MEMENİN NÖROENDOKRİN KARSİNOMU: 18 HASTA VE UZUN DÖNEM SONUÇLARI

Abstract

Amaç: Nöroendokrin meme karsinomu (NMK) nadir görülen ve özellikli bir meme tümörüdür. Bu alt tipin tedavisi ve prognozu ile ilgili bilgiler sınırlıdır. Çalışmamızda, bu nadir görülen tümörün klinikopatolojik özelliklerini, tedavisini ve klinik sonuçlarını inceledik. Gereç ve Yöntemler: Temmuz 2008 ve Ocak 2018 tarihleri arasında NMK tanısı alan hastaların verileri retrospektif olarak incelendi. Bulgular: Toplam kayıtlı 4896 meme kanseri hastasının 18’i NMK idi (toplam vakaların %0,4’ü). Ortanca yaş 61,5 (30-82) olarak bulundu. On üç hastaya (%72,2) meme koruyucu cerrahi uygulandı. Sekiz hastaya ise aksiller lenf nodu diseksiyonu yapıldı. Sadece bir hasta patolojik evre 3 iken tüm hastalar patolojik olarak T1 ve T2 idi. Ortanca tümör boyutu 20,5 mm (10-45) olarak bulundu. Sadece iki hasta küçük hücreli alt tipi iken 16 hasta iyi-diferansiye alt tipindeydi. Tüm hastalar hormon reseptör pozitif ve HER2/ neu negatifti. Ki-67 değeri bilinen 15 hastadan 3 tanesinde yüksek Ki-67 değeri (>%20) mevcuttu. Ortanca 101 (33-148) aylık takip süresinde lokal-bölgesel veya uzak rekürrens görülmedi. On sekiz hastada hastalığa bağlı ölüm görülmedi. Sonuç: NMK genellikle hormon reseptör pozitif ve HER2/neu negatif olacak şekilde luminal A veya B olarak tespit edilmektedir. Aksilla pozitif hastalar olsa da özellikle iyi-diferansiye alt grupta sağ kalımlar çok iyidir. Bu hastalarda daha az girişimsel tedavi seçenekleri göz önünde bulundurulmalıdır.

Keywords

• Nöroendokrinkarsinom
• meme neoplazmı
• prognoz

NEUROENDOCRINE CARCINOMA OF THE BREAST: 18 CASES WITH LONG-TERM FOLLOW-UP

Abstract

Objective: Primary neuroendocrine carcinoma of the breast (NECB) is a rare distinct type of breast carcinoma. There is limited data about the optimal management, treatment, and prognosis. Therefore, we analyzed the clinicopathological features, management and the clinical outcome of this rare breast carcinoma. Material and Methods: Patients diagnosed as NECB between July 2008 and January 2018 were included in the study. Medical records were retrospectively reviewed. Results: A total of 4,896 breast cancer patients were reviewed and 18 NECB (0.4% of all cases) were extracted. The median age was 61.5 (30-82). Thirteen cases (72.2%) underwent breast conserving surgery. Eight patients had axillary lymph dissection. All of the cases were pathological T1 and T2. Only one patient was pathological stage 3. Median tumor size was 20.5mm (10- 45). Only two cases presented with small cell subtype, the rest were well-differentiated. Hormone receptor was positive and HER2/neu was negative for all cases. Of the 15 patients with known Ki-67, three had high expressions (≥20%). No local or distant disease recurrences and death related with NECB were detected at a median follow-up period of 101 months (33-148). Conclusion: NECB is more likely to be hormone receptor positive and HER2/neu negative as luminal A or B subtype. An excellent clinical outcome is remarkable despite a substantial number of patients with axillary lymph node positivity specifically for well-differentiated subtype. Less invasive treatment options should be kept in mind.

