Secretory carcinoma of the breast in a nine year old boy

Secretory breast carcinoma in a 41-year-old man with long-term follow-up: a special report

ABSTRACT 

Secretory breast carcinoma (SBC) is a rare tumor that is particularly rare in male adults. To our knowledge, only 28 previous male cases of secretory breast carcinoma have been reported. We present a case of secretory breast carcinoma that has the longest duration of symptoms (40 years) in a male individual until now. Typically, the clinical features and treatment of male SBC are similar with female SBC. The ETV6–NTRK3 fusion gene is a specific genetic alteration in SBC. When compared to other types of male breast cancer, patients with male secretory breast cancer are much younger, and have a lower rate of estrogen/progesterone hormone receptor positivity. Modified radical mastectomy has been favored as a therapeutic approach in all female SBC, male SBC and other types of male breast cancer.

Secretory breast carcinoma: a clinicopathological and immunophenotypic study of 15 cases with a review of the literature

Secretory breast carcinoma is a rare breast cancer with indolent clinical behavior. Recent research showed that secretory breast carcinoma belongs to the phenotypic spectrum of basal-like breast carcinomas. In this study, a clinicopathological and immunophenotypic analysis of secretory breast carcinomas from 15 Chinese patients was conducted. This patient group consisted of 2 males and 13 females, with ages ranging from 10 to 67 years old (median, 36 years old). All patients presented with a painless and firm mass. Tumor size ranged from 10 to 55 mm. Most tumors were located in the outer upper quadrant of the breast. Two patients (2 of 13, 15%) displayed positive axillary lymph nodes. At the microscopic level, the presence of intracellular and extracellular secretory material was the most remarkable feature. Most cases showed mild dysplasia cytologically. All cases were negative for estrogen receptor, progesterone receptor and HER2. The expression rate of the basal-like marker (CK5/6 or epidermal growth factor receptor) was 87% (13 of 15). The basal-like phenotype was identified in 13 cases (87%). Follow-up time ranged from 10 to 55 months (median, 19 months). None of the cases had evidence of recurrence and metastasis. Our study reveals that secretory breast carcinoma is a distinct subset of invasive breast carcinoma, with expression of basal-like markers. It should be noted that secretory breast carcinoma is different from conventional basal-like breast carcinomas. Future studies are required to further understand the prognostic significance of the basal-like markers expression in secretory breast carcinomas.

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.

Secretory carcinoma of male breast: case report and review of the literature

Secretory carcinoma is a rare low-grade breast carcinoma, initially termed "juvenile breast cancer," but it is now known to occur in adults of both sexes. It is the only epithelial tumor of the breast with a balanced translocation, t(12;15), that creates an ETV6-NTRK3 gene translocation. In this paper, a 19-year-old male patient has had a right breast mass for 9 years which suddenly increased in size with no evidence of palpable axillary lymph nodes. The mass was excised for frozen section and was diagnosed as malignant growth for simple mastectomy. Microscopic examination revealed the classical features of secretory carcinoma. The tumor cells were positive for EMA and S-100 protein and focally positive for cytokeratin and ER but negative for progesterone receptor, CD34, and CEA. Four months later the patient developed ipsilateral axillary lymph node enlargement, with lymph node metastases in five of the dissected 19 lymph nodes. The patient was treated with six courses of chemotherapy and radiotherapy. Conclusion. Though considered an indolent neoplasm, secretory carcinoma does metastasize to lymph nodes. Surgery in the form of mastectomy with axillary clearance is the treatment of choice. This paper includes a rare case report of secretory carcinoma in young male patient, with axillary lymph node metastasis in spite of the indolent nature that this tumor is known to display.

Secretory carcinoma of the breast: sonographic features

OBJECTIVE

The purpose of this series was to evaluate the sonographic features of secretory carcinoma of the breast.

METHODS

Between 1994 and 2006, 9 patients had histologically confirmed secretory carcinoma of the breast in our institution, and 6 of them underwent breast sonography. We retrospectively evaluated the sonographic findings of the patients in correlation with other available images and reviewed the clinical records.

RESULTS

Clinical manifestations were a palpable mass (n=3), a bloody nipple discharge (n=1), and screening-detected abnormalities (n=2). Breast sonograms showed masses with a round or oval (n=5) or tubular (n=1) shape, with relatively well-circumscribed (n=2) or partially microlobulated (n=4) margins, and with a hypoechoic (n=4) or an isoechoic (n=2) internal echo texture. Most lesions were single nodules (n=3) or groups of nodules (n=2) measuring 1 cm or smaller, except 1 mass measuring 3.5 cm with axillary lymph node metastasis. Two cases had associated ductectasia. Sonographic assessments were classified as Breast Imaging Reporting and Data System category 3 in 2 cases, category 4A in 3 cases, and category 4B in 1 case.

