Clinicopathologic and molecular characteristics of 44 patients with pure secretory breast carcinoma

Abstract

Objective Secretory breast carcinoma (SBC) is a rare type of breast malignancy, accounting for less than 0.02% of all infiltrating breast malignancies. The pure SBC, a type of SBC without another type of breast malignant neoplasm, is particularly rare. This study aimed to investigate the clinicopathologic and molecular features of pure SBC. Methods The main pathological parameters such as estrogen receptor (ER), progesterone receptor (PR), and human epithelial growth factor receptor 2 (C-erbB-2) were detected by immunohistochemistry (IHC), and the clinicopathologic and prognostic difference were compared with invasive ductal carcinoma (IDC). Fluorescent in situ hybridization (FISH) and reverse transcription polymerase chain reaction (RT-PCR) was performed to identify the ETV6-NTRK3 rearrangement of SBC. Results We found that the positivity rates of ER, PR, C-erbB-2, p53, and S-100 were 47.7% (21/44), 52.3% (23/44), 36.4% (16/44), 27.3% (12/44), and 95.5% (42/44), respectively, which were higher than those reported in previous studies. Special periodic acid-Schiff analysis was performed in 36 patients, and the value of the Ki-67 index ranged from 1% to 50% (mean value: 10%). Interestingly, most patients with pure SBC harbored an ETV6-NTRK3 rearrangement with an 88.6% (39/44) expression rate. Compared with IDC, the tumor size of most patients with SBC was larger than 2 cm ( P = 0.024). Ultrasound showed benign lesions, and the total misdiagnosis rate was higher ( P = 0.020). Although the pathological classification was mostly triple-negative breast cancers ( P = 0.036), there was less metastasis ( P = 0.029), and the overall prognosis was better than that of the IDC group. Conclusions Although axillary lymph node metastasis, local recurrence, or distant metastasis may occur, SBC is also considered an indolent neoplasm with a good prognosis. Once diagnosed, surgical treatment should be performed as soon as possible, followed by appropriate adjuvant chemotherapy, irradiation, and endocrine therapies.

Clinicopathologic profiling and oncologic outcomes of secretory carcinoma of the breast

“…The overwhelming majority of literature showed that SCB was negative for ER, PR, human epidermal growth factor (HER2), and positive for basal-cell markers, therefore could be classified as a peculiar subtype of TNBC 6 , 23 , 24 . Recent studies with large sample size concluded that SCB mimicked immunoprofile of hormone receptor positive cancer other than that of TNBC 5 , 11 , 25 , which was in stark contrast to the earlier reports. Our results were in support of the recent studies.…”

“…Horowitz et al 15 depicted that 5-year BCSS was 94.4% and 10-year BCSS was 91.4% in a study cohort of 83 patients. Recently, Li et al 11 uncovered that 5-year OS was 93.2%, and 10-year OS was 88.6% in a study cohort of 44 patients. Our results were in favor of prior studies, with a 5-year BCSS was 95.79%, 10-year and 20-year BCSS both were 93.16% as well as 5-year OS was 89.47%, 10-year OS was 81.58% and 20-year OS was 76.84%.…”

“…Usually, SCB has been reported as triple negative immunophenotype and positive staining for cytokeratins and EGFR, parallel to basal-like breast cancer, while the indolent clinical course as well as prolonged survival seem opposite to common triple negative breast cancer (TNBC) 6 – 8 . Of note, few studies demonstrated that SCB could present with positivity for hormone receptors 9 – 11 . Cytogenetically, ETV6-NTRK3 gene fusion is deemed as the most characteristic feature of genomic alteration of SBC 12 , 13 .…”

Secretory carcinoma of the breast, commonly exhibits the features of low grade, triple negative breast carcinoma- A Case report with updated review of literature

“…1 Afterward, it was shown that this tumor affects all age groups and can be detected in both males and females. 12 According to Jacob et al 13 the mean age of SBC is 56 years. 13 This tumor has an indolent clinical course, and according to Horowitz et al 2 the 5-year and 10-year cause-specific survival are 94.4% and 91.4%, respectively.…”

Secretory breast carcinoma in a female adult with liver metastsis: a case report and literature review

“…Immunohistochemically, the tumor cells are generally estrogen receptor (ER) and progesterone receptor (PR) negative, and do not show amplification or overexpression of human epidermal growth factor receptor 2 (HER2) [ 2 ]. The tumor cells, however, strongly express S-100 and CK5/6 in a characteristic pattern [ 3 ]. The presence of a balanced chromosomal translocation, t(12;15)(P13;q25), resulting in an Ets variant 6-neurotrophic receptor tyrosine kinase 3 (ETV6-NTRK3) fusion gene was reported by Tognon et al in 2002 [ 4 ].…”