NEUROENDOCRINE DIFFERENTIATED BREAST CARCINOMA
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1 + NEUROENDOCRINE DIFFERENTIATED BREAST CARCINOMA
2 + INTRODUCTION
3 + NEUROENDOCRINE FEATURES IN BREAST CARCINOMA Incidence of 2-5% Seen in various histopathological types of breast carcinoma Seen in both in situ and invasive carcinoma Mucinous carcinoma has the greatest association
4 + NEUROENDOCRINE CELLS IN BREAST Focally scattered in normal breast Detected in upto 50% 0f breast carcinoma Differentia tion directly from the breast carcinoma Stem cell niches of the terminal end bud (TEB)
5 WHO CLASSIFICATION OF CARCINOMA WITH NEUROENDOCRINE FEATURES NEURO- ENDOCRINE TUMOR- WELL DIFFERENTI ATED SMALL CELL CARCINOMA /POORLY DIFFERENTI ATED INVASIVE BREAST CARCINOMA WITH NEURO ENDOCRINE FEATURES
6 + CASE REPORT
7 + CASE REPORT Case report Invasive Carcinoma Breast NST with neuroendocrine features
8 + CLINICAL PRESENTATION & INVESTIGATIONS 65-year-old elderly female Mass in the upper outer quadrant of the left breast. FNAC Cytological atypia & pleomorphism suggestive of malignancy Ultrasonogram BIRADS V. CT Head and neck, Chest, Abdomen Within Normal limits
9 + GROSS Modified radical mastectomy with axillary lymph node dissection Specimen measured 18.2 x13.4 x 8.6 cms Grossly the tumour measured cms 20 lymph nodes were retrieved
10 + SPECIMEN Grey white cms with areas of hemorrhage.
11 + MICROSCOPY Neuroendocrine component & necrosis
12 + Ductal component
13 + Neuroendocrine cells
14 + Mitosis 8-10/HPF
15 + IMMUNOHISTOCHEMISTRY ER Negative PR Negative Her 2 Negative
16 + CHROMOGRANIN Weak patchy positivity
17 + SYNAPTOPHYSIN Weak patchy positivity
18 + NEURON SPECIFIC ENOLASE Strong diffuse positivity
19 + Ki-67 Labelling Index 60% (counting 1000 cells)
20 + 1/20 LN showed deposits No vascular tumor emboli No perineural invasion All margins Free of tumor No DCIS or LCIS noted
21 + SCRAF BLOOM RICHARDSON SCORE- 6 NOTTINGHAM SCORE Moderately differentiated Intermediate grade
22 + DISCUSSION
23 + HISTORY Volger Discovered presence of neuroendocrine cells in normal breast tissue Cubilla and Woodruff Reported case of Primary neuroendocrine carcinoma of the breast
24 + NEUROENDOCRINE FEATURES Cellular monotony Nuclear palisading Pseudorosette formation Loss of cell cohesion Eosinophilic cytoplasm Stippled nuclei Salt and pepper chromatin
25 + MORPHOLOGY Main et al Production of mucin retained in cells or secreted Presence of insular structures seperated by fibrovascular stroma Low nuclear grade and granulous cytosol
26 + CLINICAL FEATURES Bussolati et al -No notable differences in presentation: palpable nodule circumscribed mass on mammogram or ultrasound -Endocrine hormone related syndromes is exceptionally rare -Increase in blood levels of neuroendocrine marker CHROMOGRANI N A
27 + DIAGNOSIS OF NEUROENDOCRINE FEATURES Gary et al- Any 1 of 3 positivity IHC Chromogranin A Synaptophysin Neurone specific enolase
28 + IMMUNOPROFILE Bussolati and Badve LOW OR INTERMEDIATE GRADE CHROMOGRANIN B or A- 50% SYNAPTOPHYSIN- 16% POORLY DIFFERENTIATED NON SPECIFIC ENOLASE- 100% CHROMOGRANIN/SYNAPTOP HYSIN- 50%
29 + HORMONE RECEPTORS Murthy et al Neuroendocrine carcinoma originating from breast: confirmed by an in-situ component & immunostaining for ER and PR positivity. But many published cases lacked this finding.
30 + HISTOLOGICAL GRADE Noccioli et al HIGH GRADE HIGH PROLIFER -ATION RATE POOR PROGNOSIS
31 + MUCIN PRODUCTION Sapino et al Mucin producing tumors Better prognosis Better 5 year survival
32 + DIFFERENTIAL DIAGNOSIS METASTATIC CARCINOID DCIS with similar features supports breast origin ER, PR and GCDFP-15 support primary breast carcinoma Small cell carcinoma LUNG: CK7- CK20- BREAST CK7 + CK20- LOBULAR CARCINOMA Small cell carcinoma can be confused wth Lobular carcinoma SMALL CELL CARCINOMA E- Cadherin+ in 100% of cases LOBULAR CARCINOMA E-Cadherin negative
33 + TREATMENT Tanwani et al Modified radical mastectomy Axillary lymph node dissection Adjuvant radiation and chemotherapy Based on clinical stage and metastasis
34 + CONCLUSION
35 + CONCLUSION Neuroendocrine component in composite tumours has to be reported Diagnosis- Neuroendocrine marker positivity Prognosis- Small cell carcinoma has worse prognosis
36 + REFERENCES
37 + REFERENCES 1.G. Bussolati and S. Badve, Carcinomas with neuroendocrine features, in WHO Classification of Tumours of the Breast, S. R. Lakhani, I. O. Ellis, S. J. Schnitt, P. H. Tan, and M. J. van de Vijver, Eds., pp , IARC Press, Lyon, France, Odile David, Meena Bhattacharjee, Diffuse neuroendocrine differentiation in a morphologically composite mammary infiltrating ductal carcinoma: a case report and review of the literature. Arch. Pathol. Lab Med., 127, e131 e Mücteba Gündüz, Yalın İşcan, Yeşim Erbil, Mahmut Müslümanoğlu, Neuroendocrine differentiated breast carcinoma: a case report. J. Breast Health 5 (4), Gajender Singh, Pansi Gupta, S.K.Mathur, Sant Prakash Kataria, Sanjay Kumar, Invasive mammary carcinoma with neuroendocrine differentiation: a diagnostic challenge. Int. J. Healthcare Biomed. Res. 2 (3), Eswari Varadharajan, Shanmuga Priya, Geetha Prakash, Archana Mugundan, Praveen Easwaramurthi, Mucinous carcinoma of the breast with neuroendocrine differentiation, Iran. J. Pathol. 10 (3), A.J. Cherian, P. Ramakant, D.T. Abraham, M.J. Paul, Primary neuroendocrine carcinoma of the breast a review. ARC J. Surg. 1 (1), Gary MK Tse, Tony KF Ma, Winnie CW Chu, Wynnie WM Lam, Cycles SP Poon, Wing- Cheong Chan. Neuroendocrine differentiation in pure type mammary mucinous carcinoma is associated with favorable histologic and immunohistochemical parameters. Mod Pathol 2004; 17(5):
38 + THANK YOU
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