologic diagnosis: well-differentiated neuroendocrine tumors, small/oat cell or poorly differentiated neuroendocrine tumors, adenocarcinoma with neuroendocrine features (ANF), large cell neuroendocrine and carcinoid tumors. Survival analysis was performed for disease specific (DSS) and overall (OS) survival. Of the 284 cases identified, 52.1% were classified as well-differentiated, 25.7% small cell, 14.8% ANF, 4.9% large cell, and 2.5% carcinoid. In general, patients presented with advanced disease: 36.2% had positive lymph node metastases and 20.4% presented with systemic metastases. Five-year DSS rates for stage I-IV NECB were 88.1, 67.8, 60.5, and 12.4%, respectively, while five-year OS rates were 77.9, 57.3, 52.9, and 8.9%, respectively. DSS and OS were significantly different for well-differentiated neuroendocrine tumors and ANFs compared to small cell and carcinoid tumors. On univariate Cox proportional hazards regression, small cell carcinoma was significantly associated with worse DSS (OR 1.97, 95% CI 1.05-3.67) and OS (OR 2.66, 95% CI 1.49-4.72) compared to other neuroendocrine tumors. NECB is associated with advanced stage disease at presentation and an unfavorable prognosis for stage II-IV disease and small cell, large cell, and carcinoid histologic subtypes.
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Affiliation(s)
- Jordan M Cloyd
- Departments of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA, 94305, USA,
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47
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Annaratone L, Medico E, Rangel N, Castellano I, Marchiò C, Sapino A, Bussolati G. Search for neuro-endocrine markers (chromogranin A, synaptophysin and VGF) in breast cancers. An integrated approach using immunohistochemistry and gene expression profiling. Endocr Pathol 2014; 25:219-28. [PMID: 24277232 PMCID: PMC4160574 DOI: 10.1007/s12022-013-9277-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Discordant data are reported in the literature on the definition, incidence and clinical features of neuroendocrine (NE) carcinomas of the breast. This tumour entity is currently assessed by immunohistochemistry (IHC) detecting "general" NE markers such as chromogranin A (CHGA) and synaptophysin (SYP), but other markers have been considered as well. In the present study, in addition to CHGA and SYP, we investigated the expression of VGF, a neurotrophin-inducible gene, which is emerging as a new specific NE marker. In order to evaluate the differential expression of these neuro-endocrine markers in breast cancers, we conducted parallel immunohistochemical and gene expression analyses, using PCR, gene array and real-time quantitative PCR procedures. Data obtained in 28 cases were further validated with a meta-analysis of published datasets of 103 breast cancer cases. The value of IHC positivity (irrespective of the percentage of positive cells) was confirmed by over-expression of the related gene. However, the genetic approach emerged as more sensitive, showing over-expression of NE markers in a subset of IHC-negative carcinomas. In conclusion, the present study confirms, by a novel approach, the occurrence of NE differentiation in breast cancers. Over-expression of one or more NE marker (CHGA and/or SYP and/or VGF) characterizes a significant fraction (approximately 10 %) of infiltrative breast cancers.
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Affiliation(s)
- Laura Annaratone
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Enzo Medico
- Laboratory of Oncogenomics and Department of Oncological Sciences, Institute for Cancer Research and Treatment, University of Turin, Candiolo, Italy
| | - Nelson Rangel
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Isabella Castellano
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Gianni Bussolati
- Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
- “Victor Babes” Institute, Bucarest, Romania
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48
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Primary neuroendocrine carcinoma of the breast: clinical, imaging, and histologic features. AJR Am J Roentgenol 2014; 203:W221-30. [PMID: 25055297 DOI: 10.2214/ajr.13.10749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical, imaging, and histopathologic findings of primary neuroendocrine carcinoma of the breast. MATERIALS AND METHODS A pathology database was searched for the records of patients with a histopathologic diagnosis of primary neuroendocrine carcinoma of the breast who had undergone mammography, sonography, or MRI between 1984 and 2011. The imaging studies of eligible patients were retrospectively reviewed according to the BI-RADS lexicon, and clinical presentation and histopathologic characteristics were documented. Imaging characteristics were compared with historical controls of invasive mammary carcinoma. RESULTS Eighty-seven patients (84 women, three men; mean age, 62.9 years; range, 28-89 years) were included in the study. The mean tumor size was 3.1 cm (range, 0.6-11 cm). Sixty-five of 84 (77.4%) cancers were estrogen and progesterone receptor positive and ERBB2 negative. A palpable mass (55.8%) was a common clinical manifestation. A high-density, round or oval, or lobular mass with nonspiculated margins on mammograms and an irregular (65.4%), hypoechoic (78.4%) mass, with indistinct margins (43.5%), no or enhanced posterior acoustic features (77.9%) on sonograms were common findings. MRI revealed an irregular mass (83.3%), irregular margins (63.6%), and washout kinetics (85.7%). Neuroendocrine carcinoma presented more frequently as masses on mammograms. Calcifications were infrequent compared with their occurrence in invasive mammary cancer. CONCLUSION Primary neuroendocrine carcinoma of the breast has mammographic features that differ from those of invasive mammary carcinoma. A round, oval, or lobular mass with nonspiculated margins, positive estrogen and progesterone receptor results, and negative ERBB2 results should raise suspicion of primary neuroendocrine carcinoma.
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49
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Dieci MV, Orvieto E, Dominici M, Conte P, Guarneri V. Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist 2014; 19:805-13. [PMID: 24969162 DOI: 10.1634/theoncologist.2014-0108] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast cancer encompasses a collection of different diseases characterized by different biological and pathological features, clinical presentation, response to treatments, clinical behavior, and outcome. On the basis of cell morphology, growth, and architecture patterns, breast cancer can be classified in up to 21 distinct histological types. Breast cancer special types, including the classic lobular invasive carcinoma, represent 25% of all breast cancers. The histological diversity of breast carcinomas has relevant prognostic implications. Indeed, the rare breast cancer group includes subtypes with very different prognoses, ranging from the tubular carcinoma, associated with an indolent clinical course, to metaplastic cancer, whose outcome is generally unfavorable. New approaches based on gene expression profiling allow the identification of molecularly defined breast cancer classes, with distinct biological features and clinical behavior. In clinical practice, immunohistochemical classification based on the expression of human epidermal growth factor receptor 2 and Ki67 is applied as a surrogate of the intrinsic molecular subtypes. However, the identification of intrinsic molecular subtypes were almost completely limited to the study of ductal invasive breast cancer. Moreover, some good-prognosis triple-negative histotypes, on the basis of gene expression profiling, can be classified among the poor-prognosis group. Therefore, histopathological classification remains a crucial component of breast cancer diagnosis. Special histologies can be very rare, and the majority of information on outcome and treatments derives from small series and case reports. As a consequence, clear recommendations about clinical management are still lacking. In this review, we summarize current knowledge about rare breast cancer histologies.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Biomarkers, Tumor/biosynthesis
- Breast Neoplasms/classification
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Prognosis
- Rare Diseases/genetics
- Rare Diseases/pathology
- Receptor, ErbB-2/biosynthesis
- Receptors, Estrogen/metabolism
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Affiliation(s)
- Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Orvieto
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
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Neuroendocrine breast tumours: Breast cancer or neuroendocrine cancer presenting in the breast? Breast 2014; 23:120-7. [DOI: 10.1016/j.breast.2013.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/31/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022] Open
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