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Secretory breast carcinoma with metastatic sentinel lymph node.

Vieni S, Cabibi D, Cipolla C, Fricano S, Graceffa G, Latteri MA - World J Surg Oncol (2006)

Bottom Line: Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults.We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up.

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Affiliation: Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy. salvatorevieni@tiscali.it

ABSTRACT

Background: Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases.

Clinical presentation: In this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression. We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.

Conclusion: After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice.

No MeSH data available.


Related in: MedlinePlus

(A) PAS positive secretory material in ductular lumina and, as globular structures, in intracytoplasmic vacuoles (arrows). (B) Positive immunostain for S100 antibody, (C) Positive immunostain for E-cadherin, (D) Metastasis to sentinel lymph node. (Original magnification: A 400X; B and C 200X; D 100X).
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Figure 1: (A) PAS positive secretory material in ductular lumina and, as globular structures, in intracytoplasmic vacuoles (arrows). (B) Positive immunostain for S100 antibody, (C) Positive immunostain for E-cadherin, (D) Metastasis to sentinel lymph node. (Original magnification: A 400X; B and C 200X; D 100X).

Mentions: For microscopic examination, 5 micron sections were obtained from formalin-fixed, paraffin- embedded material and stained with hematoxylin-eosin and Alcian PAS. The lesion showed solid cell nests, intermingled with tubular structures and separated by fibrous bundles. The neoplastic nests consisted of small, uniform, well-differentiated cells, with granular or vacuolated cytoplasm and vescicular nuclei containing small nucleoli. Mitoses were scanty and atypia was mild. Eosinophilic, PAS-positive secretory material was frequently observed in the ductular lumina and, in the form of globular structures, in the intracytoplasmic vacuoles of many neoplastic cells (fig 1a). Peripherally, in the more ductular areas, extracellular Alcian blue-positive material (reminiscent of a mucinous carcinoma) was present. Vascular invasion was not evident. Immunohistochemically the neoplastic cells showed a strong positive stain for cytokeratins (MNF116, CK7) EMA, S100 (fig 1b) and e-cadherin (fig 1c). In addition, an extremely focal, weak stain for 34beta E12 and CD10 was observed.


Secretory breast carcinoma with metastatic sentinel lymph node.

Vieni S, Cabibi D, Cipolla C, Fricano S, Graceffa G, Latteri MA - World J Surg Oncol (2006)

(A) PAS positive secretory material in ductular lumina and, as globular structures, in intracytoplasmic vacuoles (arrows). (B) Positive immunostain for S100 antibody, (C) Positive immunostain for E-cadherin, (D) Metastasis to sentinel lymph node. (Original magnification: A 400X; B and C 200X; D 100X).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1764883&req=5

Figure 1: (A) PAS positive secretory material in ductular lumina and, as globular structures, in intracytoplasmic vacuoles (arrows). (B) Positive immunostain for S100 antibody, (C) Positive immunostain for E-cadherin, (D) Metastasis to sentinel lymph node. (Original magnification: A 400X; B and C 200X; D 100X).
Mentions: For microscopic examination, 5 micron sections were obtained from formalin-fixed, paraffin- embedded material and stained with hematoxylin-eosin and Alcian PAS. The lesion showed solid cell nests, intermingled with tubular structures and separated by fibrous bundles. The neoplastic nests consisted of small, uniform, well-differentiated cells, with granular or vacuolated cytoplasm and vescicular nuclei containing small nucleoli. Mitoses were scanty and atypia was mild. Eosinophilic, PAS-positive secretory material was frequently observed in the ductular lumina and, in the form of globular structures, in the intracytoplasmic vacuoles of many neoplastic cells (fig 1a). Peripherally, in the more ductular areas, extracellular Alcian blue-positive material (reminiscent of a mucinous carcinoma) was present. Vascular invasion was not evident. Immunohistochemically the neoplastic cells showed a strong positive stain for cytokeratins (MNF116, CK7) EMA, S100 (fig 1b) and e-cadherin (fig 1c). In addition, an extremely focal, weak stain for 34beta E12 and CD10 was observed.

Bottom Line: Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults.We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy. salvatorevieni@tiscali.it

ABSTRACT

Background: Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases.

Clinical presentation: In this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression. We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.

Conclusion: After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice.

No MeSH data available.


Related in: MedlinePlus