A pure invasive cribriform carcinoma of the breast with bone metastasis if untreated for thirteen years: a case report and literature review

Abstract

We report a case of pure invasive cribriform carcinoma of the breast, which had been untreated for thirteen years, being found with bone metastasis at initial presentation, because distant metastasis is rarely found in this tumor. A fifty-nine-year-old postmenopausal woman presented with a large left breast mass. Although she had noticed a lump in a left breast thirteen years ago, she had not sought treatment. The tumor had enlarged gradually since from one year before and become ulcerated. The two enlarged axillary lymph nodes were also palpable. After two cycles of neoadjuvant chemotherapy, she underwent left radial mastectomy with a free skin graft. Emission computed tomography result has confirmed bone metastasis. The histological diagnosis of the tumor revealed the pure invasive cribriform carcinoma, since over than ninety percent of invasive tumor components showed a characteristic cribriform growth, and the remainder was tubular carcinoma. She has been well without evidence of tumor recurrence for seven years after surgery and several routine postoperative therapies. Although with favorable prognosis, pure invasive cribriform carcinoma is still possible to develop into the advanced (Stage four) breast cancer if untreated for a long time. However, the survival of this patient for free disease after several locoregional and systemic therapies maybe provide a supplement for invasive cribriform carcinoma’s excellent prognosis.

Invasive cribriform carcinoma of the breast: A report of nine cases and a review of the literature

“…The study by Colleoni et al ( 8 ) recommended that favorable histotypes (e.g., the tubular, cribriform, mucinous and papillary types) with luminal tumors may be suitable for no therapy or endocrine therapy alone. However, such decisions must be made cautiously, as it is still possible to have local recurrence, as in the present case, or distant (bone) metastasis if not treated ( 7 ). We therefore hypothesize that chemotherapy and radiotherapy remain necessary for high-risk patients.…”

“…This result demonstrated that the prognosis of mixed ICC is less favorable than that of the pure form ( 1 , 3 , 15 ). However, pure ICC could also result in distant (bone) metastasis if untreated ( 7 ). In the present study, one patient who received radiotherapy and short-term hormonal therapy without chemotherapy developed local recurrence following breast-conserving surgery, which indicated that adjuvant chemotherapy may play an essential role following surgery.…”

“…The carcinoma has a low frequency of axillary nodal metastases and a favorable prognosis ( 2 ). Previous immunohistochemical studies ( 2 , 5 – 7 )have revealed that the majority of patients with ICC exhibited estrogen receptor (ER) and progesterone receptor (PR) positive tumors, while human epidermal growth factor receptor 2 (HER2) amplification was rarely observed ( 5 ). For this reason, some people recommended that this favorable histotype with luminal tumor may be suitable for no therapy or endocrine therapy alone ( 8 ).…”

Rare breast tumors: Review of the literature

“…The new definition of the World Health Organization (WHO) describes pure ICC as a carcinoma with infiltrating components presenting more than 90% of cells of invasive cribriform pattern. 9 The tumor may present as a frequently occult mass, difficult for radiological detecting. For this reason, the lesions are usually large at presentation although they grow slowly.…”

Untreated Axillary Node Metastasis of Occult Breast Primary Six Years after Diagnosis

“…One case report exists of a pure invasive cribriform carcinoma of the breast left untreated for 13 years. 4 Pure cribriform carcinoma is usually low grade and slowly progressive. Our tumor did not display these features, however.…”