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Primary small cell neuroendocrine carcinoma of the breast. (A): Neuroendocrine tumour infiltration from sheets of uniform cells with round nuclei; (B): immunohistochemistry for oestrogen receptor shows nuclear reactivity only in non-neoplastic ductal cells while tumour cells are negative; (C): at least for 50% of the population it shows cytoplasmic reactivity for chromogranin and (D): Very high Ki67 proliferative index.
Source publication
Introduction:
Primary neuroendocrine neoplasms (NENs) in the breast are very rare. Until 2011, the prevalence was 0.1% of all breast lesions and 1% of all NENs, whereas metastatic breast NENs represent 1%-2% of all breast tumours. However, it seems that over the last 5 years the diagnostic frequency of breast NENs has increased, probably for more...
Context in source publication
Context 1
... fact, the literature reveals cases of NENs metastatic to the breast with an occult primary carcinoid tumour. However, differentiating between primary and secondary breast lesions is essential, owing to different clinical management and prognosis [41,48] (Figure 1). The ileum is the most common primary site of metastatic NEN breast lesions, followed by the appendix, duodenum, pancreas, lung and ovary [5,33,42,43]. ...
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Citations
... Surgery is the recommended treatment for patients with resectable Br-NEN. It is important to distinguish between primary and metastatic lesion in the breast (13,48). In our presented group, 16 (73%) of the patients underwent breast-conserving surgery (BCS), and 13 (60%) of them had a sentinel lymph node biopsy (with only one requiring subsequent ALND). ...
Background
Primary neuroendocrine neoplasms of the breast (Br-NENs) are rare. The classification has been updated in recent years making interpretation of the data published challenging. It is unclear whether neuroendocrine differentiation is associated with poorer prognosis and what treatment approaches should be applied.
Methods
The database for breast cancer patients treated between 2009 and 2022 at the Maria Sklodowska-Curie National Research Institute of Oncology Branch Krakow was explored to search for Br-NENs. Patients’ medical and pathological data were collected and analyzed.
Results
We included 22 females with Br-NEN without metastases at the time of diagnosis. The median age was 64 years (range: 28-88), Of the cases, 18 were hormone receptor positive, all were HER-2 negative, the median Ki67 was 27% (10-100%). The median tumor size at the time of diagnosis was 29.5mm (7-75mm), 9 patients were N-positive. DCIS was present in 5 cases. Only one case was negative for chromogranin and synaptophysin staining, but data were missing for 4 cases. Nine patients received adjuvant chemotherapy, mainly based on anthracyclines and taxanes, while 16 received adjuvant hormonal therapy and 15 received postoperative radiotherapy. Radical surgery was performed in all patients, but two underwent suboptimal tumorectomy. One patient had local recurrence, three experienced metastatic disease, all involving the lungs, but these patients are still alive. The median follow-up was 96 months (8–153). Two patients died, with a follow up time of no recurrence >4 years. Our results were compared to twelve case series collecting clinical data on Br-NENs, with median patient number of 10.5 (range: 3-142).
Conclusion
Br-NENs represent a heterogenous group of diseases, lacking data from prospective studies or clinical trials. There are no established treatment standards tailored for Br-NENs. Our patients’ cohort exhibited a favorable prognosis, potentially attributed to lower tumor stage and Ki67 index compared to other reported case series. We suggest that radical surgery and postoperative radiotherapy be administered akin to standard treatment for breast cancer of no special type. ESMO also advocates for this approach in systemic treatment, although we recommend considering platinum-based chemotherapy for patients with poorly differentiated Br-NENs exhibiting high Ki67.
... However, microcalcifications and spiculations in primary breast cancers are uncommon in breast metastasis [6]. In contrast to primary breast cancer, breast metastases are likely to be smaller and are located more superficially but without skin or nipple retraction [2,8,9]. Additionally, unlike primary breast cancers, which generally show proliferation of fibrous connective tissue around the tumor, breast metastases lack this desmoplastic reaction and architectural distortion is usually not observed [2]. ...
