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Hussain M, Abbott M, Zargham R, Pabani A, Khan OF. Evolution of an invasive ductal carcinoma to a small cell carcinoma of the breast: A case report. Medicine (Baltimore) 2022; 101:e28433. [PMID: 35029184 PMCID: PMC8758025 DOI: 10.1097/md.0000000000028433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Small cell carcinoma (SCC) is a rare subtype of breast cancer and presents a complex diagnostic and treatment challenge, due to paucity of data. To the best of our knowledge, most cases of breast SCC reported in the literature describe a de novo breast primary. Our case is unique as it describes the evolution of an invasive ductal carcinoma after treatment into a SCC of the breast. PATIENT CONCERNS AND DIAGNOSIS We report a case of a 53-year-old female, lifelong non-smoker, who initially presented with breast mass noted on self examination. Breast and axillary lymph node biopsy demonstrated a hormone receptor positive invasive ductal carcinoma with a metastatic T3 lesion. INTERVENTION She was treated with first-line palbociclib/letrozole with initial clinical response, and at progression was switched to capecitabine with no response. Repeat biopsy of the axillary lesion showed evolution of the tumor into a triple negative breast cancer. She was then treated with third-line paclitaxel and radiation therapy with good initial response. She eventually had further disease progression and presented with a new mediastinal lymphadenopathy causing SVC syndrome. Biopsy of this showed a small cell variant of breast neuroendocrine carcinoma. Due to the evolution of histology in this case, a retrospective review of her initial breast specimen as well as the second biopsy from the axilla was conducted which confirmed that the mediastinal lymphadenopathy was metastatic from the original breast tumor. OUTCOMES AND LESSONS We speculate that the initial treatment allowed a minority of treatment-resistant neuroendocrine cells to grow and become the dominant face of the tumor. Our patient had an excellent response to carboplatin/etoposide and consolidative locoregional radiotherapy but presented with an early intracranial recurrence. This is a similar pattern of metastases as seen in lung SCC and highlights a potential role for prophylactic cranial irradiation in breast SCC. Further studies are needed to better understand the biology and treatment of breast SCC which continues to present a challenge for clinicians.
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Affiliation(s)
- Marya Hussain
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marcia Abbott
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Ramin Zargham
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Omar F. Khan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Bean GR, Najjar S, Shin SJ, Hosfield EM, Caswell-Jin JL, Urisman A, Jones KD, Chen YY, Krings G. Genetic and immunohistochemical profiling of small cell and large cell neuroendocrine carcinomas of the breast. Mod Pathol 2022; 35:1349-1361. [PMID: 35590107 PMCID: PMC9514991 DOI: 10.1038/s41379-022-01090-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/09/2022]
Abstract
Neuroendocrine carcinomas (NEC) of the breast are exceedingly rare tumors, which are classified in the WHO system as small cell (SCNEC) and large cell (LCNEC) carcinoma based on indistinguishable features from their lung counterparts. In contrast to lung and enteropancreatic NEC, the genomics of breast NEC have not been well-characterized. In this study, we examined the clinicopathologic, immunohistochemical, and genetic features of 13 breast NEC (7 SCNEC, 4 LCNEC, 2 NEC with ambiguous small versus large cell morphology [ANEC]). Co-alterations of TP53 and RB1 were identified in 86% (6/7) SCNEC, 100% (2/2) ANEC, and 50% (2/4) LCNEC. The one SCNEC without TP53/RB1 alteration had other p53 pathway aberrations (MDM2 and MDM4 amplification) and was immunohistochemically RB negative. PIK3CA/PTEN pathway alterations and ZNF703 amplifications were each identified in 46% (6/13) NEC. Two tumors (1 SCNEC, 1 LCNEC) were CDH1 mutated. By immunohistochemistry, 100% SCNEC (6/6) and ANEC (2/2) and 50% (2/4) LCNEC (83% NEC) showed RB loss, compared to 0% (0/8) grade 3 neuroendocrine tumors (NET) (p < 0.001) and 38% (36/95) grade 3 invasive ductal carcinomas of no special type (IDC-NST) (p = 0.004). NEC were also more often p53 aberrant (60% vs 0%, p = 0.013), ER negative (69% vs 0%, p = 0.005), and GATA3 negative (67% vs 0%, p = 0.013) than grade 3 NET. Two mixed NEC had IDC-NST components, and 69% (9/13) of tumors were associated with carcinoma in situ (6 neuroendocrine DCIS, 2 non-neuroendocrine DCIS, 1 non-neuroendocrine LCIS). NEC and IDC-NST components of mixed tumors were clonally related and immunophenotypically distinct, lacking ER and GATA3 expression in NEC relative to IDC-NST, with RB loss only in NEC of one ANEC. The findings provide insight into the pathogenesis of breast NEC, underscore their classification as a distinct tumor type, and highlight genetic similarities to extramammary NEC, including highly prevalent p53/RB pathway aberrations in SCNEC.
