International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Neuroendocrine tumor of the breast: Is it primary or metastatic?
Ornela A. Dervishaj1, Alexandra S. Renzi1, Romulo Genato1, Philip Q. Xiao2, Armand P. Asarian1
1Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201.
2Department of Pathology and Laboratory Medicine, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY 11201.

doi:10.5348/ijcri-201607-CR-10594

Address correspondence to:
Philip Xiao
MD, FCAP Chairman, Department of Pathology
The Brooklyn Hospital Center, Brooklyn
NY 11201

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How to cite this article
Dervishaj OA, Renzi AS, Genato R, Xiao PQ, Asarian AP. Neuroendocrine tumor of the breast: Is it primary or metastatic? Int J Case Rep Images 2016;7(1):34–39.


Abstract
Introduction: Neuroendocrine breast carcinoma is a rare form of tumor that may be either primary or metastatic.
Case Report: We present the case of a patient who was referred to our outpatient office with the diagnosis of a triple negative invasive breast carcinoma on an ultrasound-guided core needle biopsy. The patient subsequently underwent a lumpectomy with sentinel lymph node biopsy. Postoperative pathology revealed neuroendocrine carcinoma of the breast with sentinel lymph node biopsy negative for carcinoma. The tumor cells were positive for AE1/AE3, chromogranin, synaptophysin and CD-56 but negative for estrogen, progesterone and HER2. To exclude a primary carcinoma elsewhere, we obtained a whole body PET scan which showed a mildly hypermetabolic mesenteric mass in the midline with curvilinear calcification. Computed tomography scan of the abdomen and pelvis with oral and IV contrast showed a mass-like soft tissue within the terminal ileum with thickening of the cecum. An octreotide scan of the whole body revealed abnormal activity in the midline of the lower abdomen 6 hours and 24 hours after administration of octreotide. Colonoscopy showed a nodular friable mass in the ileocecal valve extending from the terminal ileum. Biopsy from the colonoscopy demonstrated a neuroendocrine carcinoma. The patient subsequently underwent a right hemicolectomy with primary anastomosis. Postoperative pathology was concordant with a neuroendocrine carcinoma and 9 of the 20 lymph nodes were positive for carcinoma. We performed a literature review to explore the reported incidence, diagnosis and treatment of this rare tumor metastasizing to the breast.
Conclusion: Differentiating between primary and metastatic tumor of the breast represents a challenge, albeit an important one, as the first disease can subject the patient to the morbidities of a mastectomy with axillary node dissection and the other is locally controlled.

Keywords: Breast cancer, Colorectal metastasis, Neuroendocrine tumor


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Author Contributions
Ornela A. Dervishaj – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alexandra S. Renzi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Romulo Genato – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Philip Q. Xiao – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Armand P. Asarian – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Ornela A. Dervishaj et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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