Secretory breast carcinoma in a female adult with liver metastsis: a case report and literature review

Background Secretory breast carcinoma is an uncommon subset of breast cancer that usually has a favorable outcome. Although initially described in children, it also occurs in adults where it may metastasize, possibly resulting in death. To date, only 20 cases of secretory breast carcinoma with distant metastases have been described. Case presentation A 42-year-old female presented with liver metastasis after modified radical mastectomy of the left breast in 2008 at 34 years of age. The liver metastasis was morphologically similar to the primary tumor. Pan-TRK and Fluorescence in situ hybridization showed a rearrangement in the ETV6 gene. She subsequently underwent adjuvant chemotherapy with a fatal outcome. Conclusions Although secretory breast carcinoma is usually associated with favorable outcomes, our study and reviews provide a novel insight into the genetic spectrum and treatment of secretory breast carcinoma showing reduced expression of hormone receptors, abnormal genomic profiles, and possible poor prognosis. Targeted therapy may curb clinically aggressive cases. Additional molecular investigations are needed to determine the links between specific mutations and poor prognosis.

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

Secretory breast carcinoma in adulthood: A case report with literature review

Introduction. Secretory breast carcinoma is rare subtype of breast carcinoma which occurs primarily in children and young adults, so in the past it was called juvenile carcinoma. Case report. A 67-year-old female patient presented with mass of the right breast since one month. After physical, routine laboratory examination and mammography, core needle biopsy was performed and histopathological examination confirmed invasive carcinoma. Immunohistochemically, estrogen-receptors (ER) and progesteron-receptors (PR) showed weak positive reaction in 10% of tumor cells, while human epidermal growth factor receptor-2 (HER-2) was without expression. After an adequate preoperative preparation, operation was done ? quadrantectomy with sentinel lymph node biopsy. Postoperatively, the patient was treated with 6 cycles of cyclophosphamide, methotrexate and fluorouracil (CMF) combination, radiotherapy (60 Gy) and tamoxifen. After 5-year follow-up the patient had no signs of the disease. Conclusion. Secretory breast cancer is a rare subtype of invasive breast carcinoma with wide age range of occurrence and good prognosis despite its triplenegative immunophenotype. Although the therapeutic management is non-consensual for this breast cancer special type, surgery is considered the mainstay of the treatment as well as the adjuvant chemotherapy and radiation.

How I treat NTRK gene fusion-positive cancers

NTRK fusions are found at low frequencies (commonly <1%) in a range of common tumour types and at high frequencies (up to or greater than 90%) in rare cancer types (secretory breast carcinoma, mammary analogue secretory carcinoma and infantile fibrosarcoma). The fusions typically occur in a mutually exclusive fashion with other strong mitogenic drivers, and it is of significant importance to identify patients in order to offer transformative treatment with TRK inhibitors. Larotractinib or entrectinib have resulted in fast and durable response with few and reversible adverse events. Even though on-target resistance may occur, second generation TRK inhibitors are in development and have shown promising activity. Diagnostic strategies must be applied, considering available assays and specific tumour types.