Neuroendocrine carcinoma of the breast: a case report and review of the literature

Neuroendocrine carcinoma (NEC) is a very rare condition among other types of invasive cancer of breast. Whole-body screening should be performed in order to detect any metastatic or primary disease localization. A 58-year-old patient admitted to hospital with palpable mass on the right retro areolar region and with bloody nipple discharge. Due to axillary positivity with a diagnosis of neuroendocrine carcinoma neoadjuvant chemotherapy was performed. The pathological stage was reported T2N2 with a 2 cm tumor and 5 of 11 lymph node positivity after modified radical mastectomy following neoadjuvant therapy. Tumor cells were stained with positive for neuroendocrine markers. She received adjuvant hormonal treatment with aromatase inhibitors and on regular follow-up with a free of disease to date. The neuroendocrine tumor of the breast is a diagnosis of exclusion. Primary or metastasis distinction is compulsory for the planning of appropriate treatment. There is still a debate on how neuroendocrine differentiation affects the clinical outcome.

___

  • 1. Cubilla AL, Woodruff JM. Primary carcinoid tumor of breast: a report of eght patients. Am J Sur Pathol 1977;1:283-92.
  • 2. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-59.
  • 3. Singh S, Aggarwal G, Kataria SP, Kalra R, Duhan A, Sen R. Primary neuroendocrine carcinoma of breast. J Cytol 2011;28:91-2.
  • 4. Sapino A, Bussolati G. Is detection of endocrine cells in breast adenocarcinoma of diagnostic and clinical significance? Histopathology 2002;40:211-4.
  • 5. Wang J, Wei B, Albarracin CT, Hu J, Abraham SC, Wu Y. Invasive neuroendocrine carcinoma of the breast: a population-based study from the surveillance, epidemiology and end results (SEER) database. BMC Cancer 2014;14:147.
  • 6. Sapino A, Righi L, Cassoni P, Papotti M, Gugliotta P, Bussolati G. Expression of apocrine differentiation markers in neuroendocrine breast carcinomas of aged women. Mod Pathol 2001;14:768-76.
  • 7. Righi L, Sapino A, Marchiò C, Papotti M, Bussolati G. Neuroendocrine differentiation in breast cancer: established facts and unresolved problems. Semin Diagn Pathol 2010;27:69-76.
  • 8. Adams RF, Parulekar V, Hughes C, Kadour MJ, Talbot D. Radiologic characteristics and management of screen-detected metastatic carcinoid tumor of the breast: a case report. Clin Breast Cancer 2009;9:189-92.
  • 9. Park YM, Wu Y, Wei W, Yang WT. Primary neuroendocrine carcinoma of the breast: clinical, imaging, and histologic features. Am J Roentgenol 2014;203:W221-30.
  • 10. Tang F, Wei B, Tian Z, Gilcrease MZ, Huo L, Albarracin CT, et al. Invasive mammary carcinoma with neuroendocrine differentiation: histological features and diagnostic challenges: histological features of mammary NEC. Histopathology 2011;59:106-15.
  • 11. Gould VE, Lee I, Wiedenmann B, Moll R, Chejfec G, Franke WW. Synaptophysin: a novel marker for neurons, certain neuroendocrine cells, and their neoplasms. Human Pathol 1986;17:979-83.
  • 12. Tapia FJ, Barbosa AJA, Marangos PJ, Polak JM, Bloom SR, Dermody C, et al. Neuron-specific enolase is produced by neuroendocrine tumors. Lancet. 1981;317:808-11.
  • 13. Mohanty SK, Kim SA, DeLair DF, Bose S, Laury AR, Chopra S, et al. Comparison of metastatic neuroendocrine neoplasms to the breast and primary invasive mammary carcinomas with neuroendocrine differentiation. Mod Pathol 2016;29:788-98.
  • 14. Wei B, Ding T, Xing Y, Wei W, Tian Z, Tang F, et al. Invasive neuroendocrine carcinoma of the breast: a distinctive subtype of aggressive mammary carcinoma. Cancer 2010;116:4463-73.
  • 15. Wolff AC, Hammond MEH, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007;131:18-43.
  • 16. La Rosa S, Capella C, Sessa F, Riva C, Leone BE, Klersy C, et al. Prognostic criteria in nonfunctioning pancreatic endocrine tumours. Vichows Archiv A Pathol Anat.1996;429:323-33.
  • 17. Squires MH, Volkan Adsay N, Schuster DM, Russell MC, Cardona K, Delman KA, et al. Octreoscan versus FDG-PET for neuroendocrine tumor staging: a biological approach. Ann Surg Oncol 2015;22:2295-301.
  • 18. Putzer D, Gabriel M, Henninger B, Kendler D, Uprimny C, Dobrozemsky G, et al. Bone metastases in patients with neuroendocrine tumor: 68Ga-DOTA-Tyr3-octreotide PET in comparison to CT and bone scintigraphy. J Nucl Med 2009;50:1214-21.
  • 19. Irelli A, Sirufo MM, Morelli L, D’Ugo C, Ginaldi L, De Martinis M. Neuroendocrine cancer of the breast: a rare entity. J Clin Med 2020;9:1452.
  • 20. Adams RW, Dyson P, Barthelmes L. Neuroendocrine breast tumours: breast cancer or neuroendocrine cancer presenting in the breast? Breast 2014;23:120-7.