Metastatic secretory breast cancer. Non-responsiveness to chemotherapy: Case report and review of the literature

Abstract

Secretory carcinoma of the breast is a rare and indolent tumour originally described in children but occurring equally in the adult population. The principal management problems following primary surgical treatment are local recurrence and axillary lymph node metastases. Distant metastases are extremely rare. We present the case of a 27-year-old woman with pulmonary metastases from a secretory breast cancer treated by mastectomy and axillary lymph node dissection 12 years previously. There was no response to chemotherapy; however, the patient remained alive and active two years from presentation with metastatic disease and one year from cessation of all cytotoxic chemotherapy. She eventually died of respiratory failure two and a half years after presentation. To our knowledge, this is only the fourth reported case of distant metastases from secretory breast cancer and the second reported case in which current active chemotherapy has been used. We review the literature and discuss the apparent chemoresistance of this tumour including the lack of membrane staining for Her2/neu. In the absence of any proven effective chemotherapy we believe that symptom control becomes the focus of management and offers patients with metastatic secretory breast cancer the greatest chance of a functional and good quality existence.

Secretory breast carcinomas with ETV6-NTRK3 fusion gene belong to the basal-like carcinoma spectrum

“…22 Previous published series and case reports indicated that secretory breast carcinoma is associated with a more favorable outcome than other subtypes of invasive breast carcinomas. 11 However, more recent studies have showed that outcome is age-related.…”

Secretory breast carcinoma—case report and review of the medical literature

“…It was originally termed 'juvenile breast cancer' by McDivitt and Stewart in 1966, because the only known patients were children or very young women. [1][2][3] However, subsequent studies have included many adult patients, including a substantial number of postmenopausal women, so much so that approximately two-thirds of the almost 100 published cases have been in adults. Consequently, the term juvenile breast cancer has been replaced by the more descriptive 'secretory breast cancer' (SBC).…”

“…Consequently, the term juvenile breast cancer has been replaced by the more descriptive 'secretory breast cancer' (SBC). 3,4 The tumour can occur anywhere in the breast. It frequently presents as a mobile, well-circumscribed, subareolar mass, sometimes simulating fibroadenoma.…”

“…It frequently presents as a mobile, well-circumscribed, subareolar mass, sometimes simulating fibroadenoma. 3,5 Although it is well circumscribed macroscopically, there may be foci of invasion in the surrounding breast tissue and associated ductal carcinoma in situ (DCIS), which can be responsible for local recurrence after incomplete excision. 3,4 Three histological patterns are seen, in varying combinations: tubular, compact and honeycomb.…”

Secretory Breast Carcinoma With Extensive Intraductal Component: Case Report

“…Distant spread is extremely rare, but when it occurs chemo-resistance, leading to adverse prognosis and dismal outcome, should be suspected. However, patients with secretory carcinomas, in contrast to stage-matched ductal counterparts, have better survival [6]. Despite all favorable features, adequate surgical treatment consists of mastectomy, rather than local excision [1,[7][8][9].…”