Breast cancer in a 6-year-old child

Paediatric and Adolescent Breast Cancer: A Narrative Review

Breast cancer is the most prevalent form of cancer worldwide. Every year, it affects a significant number of women in the UK and is considered one of the leading causes of cancer-related deaths globally. While breast cancer is primarily linked to adult women, its occurrence in children and adolescents is exceedingly rare. This study conducted a narrative review spanning from 1999 to 2023, examining 32 case reports to investigate the characteristics of breast cancer in the paediatric age group. These reports focused on patients under 18 years old who were diagnosed with primary glandular breast cancer, excluding cases originating from other tissues like angiosarcoma, leukaemia, and metastatic cancer. The data analysis encompassed various parameters, including gender, age, histology, receptor status, lymph node involvement, treatment methods, and genetic characteristics. From the published case reports, it was concluded that the most common type of breast cancer affecting children and adolescents is secretory breast carcinoma and predominantly occurs in females. It is typically hormone receptors negative, and the preferred treatment approach involves mastectomy as breast conservation surgery to preserve the developing breast tissue is a real challenge due to limited breast tissue volume in this age group.

Advancement of secretory breast carcinoma: a narrative review

BACKGROUND AND OBJECTIVE

Secretory breast carcinoma (SBC) is a rare breast malignancy. Most available studies on SBC are case reports or small case series, and the few large-sample studies available lack critical information due to database limitations. To improve the understanding of SBC and provide a reference for clinical practice, we systematically reviewed the demographic, clinical, pathologic, and genetic characteristics of SBC, as well as its treatment and prognosis.

METHODS

We conducted a PubMed search with the keywords "secretory breast carcinoma" or "juvenile breast carcinoma". Relevant English-language publications published from January 1966 to February 2022 were screened manually at 3 levels-title, abstract, and full text-to identify the articles that presented the demographic, clinical, pathologic, and genetic characteristics of SBC, as well as its treatment and prognosis.

KEY CONTENT AND FINDINGS

SBC lacks specific clinical manifestations and has typical pathological and molecular characteristics, including intracellular and extracellular eosinophilic secretions, immune spectrum similar to hormone receptor-positive tumors, and the ETV6-NTRK3 fusion gene. Surgery remains the primary treatment for SBC. Postoperative radiotherapy is recommended by most researchers for adult SBC but not for pediatric patients. The evidence of chemotherapy and endocrine therapy is insufficient, and targeted therapy of the ETV6-NTRK3 fusion gene shows a good response. Most patients with SBC have a good prognosis except for a few patients who experience distant metastases. Future studies will be focused on the molecular characteristics of those patients with SBC who have a poor prognosis.

CONCLUSIONS

The development of histopathology and molecular genetics has promoted the progress of the clinical diagnosis of SBC. The purpose of this review is to serve as a guide for the better clinical treatment of SBC, particularly in the areas of disease identification and prognosis classification for patients.

Breast cancer in a teenage girl with BRCA mutation: A case report from a low middle-income country

Introduction

Case history

Discussion

Conclusion

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The case of the youngest known breast cancer patient in Pakistan.

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Genetic counseling should be readily offered in low middle-income countries.

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Triple assessment is a mandatory tool to diagnose a breast lump in any age group.

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Up-to-date guidelines should be followed for managing breast lumps,

Primary breast lymphoma of childhood: a case report and review of literature

Background

Primary breast lymphoma (PBL) is an extremely rare neoplasm in children; by definition, it manifests in the breast without evidence of lymphoma elsewhere, except ipsilateral axillary nodes.

Case presentation

We report a case of a 15-year-old girl diagnosed with diffuse large B-cell lymphoma (DLBCL) of the right breast: the patient received chemotherapy and rituximab, achieving complete remission. A literature review revealed other 11 cases of pediatric PBL; it mainly affects female adolescents and can involve right and left breast equally. Different histologic subtypes have been described, arising from both B-cell and T-cell. Therapeutic approaches were very different, from chemotherapy to local treatment with surgery and/or radiotherapy.

Conclusions

Our case is the first in which rituximab was administered, suggesting to be a promising therapy in B-cell PBL, as already demonstrated in pediatric B-cell lymphoma from other sites. Further investigations are needed to identify prognostic factors and establish the most effective treatment.

Secretory breast carcinoma in a male child: Case report and literature review

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Even slow growing mammary lesions in a male child may be malignant.