Breast metastases from small cell lung carcinoma (SCLC) are extremely rare. Although reports of breast metastases from SCLC exist, only three studies have reported solitary and synchronous breast metastases. Herein, we present a case of SCLC with solitary and synchronous breast metastases. This unusual case highlights the importance of the combined use of radiological and immunohistochemical features to accurately distinguish solitary metastatic SCLC from primary breast carcinoma or metastatic carcinoma of other types of lung cancer. It also emphasizes the importance of the differences between solitary metastatic SCLC and primary breast carcinoma or metastatic carcinoma of other types of lung cancer for the respective prognoses and development of appropriate therapeutic plans.
... differentiate from a primary breast carcinoma or even from benign breast lesions [8] . ...
... Histology and immunohistochemistry (IHC) play a pivotal role not only in diagnosis but also in determining therapeutic strategy of the patients [8] . The histopathological features of NETs are characteristics in the great majority of cases. ...
Breast metastases are uncommon findings compared to primary breast cancer and in particular bilateral secondary breast lesions from neuroendocrine tumor (NET)s are extremely rare with just less over 13 cases described in literature. We reported herewith the case of a 54-year-old woman who presented to our Breast Unit after noticing multiple, mobile, bilateral breast lumps. Imaging studies confirmed the presence of multiple, circumscribed, bilateral breast masses with slightly spiculated margins, classified as suspicious for malignancy (BI-RADS 4). A tru-cut biopsy was carried out on the largest lesion of each side and histopathologic and immunohistochemistry examination was consistent with metastases from pancreatic neuroendocrine tumor (PNET). Total-body CT revealed the presence of a mass located in the pancreatic body - tail with associated abdominal lymphadenopathies and multiple secondary nodules in bilateral breast and in the liver. Stage IV disease was diagnosed, patient did not undergo surgery and started LAR – octreotide therapy. Although rare, breast metastases from NETs represent an important diagnostic challenge for practitioners because of the difficulty to differentiate from a primary breast carcinoma or even from benign breast lesions. Clinicians should be aware of the possibility of bilateral breast metastases in differential diagnosis of breast lesions in order to ensure the correct diagnosis and the most appropriate management of these patients.
... Other types of lung cancer, including small cell carcinoma, seldomly metastasize to the breast [10] . It is possible that secondary breast cancers may be more frequent than previously thought, as some may have been misdiagnosed as primary tumors [11] . Increased awareness, modern technology and imaging tools may help in correct diagnosis. ...
... Four major types of lung neuroendocrine neoplasms are recognized by the WHO: typical carcinoid, atypical carcinoid, small cell lung cancer, and large cell neuroendocrine carcinoma [11] . There have been 2 prior case reports of neuroendocrine neoplasm of unspecified type with bilateral breast metastases [1 ,6] , and only 1 other documented case of small cell lung carcinoma with bilateral breast metastases [12] . ...
... There have been 2 prior case reports of neuroendocrine neoplasm of unspecified type with bilateral breast metastases [1 ,6] , and only 1 other documented case of small cell lung carcinoma with bilateral breast metastases [12] . Bilateral breast metastases from an atypical lung carcinoid has also been reported [11] . Note that primary mammary small cell carcinoma is very rare. ...
Differentiation of primary versus secondary breast cancer can be difficult, with the relative rarity of the latter representing a diagnostic challenge. Here, we present a case of small cell lung cancer with synchronous bilateral breast metastases in a 52-year-old female. There are less than 5 other cases of small cell lung cancer with bilateral breast metastases reported in the literature to date. The breast metastases represented the first clinical and imaging manifestation of malignancy in our case. We present the patient's disease course including multi-modal imaging, histopathologic analysis, and clinical management. We aim to highlight the entity of secondary breast cancer and how multidisciplinary collaboration can help arrive at the diagnosis, which is critical for prognosis and treatment planning in this patient population.
