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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 1  |  Page : 71-73
Primary neuroendocrine carcinoma of the breast


Department of Pathology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, India

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   Abstract 

Primary neuroendocrine carcinoma of the breast is rare-only about 30 cases have been reported in literature. Immunohistochemical examination showing expression of chromogranin and/or synaptophysin confirms evidence of neuroendocrine differentiation. Usually foci of neuroendocrine differentiation can be seen in breast carcinoma and are reported to be present in about 2-5% of breast cancer cases. Here, we report a case of breast carcinoma in which most of the areas studied on the tissue section showed neuroendocrine differentiation.

Keywords: Neuroendocrine carcinoma of breast, synaptophysin, chromogranin

How to cite this article:
Akhtar K, Zaheer S, Ahmad S S, Hassan M J. Primary neuroendocrine carcinoma of the breast. Indian J Pathol Microbiol 2009;52:71-3

How to cite this URL:
Akhtar K, Zaheer S, Ahmad S S, Hassan M J. Primary neuroendocrine carcinoma of the breast. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Apr 23];52:71-3. Available from: http://www.ijpmonline.org/text.asp?2009/52/1/71/44970



   Introduction Top


Many benign and malignant lesions of various organs may show neuroendocrine differentiation. [1] In many recent studies, the incidence of neuroendocrine differentiation in breast carcinoma is said to be between 2-5%. [2] Primary neuroendocrine carcinoma of the breast is rare. In a review of literature in 2005, Adegbola, et al . [3] have documented that less than 30 cases have been reported in literature. Primary neuroendocrine carcinoma of the breast is a group that exhibits morphological features similar to those of neuroendocrine tumors of both the gastrointestinal tract and the lung. They express neuroendocrine markers in more than 50% of the cell population. [4]

Here, we report a case of breast carcinoma in which most of the areas studied on the tissue section showed neuroendocrine differentiation.


   Case Report Top


A 40-year-old female presented to the breast surgeon with a history of pain and lump in the left breast for the past 45 days. Upon examination, a hard tender lump was felt in the breast measuring 5x6 cm. Local skin temperature overlying the lump was raised. An examination of the axilla showed multiple hard axillary swellings.

The patient underwent a fine needle aspiration examination of the breast including the axillary lymph node in which cells suspicious of malignancy were seen and the diagnosis of carcinoma breast with metastasis to the axillary lymph node was made. The patient underwent a radical mastectomy and the specimen was submitted for a histopathological examination. On gross examination, left breast tissue measuring 13x8x7 cm was received along with axillary tail and attached lymph nodes. On cut section, a well-defined tumor measuring 8.5x6.5x3 cm was present in the upper outer quadrant of the breast extending medially, firm in consistency with very few areas of hemorrhage and necrosis [Figure 1]. Upon microscopic examination, the breast tissue in the region of tumor showed tumor cells arranged in solid nests that were sharply outlined and separated by fibrovascular stroma [Figure 2]. Cells were relatively small and uniform in size and shape with granular nuclear chromatin and a moderate amount of granular eosinophilic cytoplasm [Figure 3]. An immunohistochemical examination revealed synaptophysin positivity [Figure 4] and the diagnosis of breast carcinoma with metastasis to the axillary lymph node was made.


   Discussion Top


In 1947, Volger indicated the existence of neuroendocrine cells in mammary tissue. [5] Neuroendocrine differentiation detected in breast carcinoma showed morphological similarities to carcinoma of the gastrointestinal system, lung, or other non endocrine organs with endocrine differentiation and carcinoid tumor. [1] In primary neuroendocrine carcinoma of the breast, more than 50% of the cell population shows neuroendocrine differentiation. [2] Breast carcinoma, not otherwise specified (NOS), with focal endocrine differentiation revealed by immunohistochemical expression in scattered cells is not included in this group. [2] Breast neuroendocrine carcinomas used to be known as argyrophilic breast carcinoma, breast carcinoid tumor, or endocrine carcinoma but now are classified as breast carcinoma with neuroendocrine differentiation or primary neuroendocrine breast carcinoma. [4],[6]

About 2-5% of breast carcinomas have neuroendocrine differentiation and are most commonly seen in the 6th to 7th decade of life in female patients.[2] The existence of neuroendocrine differentiation has also been shown in male breast carcinoma. [4] Clinically, there are no notable or specific differences in presentation from other tumor types in the breast. [4] Neuroendocrine breast carcinoma, on microscopic examination, usually shows alveolar structures or solid sheets of cells with a tendency to produce peripheral palisading. Depending upon the cell types, grade and degree of differentiation, neuroendocrine carcinoma has been categorized in the following subtypes: solid neuroendocrine carcinoma, small cell/oat cell carcinoma and large cell neuroendocrine carcinoma.[4] Grimelius staining is specific and demonstrates argyrophilia in neuroendocrine breast carcinoma. On ultra structural examination, dense core granule or electron dense granule is characteristic. An immunohistochemical examination showing expression of chromogranin and/or synaptophysin confirms evidence of neuroendocrine differentiation. [2]

A histopathological examination of our patient made us consider the presence of neuroendocrine differentiation because of the existence of nest and solid structures of group of uniform cells with round to oval hyperchromatic nuclei with salt and pepper chromatin and scanty cytoplasm showing rare mitosis. The immunohistochemical reaction was positive for synaptophysin.

This case showing neuroendocrine differentiation of the tumor with immunohistochemical findings is presented because of its rarity. To conclude, primary neuroendocrine carcinoma of the breast is a group that exhibits morphological features similar to those of neuroendocrine tumors of both the gastrointestinal tract and the lung. They express neuroendocrine markers in more than 50% of the cell population.

 
   References Top

1.Ozbilim G, Kilicarslan B, Tezer E, Buyukkece A, Ustun M, Karaveli S, et al . Breast carcinoma showing neuroendocrine differentiation characterized with ectopic hormone production (2 case report). Turk J Med Sci 2000;30:609-13.  Back to cited text no. 1    
2.Sapino A, Righi F, Cassoni P, Papotti M, Gugliotta P, Bussolati G. Expression of the neuroendocrine phenomenon in carcinoma of the breast. Semin Diagn Pathol 2000;17:127-37.  Back to cited text no. 2    
3.Adegbola T, Connolly CE, Mortimer G. Small cell neuroendocrine carcinoma of the breast: A report of three cases and review of the literature. J Clin Pathol 2005;58:775-8.   Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Ellis IO, Schnitt SJ, Sastre-Garau X. Invasive breast carcinoma. In: Tavassoli FA, Devilee P, editors. World health organization classification of tumours. Pathology and genetics of the tumours of breast and female genital organs. Lyon: IARC press; 2003. p. 13-59.  Back to cited text no. 4    
5.Volger E. Ueber das basilare Helle-Zellen-Organ der menschlichen Brustdruese. Klin Med year;2:159-68.   Back to cited text no. 5    
6.Tavosoli FA, Pathology of the breast. 1st ed. Norwalk: Connecticut. Appleton and Lange; 2000.  Back to cited text no. 6    

Top
Correspondence Address:
Sufian Zaheer
H. No. 4/1129, Sir Syed Nagar, Aligarh 202 002, UP
India
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DOI: 10.4103/0377-4929.44970

PMID: 19136787

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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