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Secretory breast cancer positive for estrogen and progesterone receptors is very rare in a male child.

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Secretory breast cancer after surgical excision usually does not require adjuvant therapy.

Introduction

The secretory breast carcinoma is very rare in children. It represents less than 1% of malignancy cases in childhood and is even less common in males, with 15 cases reported until 2004. Therefore, the aim of this study is to report a male child with breast carcinoma and review literature.

Presentation of case

A 14-year-old male patient with a history of a painless slow-growing lump in the left breast and, five years later, onset of yellow discharge from the papilla. Ultrasound scanning demonstrated a well- defined, regular, homogeneous and hypoechoic mass.

Nodule excision was initially performed, followed by mastectomy, due to compromised radial margin. Immunohistochemistry revealed weakly positive estrogen and progesterone receptors. Adjuvant therapy was not required. Sixteen months after resection, the patient is well with no complaints or recurrence.

Discussion

Due to its rarity, there is no therapeutic guideline. Although the recommended treatment is still surgical excision, there is no consensus as to its extent. Prognosis is usually favorable. Our patient was submitted to mastectomy with sentinel lymph node biopsy due to compromised radial margin.

Conclusion

Secretory breast carcinoma is a rare form of breast cancer, especially in male children; which hampers standardization of diagnosis, treatment and prognosis establishment.

A case of secretory breast cancer in a 6 year-old girl: is it possible to make a correct preoperative diagnosis?

Secretory breast carcinoma constitutes the majority of breast cancers in children and young people less than 20 years of age. Noninvasive examination is particularly necessary for the diagnosis of breast carcinoma in children. Herein, we report a case of secretory breast carcinoma in a 6-year-old girl with psychomotor retardation. She was referred to our outpatient clinic for evaluation of a palpable mass in her left breast. A hard mass, rather than the increase in size typical of premature thelarche, was palpated. An excision biopsy was performed. Pathological findings revealed an invasive secretory breast carcinoma. We performed a retrospective review of the preoperative findings of this case, and compared it to the pathological diagnosis. Elastography, which can be performed without deep sedation or general anesthesia and without causing pain, resulted in a stiffness score of 4; however, the distinction between benign and malignant tumors on elastography, which is important to decide the intra-operative procedures, was not sufficient according to the Japanese breast cancer society clinical guidelines. This is the first report of secretory breast carcinoma in a child with a stiffness score determined by tissue elasticity imaging. A breast mass in a child with a high stiffness score of more than 4 on elastography should be referred for invasive diagnostic procedures, such as fine needle aspiration or excisional biopsy. According to our experience, an accurate preoperative diagnosis could be possible for malignant breast tumors in children. Such parameters as stiffness score on elastography are practical, noninvasive, and objective diagnostic tools for the accurate preoperative diagnosis of breast tumors in children.

Breast Lesions in Children and Adolescents: Diagnosis and Management

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.

Rare breast cancer: 246 invasive secretory carcinomas from the National Cancer Data Base

BACKGROUND AND OBJECTIVES

Invasive secretory breast carcinoma (SBC) is a rare subtype of breast malignancy.

METHODS

Cases of SBC and infiltrating ductal carcinoma (IDC) from the National Cancer Database (1998-2011) were queried.

RESULTS

Patients with SBC (n = 246) and IDC were identified (n = 1,564,068). The group with SBC was younger (age 56.4 ± 16.0 vs. 60.4 ± 13.9 years, P < 0.001), had similar tumor size (19.9 ± 17.8 vs. 21.6 ± 25.5 mm, P = 0.297), more frequently African-Americans (24.1 vs. 14.8 vs. 13.7; P = 0.004), more well-differentiated (32 vs. 18%, P < 0.001) and less likely to be hormone receptor positive (ER: 64 vs. 76%, P = 0.001; PR: 43 vs. 65%, P < 0.001). No differences were found for incidence of node-positivity (32 vs. 34%, P = 0.520) and stage IV presentation (2.4 vs. 3.6%, P = 0.372). Breast conserving surgery (60 vs. 58%, P = 0.405) and hormonal therapy (67 vs. 71%, P = 0.489) rates were similar. Systemic chemotherapy was used less often for SBC (38 vs. 45%, P = 0.035). The overall survival of all patients with SBC was better than all patients with IDC (median not reached vs. 14.8 years, P = 0.025).

