Abstract
BackgroundSecretory 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 presentationIn 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.ConclusionAfter 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.
Highlights
Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes found in adults
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
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
Summary
Since very few cases of secretory carcinoma have been described in literature, it is imperative to report any new cases observed in order to establish the most suitable therapeutic approach. We hypothesize that oestrogen- and progesterone-negative immunostain should not be considered as markers of an unfavourable outcome but, together with S100 and Cd10 positive immunostain, might be linked to the histogenetic origin of the tumour from the basal cells of the duct. The fact that this neoplasia is not very aggressive suggests that surgical treatment should be kept as conservative as possible. Since reports in literature have shown optimal results regarding the value of bioptic staging of the sentinel lymph gland, we are of the opinion that this treatment choice is valid in order to avoid axillary lymphadenectomy, useless in patients affected by neoplasias which are not aggressive, such as the secretory breast carcinoma
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