J Breast Cancer.  2015 Dec;18(4):404-408. 10.4048/jbc.2015.18.4.404.

Primary Neuroendocrine Carcinoma of the Breast with Clinical Features of Inflammatory Breast Carcinoma: A Case Report and Literature Review

• Lee DH
• Park AY
• Seo BK
• Kim YS
• Lee KY
• Cha SH

• KMID: 2176294
• DOI: http://doi.org/10.4048/jbc.2015.18.4.404

Abstract

Primary neuroendocrine carcinoma of the breast (NECB) is a very rare type of invasive breast carcinoma. Most NECBs appear on breast imaging as solid masses of varied shapes and margins, and have worse clinical outcomes than does invasive ductal carcinoma, not otherwise specified. However, there have been no reports to date regarding NECB with features of inflammatory breast carcinoma. Here, we describe the clinical, radiol-ogic, and pathologic findings of the first reported case of primary NECB presenting as inflammatory breast carcinoma. The patient complained of diffuse right breast enlargement and erythema. Mammography identified severe breast edema and axillary lymphadenopathy. Ultrasound detected an irregular, angular, hypoechoic mass with dermal lymphatic dilatation. On magnetic resonance imaging, the mass had rim enhancement and the entire right breast showed heterogeneous enhancement with malignant kinetic features. Pathology identified the mass as a primary NECB with positive for synaptophysin, CD56, estrogen and progesterone receptors.

Keyword

Breast neoplasms; Magnetic resonance imaging; Neuroendocrine carcinoma; Ultrasonography

MeSH Terms

Breast Neoplasms
Breast*
Carcinoma, Ductal
Carcinoma, Neuroendocrine*
Dilatation
Edema
Erythema
Estrogens
Humans
Inflammatory Breast Neoplasms*
Lymphatic Diseases
Magnetic Resonance Imaging
Mammography
Pathology
Receptors, Progesterone
Synaptophysin
Ultrasonography
Estrogens
Receptors, Progesterone
Synaptophysin

Figure

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  Figure 1 Mammographic findings. Craniocaudal (CC) view (A), mediolateral oblique (MLO) view (B). Both CC and MLO views show severe skin thickening (arrowheads) in the right breast. There is dense dystrophic calcification in the right subareolar area. Enlarged lymph A B nodes (arrows) are also noted in both axilla.

• 

  Figure 2 Breast ultrasound (US) findings. (A) A breast US image shows diffuse skin thickening and dilatation of dermal lymphatics (arrowheads). (B) There is an angular-margined, irregular-shaped, hypoechoic mass (arrows) in the 9 o'clock position of the right breast. (C) There are enlarged lymph nodes with loss of internal fatty hila in the right axilla (arrows).

• 

  Figure 3 Breast magnetic resonance imaging findings. (A) Axial precontrast T2-weighted image shows an indistinct irregular high signal intensity mass (arrow) in the right 9 o'clock position and diffuse skin and chest wall edema (arrowheads). (B) Sagittal postcontrast T1-weighted image shows the mass (arrows) in the right 9 o'clock direction with rim enhancement. Multiple enlarged lymph nodes (white arrowheads) are seen in the right axilla. In the right subareolar area, there is a dark round lesion which corresponds to a calcification (black arrowhead). The entire breast parenchyma has heterogeneous enhancement.

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  Figure 4 Pathologic findings of the core biopsy specimen. (A) H&E staining shows irregular nests or interconnected trabecular formation of tumor cells with fine granular chromatin and indistinct nucleoli (×400). On immunohistochemistry, tumor cells show diffuse positive staining for synaptophysin (B), CD56 (C), and estrogen receptor markers (D) (×400).

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