CONCLUSION

SBC is an uncommon tumor that is often well-differentiated and seen in younger women. Contrary to prior reports, they are frequently hormone receptor-positive. Compared to IDC, overall survival is improved. J. Surg. Oncol. 2016;113:721-725. © 2016 Wiley Periodicals, Inc.

Management of pediatric and adolescent breast masses

Breast masses in children and adolescents are uncommon and most often benign. Occasionally, however, they require surgical intervention for lifestyle limiting symptoms or malignant potential. These masses are best evaluated with physical exam and ultrasound. Breast masses likely to be encountered by the surgeon in the pediatric and adolescent population include intraductal papillomas, phyllodes tumors, primary breast cancer, and metastatic lesions. Unlike adults, pediatric and adolescent breast cancer tends to be of the secretory variety and typically have less metastatic potential. However, cases of inflammatory and medullary breast cancers have also been reported in girls and appear more aggressive. Radiation exposure during breast development is a risk factor to subsequent development of breast cancer. Surgical objective for a concerning pediatric and adolescent breast mass is complete resection while preserving normal breast development, when appropriate. The need for routine axillary dissection for malignant cases in children appears unnecessary from the limited data available, and the authors favor sentinel lymph node sampling and reserve axillary dissection for positive lymph nodes.

Imaging of the adolescent breast

The mainstay of breast imaging in the adolescent is ultrasonography. There is occasionally a need for additional imaging, particularly with magnetic resonance imaging (MRI). Imaging of the adolescent breast differs substantially from the adult in both the imaging modalities utilized and the relative likelihood of pathologies encountered. The majority of lesions in the adolescent are benign, but the presence of a breast lesion may cause anxiety to patients and their families due to the wide awareness of breast malignancy in the adult population. It is important to be aware of the imaging modalities available to image the adolescent breast to prevent unnecessary radiation exposure while answering the clinical question. The current recommendations for adolescent diagnostic and screening breast imaging will be reviewed. Benign breast lesions such as fibroadenomas, fibrocystic change, pseudoangiomatous stromal hyperplasia, gynecomastia, and posttraumatic or infectious lesions with their associated imaging findings and management will be outlined. Additionally, review of breast malignancies that can affect adolescents will provide the reader with features to distinguish benign from malignant processes in the adolescent based on imaging findings and clinical presentation.

Breast carcinoma in a prepubertal girl

Breast carcinoma is a very rare disease in children. We present a rare case of breast cancer in an 11-year-old prepubertal girl. Clinically, it was a case of locally advanced breast cancer (T4bN1M0). The core biopsy report showed adenocarcinoma of the not otherwise specified (NOS) variety (oestrogen receptor-negative, progesterone receptor-negative and human epidermal growth factor receptor 2-negative). Diagnosis was late in this case due to lack of suspicion. A modified radical mastectomy was considered to be adequate treatment. Histologically, it was adenocarcinoma NOS, which is rare in young girls (the secretory type being more common). Incidence, differential diagnoses, investigation and management of breast carcinoma in young girls are discussed. The purpose of reporting this case is to highlight that prevention and early detection of breast carcinoma in children is very important.

Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up

Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.

Incidental finding of synchronous bilateral ductal carcinoma in situ associated with gynecomastia in a 15-year-old obese boy: case report and review of the literature

Carcinoma of the breast is rarely encountered in the male population and is even less prevalent in the pediatric male population. Studies have suggested an association between male breast carcinoma and gynecomastia, but conflicting results have been shown. Only 3 cases of carcinoma in situ associated with bilateral gynecomastia during puberty have been described in the literature. Here, we present the case of a 15-year-old boy with bilateral gynecomastia who was found to have synchronous bilateral ductal carcinoma in situ.

Pleomorphic carcinoma of the breast in a 17-year-old woman

We report a 17-year-old woman with refractory high-grade breast cancer who died early after surgery, with reference to the histogenesis of the cancer. Macroscopically, the tumor was cystic, composed of a mixture of solid and myxomatous areas. Histologically, the tumor exhibited ductal structures and areas with squamoid features. Cancer cells were markedly atypical and polymorphic, and included a mixture of bizarre and eosinophilic cells with rhabdoid feature-like free cells. Immunohistochemically, cytokeratin (CK) 8, CK 18, 34 beta E12, CD10, involucrin, CK14, and vimentin were partially positive, whereas estrogen and progesterone receptors and HER-2 were negative. These findings suggest an undifferentiated cancer whose cells have multilineage potential to differentiate into mesenchymal, basal, and squamoid cells, and it was diagnosed as pleomorphic carcinoma, which is a histological type hitherto unreported in young girls. The cancer was refractory to treatment, and the patient died 1 year and 5 months after surgery despite chemotherapy and radiotherapy.

