Neuroendocrine Cancer of the Breast: A Rare Entity

Irelli, Azzurra; Sirufo, Maria Maddalena; Morelli, Luca; D'Ugo, Carlo; Ginaldi, Lia; Martinis, Massimo De

doi:10.3390/jcm9051452

Cited by 35 publications

(33 citation statements)

References 47 publications

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“…In 2012, WHO removed the second criterion in the above definition, i.e., the expression of NE markers in more than 50% of the tumor cells ( 11 ). In 2019, however, there was a radical change in the WHO classification of NE tumors/carcinomas, NE carcinoma was defined as an aggressive tumor, which is characterized by: low/intermediate grade, NE morphology, and supports the presence and supported by the presence of neurosecretory granule and diffuse, uniform immunoreactivity for NE markers ( 2 , 3 ). The first-line markers of NE differentiation are CgA, Syn, and CD56 ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

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Primary neuroendocrine carcinoma of the breast with markedly elevated alpha-fetoprotein: a case report

Wang¹,

Wang²,

Du³

et al. 2021

Transl Cancer Res TCR

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Primary neuroendocrine carcinoma of the breast (PNECB) is a relatively rare subtype of breast cancer that has seldom been studied since its initial description. At present, the pathogenesis of the disease remains unknown, and there exit no specific clinical guidelines or specifications for its diagnosis and treatment. In addition, alpha-fetoprotein (AFP)-despite being a tumor marker-plays a small role in the diagnosis of breast cancer. Here, we explain the diagnosis and treatment of primary neuroendocrine (NE) breast carcinoma in a patient with a markedly elevated level of AFP. A 52-year-old woman visited our hospital, reporting she had palpated a nodule in her left breast 1 day before admission. After ultrasonographic detection of the hypoechoic lesion in her left breast-which was classified according to the Breast Imaging Reporting and Data System (BI-RADS) as grade 4C-and the abnormal enlargement of her left axillary lymph nodes, the patient was referred to our department as a case of malignant breast tumor. Meanwhile, the level of the tumor marker AFP was found to be over 1,210 ng/mL (0-7 ng/mL). And the patient had no past medical history of increased AFP, abnormal liver function, or gastrointestinal tumor. Analysis of the surgical specimens obtained from the left breast showed grade II invasive ductal carcinoma with NE differentiation.After discussion with a multidisciplinary team (MDT), according to the results of pathological and immunohistochemical examinations, the patient was diagnosed with PNECB. Due to axillary lymph node metastasis, she received combined chemotherapy with cyclophosphamide, epirubicin, and paclitaxel on postoperative day 13. Up to now, six cycles of chemotherapy have been successfully administered, with no evidence of adverse reactions. AFP levels were all above 1,210 ng/mL during chemotherapy. At the time of submission, the patient has been followed up for 10 months and there has been axillary lymph node metastasis, but no tumors in other parts have been found. Therefore, we think that the increase in AFP levels is related to the occurrence and poor prognosis of PNECB.

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Section: Discussionmentioning

confidence: 99%

“…Primary neuroendocrine carcinoma of the breast (PNECB) is a rare tumor, representing only 0.5–1% of all breast carcinomas ( 1 , 2 ). In 2019, the World Health Organization redefined neuroendocrine (NE) tumors as aggressive tumors, and their characteristics are low/intermediate grade ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Primary neuroendocrine carcinoma of the breast with markedly elevated alpha-fetoprotein: a case report

Wang¹,

Wang²,

Du³

et al. 2021

Transl Cancer Res TCR

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“…It is acknowledged that sex drives most of these mechanisms and actors [ 23 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ]. However, it is not easy to draw conclusions on how these influences manifest themselves in different types of neoplasms, in individual people and how they interfere with different therapeutic strategies.…”

Section: Sex and Effectiveness Of Cancer Immunotherapymentioning

confidence: 99%

Sex and Gender Influences on Cancer Immunotherapy Response

et al. 2020

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The global burden of cancer is growing and a wide disparity in the incidence, malignancy and mortality of different types of cancer between each sex has been demonstrated. The sex specificity of cancer appears to be a relevant issue in the management of the disease, and studies investigating the role of sex and gender are becoming extremely urgent. Sex hormones are presumably the leading actors of sex differences in cancer, especially estrogens. They modulate gene expression, alter molecules and generate disparities in effectiveness and side effects of anticancer therapies. Recently immunotherapy aims to improve anticancer treatment strategies reducing off-target effects of chemotherapy and direct cancer cells killing. It is recognized as a fruitful strategy to treat and possible to cure cancer. Immunotherapeutic agents are used to activate or boost the activation of the immune system to fight cancer cells through physiological mechanisms often evaded in the offensive march of the disease. These therapeutic strategies have allowed new successes, but also have serious adverse effects including non-specific inflammation and autoimmunity. Sex and gender issues are of primary importance in this field, due to their recognized role in inflammation, immunity and cancer, and the clarification and understanding of these aspects is a necessary step to increase the responses and to diminish the adverse effects of immunotherapy. This review describes the available knowledge on the role of sex and gender in cancer immunotherapy, and will offer insights to stimulate the attention and practice of clinicians and researchers in a gender perspective of new cancer treatment strategies.

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“…The two most frequent subtypes of invasive BC are carcinoma not otherwise specified (70–75% of cases) and lobular carcinoma (12–15%). The other 18 subtypes exhibit specific morphological traits and are rare (0.5–5%) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Invasive Ductal Breast Cancer with Osteoclast-Like Giant Cells: A Case Report Based on the Gene Expression Profile for Changes in Management

Irelli

Sirufo

Quaglione³

et al. 2021

JPM

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We report the case of a 49-year-old woman diagnosed with a rare histotype of early breast cancer (BC), invasive ductal carcinoma with osteoclast-like giant cells (OGCs), from the perspective of gene profile analysis tests. The patient underwent a quadrantectomy of the right breast with removal of 2 cm neoplastic nodule and three ipsilateral sentinel lymph nodes. The Oncotype Dx gave a recurrence score (RS) of 23, and taking into account the patient’s age, an RS of 23 corresponds to a chemotherapy benefit of 6.5%. After a multidisciplinary collegial discussion, and in consideration of the patient’s age, the absence of comorbidity, the premenopausal state, the rare histotype and the Oncotype Dx report, the patient was offered adjuvant chemotherapy treatment followed by hormone therapy. This case may be an example of the utility of integrating gene expression profiling tests into clinical practice in the adjuvant treatment decision of a rare histotype BC. The Oncotype Dx test required to supplement the histological examination made us opt for the proposal of a combined treatment of adjuvant chemotherapy followed by adjuvant hormone therapy. It demonstrates the importance of considering molecular tests and, in particular, the Oncotype Dx, in estimating the risk of disease recovery at 10 years in order to identify patients who benefit from hormone therapy alone versus those who benefit from the addition of chemotherapy, all with a view toward patient-centered oncology. Here, we discuss the possible validity and limitations of the Oncotype Dx in a rare luminal A-like histotype with high infiltrate of stromal/inflammatory cells.

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Neuroendocrine Cancer of the Breast: A Rare Entity

Cited by 35 publications

References 47 publications

Primary neuroendocrine carcinoma of the breast with markedly elevated alpha-fetoprotein: a case report

Primary neuroendocrine carcinoma of the breast with markedly elevated alpha-fetoprotein: a case report

Sex and Gender Influences on Cancer Immunotherapy Response

Invasive Ductal Breast Cancer with Osteoclast-Like Giant Cells: A Case Report Based on the Gene Expression Profile for Changes in Management

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