Abstract
BackgroundSecretory carcinoma of the breast is one of the rarest entities, accounting for less than 0.15 % of all infiltrating breast carcinomas. It has characteristic histopathological and molecular features and, in general, a more favorable prognosis. In this case report, we describe a local, advanced secretory carcinoma of the breast with aggressive course and an unfavorable outcome.Case presentationA hard, painless, and palpably bossed mass approximately 12.0 cm in diameter occupied most of the left breast of a 39-year-old woman with fixation to the overlying skin. Breast ultrasonography and magnetic resonance imaging (MRI) scans gave the same grading as BI-RADS IV. A needle biopsy was performed, and the pathological diagnosis was secretory carcinoma. Neoadjuvant chemotherapy (NAC) was then performed, after which ultrasonography and MRI scans revealed chemo-resistance of the tumor to NAC. Left breast mastectomy and axillary lymphadenectomy were subsequently performed. Tumor cells were triple-negative and positive for S-100 and periodic acid-Schiff (PAS) staining. Fluorescence in-situ hybridization (FISH) analysis indicated a fusion arrangement of the ETV6-NTRK3 gene. The patient developed multiple distant metastases in the brain and died of these metastases 19 months after initial diagnosis.ConclusionsSecretory carcinomas of the breast have been described as a low-grade histologic subtype with a favorable prognosis. This case showed chemo-resistance to neoadjuvant chemotherapy, multiple distant metastases, and a final unfavorable outcome. Further research is needed to better understand the behavior and treatment of this rare tumor.
Highlights
Secretory carcinoma is a very rare type of breast carcinoma
Secretory carcinomas of the breast have been described as a low-grade histologic subtype with a favorable prognosis
This carcinoma of the breast has generally been described as having a favorable prognosis, which has suggested that treatment should be as conservative and non-aggressive as possible [5]
Summary
Secretory carcinoma is a very rare type of breast carcinoma. It was first reported in children and known as juvenile breast carcinoma [1], but it is known to occur in adults of both sexes. It was shown that an ETS variant 6-neurotrophic tyrosine kinase receptor type 3 (ETV6-NTRK3) gene fusion was associated with secretory carcinoma [3, 4] This carcinoma of the breast has generally been described as having a favorable prognosis, which has suggested that treatment should be as conservative and non-aggressive as possible [5]. We report a case of a 39-year-old woman who suffered from local advanced secretory carcinoma of the breast with chemo-resistance to neoadjuvant chemotherapy, subsequent multiple brain metastases, and had an unfavorable outcome. It has characteristic histopathological and molecular features and, in general, a more favorable prognosis In this case report, we describe a local, advanced secretory carcinoma of the breast with aggressive course and an unfavorable outcome. The patient developed multiple distant metastases in the brain and died of these metastases 19 months after initial diagnosis
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