From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation

The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.

Secretory breast carcinoma with metastatic sentinel lymph node

BACKGROUND

Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases.

CLINICAL PRESENTATION

In this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression. We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.

CONCLUSION

After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice.

Syringocystadenoma papilliferum: a rare breast tumor in a young boy

Syringocystadenoma papilliferum of the breast is extremely rare in children. However, some occasional cases have been diagnosed in females. This report documents a case of syringocystadenoma papilliferum occurring in a healthy 4-year-old male. Histopathologically, this tumor, located deep in the dermis, was characterized by the presence of papillary projections extending into the lumen of epithelial cystic invaginations in a background of dense fibrous tissue. The papillary projections and the duct-like structures were lined by an inner columnar epithelium, which demonstrated luminal apical decapitation secretion, and had an outer layer of smaller cuboidal cells. These findings support apocrine differentiation in this case. A fairly dense mononuclear infiltrate in the stroma of the tumor, especially in the papillary projections, was also present. Although syringocystadenoma papilliferum is rare in children, it should not be summarily ruled out during examinations of masses found in the pediatric male breast. It is important to recognize this unusual location of the tumor so that a prompt diagnosis, based on histopathology and surgical excision, can be proposed.

Secretory Carcinoma of the Breast

We report an elderly case of an indolent breast tumor in a 66-year-old woman. The patient presented with a locally advanced mass in the right breast that was present for 13 years, accompanied by bleeding and ulceration since the last 5 years. She had a modified radical mastectomy with axillary dissection. She was found to have secretory carcinoma with a tumor size of 8 x 4 x 4 cm in diameter. Two out of the 22 removed lymph nodes were involved. The secretory material stained positive with lactalbumin, as well as showed positivity with PAS. The patient received six cycles of adjuvant chemotherapy followed by chest wall irradiation. She is disease free with a follow-up period of 24 months. Preoperative chemotherapy should be primarily replaced by curative surgery in such indolent cancers, despite locally advanced disease.

Congenital and Acquired Pediatric Breast Anomalies: A Review of 20 Years??? Experience

BACKGROUND

The purpose of this article was to review the senior author's 20 years of experience in the treatment of pediatric breast abnormalities, to propose a classification system for their treatment, and to provide a synopsis of treatment options.

METHODS

Congenital and acquired breast anomalies were identified in a retrospective chart review (n = 66). Breast abnormalities were classified as hyperplastic (n = 44), deformational (n = 11), or hypoplastic (n = 11). Hyperplastic abnormalities included gynecomastia, hyperplasia, polythelia, polymastia, and giant fibroadenoma. Deformational abnormalities were categorized as either iatrogenic (previous thoracostomy, thoracotomy, or tumor excision) or traumatic (thermal or penetrating injuries). Hypoplastic abnormalities included athelia, unilateral and bilateral hypoplasia, tuberous breast, and Poland syndrome. Type of surgery, age at initial operation, and number of operations were recorded for all patients.

RESULTS

Hyperplastic abnormalities were treated with breast reduction techniques and required the fewest operations per patient (1.14), followed by iatrogenic breast injury (2.1 per patient). The average number of procedures required for hypoplastic abnormalities was 2.45 per patient. The highest reoperation rates were seen in patients with burn injuries to the breast and patients with Poland syndrome. Mean age at initial operation was highest in the deformational group (18.5 years) and lowest in the hyperplastic group (17.4 years).

CONCLUSION

Classification of pediatric breast abnormalities and considerations about timing for surgery and the likely need for staged operations aid in anticipating and optimizing clinical outcomes.

Treatment of pediatric breast problems

Pediatric breast anomalies are relatively common. Treatment options depend on whether the abnormalities are hyperplastic, deformational, or hypoplastic. Hyperplastic anomalies require reduction techniques, whereas deformational and hypoplastic lesions require augmentation techniques and are more likely to require revisional surgeries. These designations aid the surgeon in decision-making about timing for treatment and in optimizing aesthetic outcomes.