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Affiliation(s)
- Gregory R. Bean
- grid.168010.e0000000419368956Department of Pathology, Stanford University School of Medicine, Stanford, CA USA
| | - Saleh Najjar
- grid.168010.e0000000419368956Department of Pathology, Stanford University School of Medicine, Stanford, CA USA
| | - Sandra J. Shin
- grid.413558.e0000 0001 0427 8745Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY USA
| | - Elizabeth M. Hosfield
- grid.414890.00000 0004 0461 9476Department of Pathology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA USA
| | - Jennifer L. Caswell-Jin
- grid.168010.e0000000419368956Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA USA
| | - Anatoly Urisman
- grid.266102.10000 0001 2297 6811Department of Pathology, University of California San Francisco, San Francisco, CA USA
| | - Kirk D. Jones
- grid.266102.10000 0001 2297 6811Department of Pathology, University of California San Francisco, San Francisco, CA USA
| | - Yunn-Yi Chen
- grid.266102.10000 0001 2297 6811Department of Pathology, University of California San Francisco, San Francisco, CA USA
| | - Gregor Krings
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
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Boutrid H, Kassem M, Tozbikian G, Morgan E, White J, Shah M, Vandeusen J, Sardesai S, Williams N, Stover DG, Lustberg M, Wesolowski R, Pudavalli V, Williams TM, Konda B, Fortier S, Carbone D, Ramaswamy B, Cherian MA. TTF-1 Positive Primary Small Cell Carcinoma of the Breast: A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:228. [PMID: 32411090 PMCID: PMC7201766 DOI: 10.3389/fendo.2020.00228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 01/22/2023] Open
Abstract
Primary small cell carcinoma of the breast (SCCB) is a rare tumor subtype comprising <0.1% of all breast carcinomas. Here we present a case of thyroid transcription factor-1 (TTF-1) positive SCCB that recurred within 3 years of diagnosis in the lung and lymph nodes. Given the small number of cases, no clear guidelines exist on the appropriate management of patients with these aggressive tumors. We present a case study and review the current literature to highlight the knowledge gaps and needs of patients with these rare tumors. A 50-year-old premenopausal woman with no family history, presented with a palpable right breast mass. Biopsy was consistent with primary SCCB that was poorly differentiated, positive for synaptophysin and chromogranin and TTF-1 and presence of ductal carcinoma in situ component showing neuroendocrine differentiation. Imaging with PET, CT, and MRI brain excluded any other sites of primary disease. She underwent a right lumpectomy with axillary lymph node dissection and was treated with adjuvant cisplatin-based chemotherapy and concurrent radiation therapy. Thirty-four months later, routine scans showed a new right lower-lobe lung nodule and an enlarged sub-carinal node that was proven to be poorly differentiated neuroendocrine cancer. This case report sheds light on a rarely described disease and provides a comprehensive approach to diagnosis and management. Primary SCCB is an extremely rare, aggressive form of breast cancer that is molecularly and histologically similar to SCLC. However, a review of the literature highlights recent mutational analyses that show important differences between these two cancer types, including an increase in PIK3CA mutations in primary SCCB. Further studies, including genomic analyses are needed to better define this malignancy and to develop a standard treatment.
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Affiliation(s)
- Hinda Boutrid
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Mahmoud Kassem
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Evan Morgan
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Julia White
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Manisha Shah
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Jeffrey Vandeusen
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Sagar Sardesai
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Nicole Williams
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Daniel G. Stover
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Maryam Lustberg
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Wesolowski
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Vinay Pudavalli
- Department of Neurological Surgery, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Terence M. Williams
- Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Bhavana Konda
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Stephanie Fortier
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - David Carbone
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Bhuvaneswari Ramaswamy
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
| | - Mathew A. Cherian
- Stefanie Spielman Comprehensive Breast Cancer, The Ohio State University, Columbus, OH, United States
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, OH, United States
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