CONCLUSIONS

Secretory carcinoma of the breast is frequently shown as a small benign-looking nodule or group of nodules or sometimes as an intraductal lesion with a low clinical stage on sonography. Although secretory carcinoma is a rare breast malignancy, awareness of its sonographic features will be helpful for the differential diagnosis.

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.

Cytomorphology of Rare Malignant Tumors of the Breast

This article reviews cytomorphology of rare malignant tumors of the breast: squamous carcinoma, metaplastic carcinoma, adenoid cystic carcinoma, apocrine carcinoma, secretory carcinoma, lipid-rich carcinoma, and carcinoma with choriocarcinomatous features. It is important to bear in mind the cytomorphology and diagnosis of rare malignant tumors of the breast in analysis of breast fine needle aspiration smears. Although rare, these malignant tumors can be diagnosed by the cytomorphological characteristics, and should be included in the differential diagnoses of breast neoplasms.

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.

Secretory carcinoma of the breast containing the ETV6-NTRK3 fusion gene in a male: case report and review of the literature

SUMMARY

BACKGROUND

Secretory carcinoma (SC) of the breast is a rare and indolent tumor. Although originally described in children, it is now known to occur in adults of both sexes. Recently, the tumor was associated with the ETV6-NTRK3 gene translocation.

CASE PRESENTATION

A 52-year-old male was diagnosed with secretory breast carcinoma and underwent a modified radical mastectomy. At 18 months the tumor recurred at the chest wall and the patient developed lung metastases. He was treated concurrently with radiation and chemotherapy without response. His tumor showed the ETV6-NTRK3 translocation as demonstrated by fluorescent in situ hybridization (FISH).

CONCLUSION

SC is a rare slow-growing tumor best treated surgically. There are insufficient data to support the use of adjuvant radiation or chemotherapy. Its association with the ETV6-NTRK3 fusion gene gives some clues for the better understanding of this neoplasm and eventually, the development of specific therapies.

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

Secretory carcinoma (SC) is a rare variant of breast carcinoma, which was first described in children and adolescents but it can occur at all ages. Very few cases have been reported in male patients. We describe the cytological and histopathological features of SC in a 79-yr-old man. Cytological findings demonstrated cohesive sheets of monotonous cells with round nuclei and small nucleoli. Most cells contained intracytoplasmic vacuoles, which are the key feature of an accurate diagnosis. Differential diagnosis with other tumors is discussed briefly.

Secretory carcinoma of breast in a 17-year-old male

BACKGROUND

Secretory carcinoma of the male breast (juvenile carcinoma) is a rare neoplasm. Only a few cases have been reported in the literature.

CASE REPORT

We report here a case in a 17-year old male presenting with recurrent breast swelling.

CONCLUSIONS

Though considered an indolent neoplasm, secretory carcinoma does metastasise to lymph nodes and recur after local excision. Surgery in form of mastectomy with axillary clearance is the treatment of choice.

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 breast

Secretory carcinoma of the breast is a rare but histologically distinct variant of invasive ductal carcinoma that has an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. We present the imaging and histopathologic findings of a case of this tumor that initially manifested as a palpable mass in the left breast of a 31-year-old woman. It appeared sonographically as a round, well-circumscribed but microlobulated hypoechoic solid mass. Secretory carcinoma of the breast may resemble other well-circumscribed breast carcinomas as well as some benign masses, including fibroadenomas. Breast imagers should be aware of this rare tumor's nonspecific imaging features and clinical implications when making a differential diagnosis of solid breast masses.

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.

Secretory carcinoma of the breast: a tumour analogous to salivary gland acinic cell carcinoma?

AIMS

Acinic cell-like breast carcinoma is a newly recognized entity, and few acinic cell-like breast carcinoma cases have been reported. All reported acinic cell-like breast carcinomas were counterparts of the solid type of acinic cell carcinoma of the salivary gland. We report here three cases of secretory breast carcinoma with acinic cell differentiation, and discuss the similarity between secretory breast carcinoma and acinic cell carcinoma of the salivary gland.

METHODS AND RESULTS

The cases were histologically identical to acinic cell carcinoma of the salivary gland: papillary-cystic type in case 1, a mixture of papillary-cystic, microcystic and follicular type in case 2, and microfollicular type in case 3. Immunohistochemically, the tumour cells were positive for salivary-type amylase, lysozyme, S100 protein and alpha 1-antitrypsin, and negative or less reactive for gross cystic disease fluid protein-15 and oestrogen receptor. All three cases did not reveal metastasis or recurrence.

CONCLUSIONS

These cases were typical of secretory breast carcinoma, and were clinically, histologically and immunohistochemically analogous to acinic cell carcinoma of the salivary gland. We emphasize that secretory breast carcinoma and acinic cell carcinoma of the salivary gland may be identical lesions.