[Thoracic sonography in infancy and childhood]

Thoracic sonography has become an established imaging tool for evaluating specific paediatric thoracic diseases; particularly queries such as thymomegaly, pleural effusion, pulmonal sequester or thoracic small part pathology may be reliably addressed. Using appropriate ultrasound equipment the well trained and experienced investigator may diagnose these conditions without the need for a radiating imaging modality or help to evaluate equivocal findings on chest plain films. The important requisites as well as the established disease entities that pose an indication for thoracic ultrasound are listed and described. The restrictions and setbacks are discussed, and an algorithm for additional imaging and typical scenarios is supposed in order to help and encourage the meaningful and efficient use of this non-ionising, easy applicable imaging tool to chest queries. In conclusion, this review tries to give an overview of the restrictions and indications for thoracic sonography in neonates, infants and children as a useful imaging tool when indicated.

Pseudoangiomatous Stromal Hyperplasia of the Breast in Two Adolescent Females

The majority of breast lesions that present in adolescent girls are benign, with most being fibroadenomas. Rarely, a large and rapidly growing breast mass may be found to be the more recently described entity named pseudoangiomatous stromal hyperplasia (PASH). The pathogenesis of this lesion is attributed to hyperplasia of stromal myofibroblasts in response to hormonal stimuli. To date, PASH has rarely been described in adolescence. We describe the presentation of PASH in two adolescent patients. The first is a 12-year-old girl who found a mass in her left breast 3 months prior to presentation. An excision of an 11.5 x 10 x 3.5 cm lesion weighing 347 g was performed via breast-conserving incisions. The second patient is a 16-year-old girl who also had a rapidly enlarging left breast mass removed in a similar fashion. This mass measured 12 x 11 x 6 cm and weighed 460 g. Both tumors were noted to have a smooth capsule. Histologic appearance consisted of the typical features of PASH; fibrous stroma containing numerous anastomosing slit-like spaces; some compressed and others with discernible lumina. Both patients had complete excisions and have since not experienced recurrence. Each has had excellent cosmetic results with symmetrical breast development since their resection. Pseudoangiomatous stromal hyperplasia is a rare tumor that arises in the breast. These tumors may grow quickly and often are mistaken for fibroadenomas, phylloides tumor, or angiosarcoma. They must be resected with careful attention to resection around the capsule of the tumor with breast conservation as a goal. Long-term follow-up is necessary, as some have been reported to recur.

Sentinel lymph node biopsy in juvenile secretory carcinoma

A 9-year-old girl presented with a 3-year history of a right breast mass. Excisional biopsy showed a secretory carcinoma. A treatment plan of simple mastectomy and axillary sentinel lymph node biopsy was chosen. She remains free of disease at 3-year follow-up. Sentinel lymph node biopsy offers an approach to stage the axillary lymphatic basin with a lower complication rate than formal dissection. The authors advocate its use in the treatment of pediatric breast cancer.

A fluorescence in situ hybridization study ofETV6-NTRK3 fusion gene in secretory breast carcinoma

The translocation t(12;15)(p13;q25), in which the ETV6 gene from chromosome 12 is rearranged with the NTRK3 gene from chromosome 15, has recently been identified in secretory breast carcinoma (SBC). This fusion gene was initially described in congenital fibrosarcoma and congenital mesoblastic nephroma. The biological consequence of this translocation is the expression of a chimeric protein tyrosine kinase with potent transforming activity. To assess the frequency of t(12;15)(p13;q25) in breast cancer, we developed complementary probe sets (fusion and split-apart probes) for the detection of this translocation by fluorescence in situ hybridization (FISH) in paraffin-embedded, formalin-fixed tissue sections. We tested four histologically confirmed cases of SBC for the presence of the ETV6-NTRK3 gene fusion and then applied the FISH assay to tissue microarrays (TMAs) in order to screen 481 cases of formalin-fixed, paraffin-embedded invasive breast carcinomas of various histologic subtypes. Three of the four cases of SBC revealed fusion signals. Of the 481 cases in the TMAs, 202 gave signals of sufficient quality for screening by FISH, and only one case showed fusion signals in most or all of the tumor cells. On review of the histology of this case, SBC was confirmed. On the other hand, none of the fusion-negative breast cancers revealed SBC histology. In all cases, the results from the fusion and split-apart FISH assays for the ETV6-NTRK3 fusion genes were concordant. Our data suggest that the ETV6-NTRK3 fusion gene is a specific genetic alteration in SBC.