Metastasis to breast from extramammary primary tumors is rare and account for 0.2% to 1.3% of malignant tumors in the breast. Pancreatic malignancies do not usually metastasize to the breast and very few cases have been reported in the literature. In this case report, we present an 81-year-old Caucasian female presenting with a large fungating breast mass with severe bleeding. Urgent mastectomy was performed, and pathology of the breast tumor was most consistent with a pancreatic tumor metastasizing to the breast. Palliative mastectomy for bleeding breast mass has been reported for other primary cancers and our case report is the first one reporting urgent palliative mastectomy for this histopathology. Emergency mastectomy should be considered for the rare presentation of exsanguinating hemorrhage from a large breast mass if the mass is deemed resectable from the chest wall.
Purpose of Review
Metastases to the breast (intramammary metastases, IM) from extramammary malignancies (EM) are uncommon. As prognosis is poor, timely diagnosis is key to direct patients towards appropriate treatment. We will review recent literature regarding the epidemiology, presentation, and diagnosis of IM.
Recent Findings
IM commonly present as palpable masses, with imaging findings often based on hematogenous versus lymphatic spread. While many IM are diagnosed with a history of EM, IM may also be the first presentation of distant metastatic disease. In most cases, immunohistochemical testing is required to differentiate between primary breast cancer (PBC) and IM.
Summary
Recent research, focused on immunohistochemical markers, can guide diagnosticians in differentiating IM from PBCs. Key factors to consider when diagnosing any breast mass include a prior history of cancer, imaging characteristics, histologic findings that are atypical for PBCs, and the immunohistochemical profile of each lesion.
Citation: Simard A, Alhassan B, Sioufi J, Omeroglu A, Meterissian S.
Emergency Mastectomy for a Large Breast Mass: Unusual Presentation of Disseminated Pancreatic Adenocarcinoma. Am J Surg Case Rep. 2022;3(2):1029. Abstract Metastasis to breast from extramammary primary tumors is rare and account for 0.2% to 1.3% of malignant tumors in the breast. Pancreatic malignancies do not usually metastasize to the breast and very few cases have been reported in the literature. In this case report, we present an 81-year-old Caucasian female presenting with a large fungating breast mass with severe bleeding. Urgent mastectomy was performed, and pathology of the breast tumor was most consistent with a pancreatic tumor metastasizing to the breast. Palliative mastectomy for bleeding breast mass has been reported for other primary cancers and our case report is the first one reporting urgent palliative mastectomy for this histopathology. Emergency mastectomy should be considered for the rare presentation of exsanguinating hemorrhage from a large breast mass if the mass is deemed resectable from the chest wall.
Background:
Primary breast neuroendocrine tumors (BNETs) represent < 1% of breast cancers. Diagnosing BNETs can be challenging, and a limited amount of cohort data currently exists in literature. We aimed to describe primary BNET characteristics, treatment modalities, and survival outcomes through the National Cancer Database (NCDB).
Methods:
A retrospective cohort analysis was performed using the NCDB from 2004 to 2017. BNET cases were compared with patients with invasive ductal carcinoma (IDC). A matched IDC cohort was created by matching patient age, race, and disease stage. Kaplan-Meier analysis was performed, and hazard ratios (HR) were calculated through the bootstrap sampling method.
Results:
A total of 1389 BNET and 1,967,401 IDC cases were identified. When compared with IDC patients, BNET patients were older, had more comorbidities, and were more often male (p < 0.01). BNETs were larger, higher grade, and more frequently hormone receptor negative (p < 0.01). While BNET patients were treated with surgery and radiotherapy (p < 0.01) less often compared with IDC patients, they presented at later disease stage (p < 0.001) and received systemic treatment more frequently (53.5% vs. 40%, p < 0.01). Patients with BNET had increased mortality compared with the matched IDC cohort: stage 1 HR 1.8, stage 2 HR 2.0, stage 3 HR 1.8, and stage 4 HR 1.5 (p < 0.001 for all).
Conclusion:
Patients with BNET tend to present at higher clinical stages, are more frequently hormone receptor negative, and have inferior overall survival compared with patients with IDC. Further treatment strategies and studies are needed to elucidate optimal therapies to maximize patient outcomes.
