Estrogen Receptor Positive Secretory Breast Carcinoma in a Bangladeshi Elderly Woman Diagnosed by Core Needle Biopsy

Secretory carcinoma is an extremely rare subtype of low grade invasive breast carcinoma and occurs infrequently in adults showing belligerent clinical course than in children. Surprisingly, it is the only epithelial carcinoma of breast representing characteristic balanced translocation.This paper reports a case of secretory breast carcinoma in an elderly post-menopausal woman in Bangladesh which is diagnosed by core needle biopsy. The majority of the case reports claimed this tumor to be a triple negative breast carcinoma, whereas our case report reveals a slightly different status in immunohistochemical context. A 78-years old, post-menopausal female presented with the chief complaints of painless, slowly enlarging lump in her left breast over nine months. Breast examination revealed a 2x1.5cm, well-delineated, firm, non-tender and mobile mass in the lower-outer quadrant of the left breast. Microscopically, the tumor was composed of cells containing PAS positive, diastase resistant and mucicarmine positive intra and extra-cellular secretory material and Alcian blue positive secretion was found extracellularly. The tumor cells showed strongly positive immunohistochemical reactivity for cytokeratin, EMA, E-cadherin and vimentin and focal positive reaction for S-100 protein and estrogen receptor but negative for both progesterone receptor and human epidermal growth factor receptor. Ki-67 proliferative index was about 4%. Hence, the diagnosis of secretory breast carcinoma (SBC) was made. The patient underwent modified radical mastectomy with axillary clearance without any axillary lymphnode involvement in an external center. The patient has not received any radio or chemotherapy. The patient was under continuous follow-up for 3-months.Unfortunately, owing to the nation-wide lockdown for dreadful COVID-19 pandemic, the patient couldn’t arrive at the hospital for further follow-up evaluation. Immunohistochemical (IHC) analysis has been proven to be an alternative potential method as gene analysis. Immunoprofiling of secretory breast carcinomas may play the pivotal role for selecting therapeutic strategies and predicting prognostic outcome of the disease process. Comprehending the immunohistochemical expression would make scope for applying targeted therapy in SBC patients in future. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 216-223

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Feasibility of the Less Is More Approach in Treating Low-Risk Ductal Carcinoma In Situ Diagnosed on Core Needle Biopsy: Ten-Year Review of Ductal Carcinoma In Situ Upgraded to Invasion at Surgery

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0268-oa ◽

2018 ◽

Vol 142 (9) ◽

pp. 1120-1126 ◽

Cited By ~ 9

Author(s):

Mirna B. Podoll ◽

Emily S. Reisenbichler ◽

Lania Roland ◽

Andrew Bruner ◽

Sarah Mizuguchi ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Low Risk ◽

Low Grade ◽

Core Needle

Context.— Ductal carcinoma in situ (DCIS) represents 20% of screen-detected breast cancers. The likelihood that certain types of DCIS are slow growing and may never progress to invasion suggests that our current standards of treating DCIS could result in overtreatment. The LORIS (LOw RISk DCIS) and LORD (LOw Risk DCIS) trials address these concerns by randomizing patients with low-risk DCIS to either active surveillance or conventional treatment. Objective.— To determine the upgrade rate of DCIS diagnosed on core needle biopsy to invasive carcinoma at surgery and to evaluate the safety of managing low-risk DCIS with surveillance alone, by characterizing the pathologic and clinical features of upgraded cases and applying criteria of the LORD and LORIS trials to these cases. Design.— A 10-year retrospective analysis of DCIS on core needle biopsy with subsequent surgery. Results.— We identified 1271 cases of DCIS on core needle biopsy: 200 (16%) low grade, 649 (51%) intermediate grade, and 422 (33%) high grade. Of the 1271 cases, we found an 8% upgrade rate to invasive carcinoma (n = 105). Nineteen of the 105 upgraded cases (18%) had positive lymph nodes. Low-grade DCIS was least likely to upgrade to invasion, comprising 10% (10 of 105) of upgraded cases. Three of the 105 upgraded cases (3%) met criteria for the LORD trial, and all were low-grade DCIS on core needle biopsy with favorable biology on follow-up. Conclusions.— There is a clear risk of upgrade to invasion on follow-up excision; however, applying strict criteria of the LORD trial effectively decreases the likelihood of a missed invasive component or missed aggressive pathologic features.

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A difficult-to-diagnose fibromatosis-like metaplastic carcinoma of the breast: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01110-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Daiki Takatsuka ◽

Hiroyuki Ogura ◽

Yuko Asano ◽

Akiko Nakamura ◽

Kei Koizumi ◽

...

Keyword(s):

Cell Carcinoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Metaplastic Carcinoma ◽

Low Grade ◽

Carcinoma Of The Breast ◽

Breast Ultrasonography ◽

Core Needle ◽

Spindle Cells

Abstract Background Fibromatosis-like metaplastic carcinoma (FLMCa), classified as a metaplastic carcinoma of the breast, is a very rare type of metaplastic carcinoma. We report a case of FLMCa that was difficult to diagnose. Case presentation The patient was a 56-year-old postmenopausal woman who presented with a left-sided breast mass. A 1.3-cm irregular mass was found in the lower outer quadrant of the left breast on breast ultrasonography. She underwent core needle biopsy and vacuum-assisted biopsy, but the pathological findings only revealed inflammatory cell infiltration and a high level of fibrosis, with no malignant findings. At 3 months follow-up, she underwent a repeat breast ultrasonography, which revealed an increase in the size of the mass to 1.8 cm, and a repeat core needle biopsy, which showed a few spindle cells and squamous cells positive for cytokeratin (CK)5/6 and AE1/AE3, leading to the suspicion of FLMCa. Since the amount of tissue was insufficient to establish a definitive diagnosis, she underwent a lumpectomy. We found low-grade and slightly atypical spindle cells and partly atypical spindle cell carcinoma and squamous cell carcinoma. CK5/6 and α-SMA were positive, thus confirming FLMCa. Because the margins on the edge of the nipple side and anterior side were “ink on tumor”, she underwent a mastectomy and sentinel lymph node biopsy. After the surgery, she received adjuvant chemotherapy. At 3 years and 8 months of follow-up, no recurrent or metastatic lesions were identified in her body. Conclusions FLMCa should be considered in the differential diagnosis when collagenous fibers are proliferating and malignancy is clinically suspected. Immunohistochemical analysis may be helpful in confirming this diagnosis.

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