Secretory carcinoma of the breast: a distinct variant of invasive ductal carcinoma assessed by comparative genomic hybridization and immunohistochemistry

Secretory carcinomas (SCA) are distinguished from infiltrating ductal carcinomas (IDC) of the breast by their characteristic histomorphology and more favorable prognosis and by the expression of a chimeric tyrosine kinase that is encoded by the ETV6-NTRK3 fusion gene. On this basis, we evaluated 13 SCAs (12 of them with ETV6-NTRK3 gene fusion) by molecular and immunohistochemical (IHC) methods. DNA was obtained from 8 of 13 microdissected SCAs and was analyzed for genetic alterations (GA) by comparative genomic hybridization (CGH). IHC staining was performed for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and Ki-67 (MIB1) in all 13 cases. Molecular and immunohistochemical results in SCAs were compared with previous data regarding immunohistochemical and molecular characteristics of IDCs. An average of 2.0 GAs (range: 0 to 6) were detected, including recurrent gains of chromosome 8q (37.5%) and 1q (25%) and losses of 22q (25%). Four of 13 (31%) SCAs were positive for ER, and 2 were positive for PR. The mean MIB1-labeling index was 11.4% (range: <1 to 34%). Her-2/neu protein overexpression was detected in 2 cases, including 1 with strong (score 3+) and 1 with weak HER2/neu expression (score 2+). Fluorescence in situ hybridization analysis of the latter case showed no evidence of HER-2/neu-gene amplification. Compared with previous findings in IDCs, SCAs are characterized by a relatively low number of GAs, a low proliferative rate, infrequent HER2/neu protein overexpression, decreased steroid hormone receptor expression, and expression of ETV6-NTRK3 fusion gene. These results support the hypothesis that SCAs have immunohistochemical and genetic features that distinguish them from IDCs of the usual type.

Secretory carcinoma of the male breast

BACKGROUND

Secretory carcinoma is a distinctive and rare variant of breast carcinoma with a favorable prognosis because these tumors usually behave in an indolent manner. The occurrence of this type of breast cancer in males was studied.

METHODS

An extensive literature survey concerning secretory breast cancer in males was performed. Data of one case treated in our institute were added.

RESULTS

A total of 14 cases were identified, and our case was added to this series. The median age was 17 years. The duration of symptoms varied from 1 month to 21 years, and the tumor size was 1.2 to 4 cm. Surgical treatment varied from local excision only to modified radical mastectomy. Three patients received adjuvant treatment. Lymph nodes were involved in 3 of the 10 cases undergoing axillary lymph node dissection. The primary tumor was only 1.5 cm in diameter in two of those cases. None of the patients presented with systemic metastases. Only one male was reported to develop recurrence and consequently died of systemic disease.

CONCLUSIONS

Secretory breast cancer is very rare in males and seems to occur at a younger age in males than in females. A sufficient number of female cases have been reported with recurrence after local excision. Although in females lymph node metastases are rarely observed in secretory breast carcinoma smaller than 2 cm, in male patients nodal metastases might occur more frequently in smaller tumors. Therefore, mastectomy with sentinel lymph node biopsy or axillary lymph node dissection is recommended in any male case. Biological behavior seems to be similarly favorable in either sex.

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

O carcinoma secretor (CS) da mama é uma neoplasia muito rara. O CS da mama foi inicialmente descrito em crianças e adolescentes, mas a maioria dos casos é descrito em doentes adultos. É muitas vezes associado a um prognóstico particularmente favorável, mas em doentes adultos com tumores de maiores dimensões pode apresentar um comportamento mais agressivo. Apresenta-se um caso de uma doente com 62 anos de idade, que apresentava uma volumosa tumefacção da mama com 16 anos de evolução. O exame objetivo revelou extensa fixação da lesão à pele, com sinais inflamatórios acentuados e áreas de necrose cutânea. O tratamento inicial consistiu numa mastectomia simples, com intenção paliativa. O diagnóstico anatomopatológico de carcinoma secretor (3,5 cm), sem invasão cutânea, motivou a posterior realização de esvaziamento ganglionar axilar, que revelou metástases em 2 dos 13 gânglios isolados. A doente faleceu 24 meses depois, por disseminação da doença, comprovando a maior agressividade do CS em doentes adultos com tumores de maiores dimensões (T2) e com metastização ganglionar (N1). Os autores revêem a literatura com particular ênfase nos factores de prognóstico importantes para decisão terapêutica deste tipo raro de carcinoma da mama, em doentes adultos.