Keywords

• Neuroendocrine carcinoma
• breast neoplasm
• prognosis

References

1. 1. Sapino A, Bussolati G. Is detection of endocrine cells in breast adenocarcinoma of diagnostic and clinical significance? Histopathology. 2002;40(3):211-14. [CrossRef]
2. 2. Righi L, Sapino A, Marchio C, Papotti M, Bussolati G. Neuroendocrine differentiation in breast cancer: Established facts and unresolved problems. Semin. Diagn. Pathol. 2010;27(1):69–76. [CrossRef]
3. 3. Tavassoli FA, Devilee P. Tumours of the breast. In: World Health Organization classification of tumors, pathology and genetics of tumors of the breast and female genital organs. Lyon: IARC Press; 2003, pp. 32-4.
4. 4. Wang J, Wei B, Albarracin CT,Hu J, Abraham SC, WuY. Invasive neuroendocrine carcinoma of the breast: a population-based study from the surveillance, epidemiology and end results (SEER) database. BMC Cancer. 2014;14:147-56. [CrossRef]
5. 5. Gunhan-Bilgen I, Zekioglu O, Ustun EE, Memis A, Erhan Y. Neuroendocrine differentiated breast carcinoma: Imaging features correlated with clinical and histopathological findings. Eur. Radiol 2003 ;13(4):788-93. [CrossRef]
6. 6. Lopez-Bonet E, Alonso-Ruano M, Barraza G, Vazquez- Martin A, Bernadoo L, Menendez JA. Solid neuroendocrine breast carcinomas: Incidence, clinico-pathological features and immunohistochemical profiling. Oncol. Rep 2008;20(6):1369-74.
7. 7. Wei B, Ding T, Xing Y, Wei W, Tian Z, Tang F, Abraham S, Nayeemuddin K, Hunt K, Wu Y. Invasive neuroendocrine carcinoma of the breast: a distinctive subtype of aggressive mammary carcinoma. Cancer 2010;116(19):4463-73. [CrossRef]
8. 8. Trevisi E, La Salvia A, Daniele L, Brizzi MP, De Rosa G, Scagliotti GV, Di Maio M. Neuroendocrine breast carcinoma: a rare but challenging entity. Med Oncol 2020;37(8):70. [CrossRef]

9. 9. Rosen LE, Gattuso P. Neuroendocrine Tumors of the Breast. Arch Pathol Lab Med 2017;141(11):1577-81. [CrossRef]
10. 10. Weigelt B, Horlings HM, Kreike B, Hayes MM, Hauptmann M, Wessels LF, et al. Refinement of breast cancer classification by molecular characterization of histological special types. J Pathol 2008;216(2):141-50. [CrossRef]
11. 11. Bogina G, Munari E, Brunelli M, Bortesi L, Marconi M, Sommaggio M, et al. Neuroendocrine differentiation in breast carcinoma: clinicopathological features and outcome. Histopathology 2016;68(3):422-32. [CrossRef]
12. 12. Lavigne M, Menet E, Tille JC, Lae M, Fuhrmann L, Bonneau C, et al. Comprehensive clinical and molecular analyses of neuroendocrine carcinomas of the breast. Mod Pathol 2018;31(1):68-82. [CrossRef]
13. 13. Özdirik B, Kayser A, Ullrich A, Savic LJ, Reiss M, Tacke F, et al. Primary Neuroendocrine Neoplasms of the Breast: Case Series and Literature Review. Cancers (Basel) 2020;12(3):733. [CrossRef]
14. 14. Zhang Y, Chen Z, Bao Y, Du Z, Li Q, Zhao Y, Tang F. Invasive neuroendocrine carcinoma of the breast: a prognostic research of 107 Chinese patients. Neoplasma 2013;60(2):215-22. [CrossRef]
15. 15. Cloyd JM, Yang RL, Allison KH, Norton JA, Hernandez- Boussard T, Wapnir IL. Impact of histological subtype on longterm outcomes of neuroendocrine carcinoma of the breast. Breast Cancer Res Treat 2014;148(3):637-44. [CrossRef]
16. 16. Özkurt E, Wong S, Rhei E, Golshan M, Brock J, Barbie TU. Omission of Surgical Axillary Lymph Node Staging in Patients with Tubular Breast Cancer. Ann Surg Oncol 2021;28(5):2589-98. [CrossRef]