Abstract
Ileal neuroendocrine tumors are slow-growing grade 1 or, more rarely, grade 2 neuroendocrine tumors which, however, are frequently metastatic to regional lymph nodes and the liver. A few cases of ileal neuroendocrine tumors that are metastatic to the breast have also been reported in the medical literature. The knowledge of this uncommon clinical presentation is of great importance because it needs to be differentiated from primary breast carcinomas with neuroendocrine features, which represent completely different entities with a different therapeutic approach. The diagnosis of a breast metastasis from an ileal neuroendocrine tumor and its distinction from a well-differentiated primary neuroendocrine tumor of the breast is a challenging task for clinicians and pathologists. This workup is particularly difficult when the breast lesion is the first sign of malignancy. In the present paper, we describe the clinicopathological features of an ileal neuroendocrine tumor first presenting with a breast metastasis in a 50-year-old woman and we discuss the key diagnostic features for the differential diagnosis with primary well-differentiated neuroendocrine tumor of the breast. Moreover, we have reviewed the medical literature to give the reader a comprehensive overview on this topic.
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References
Capella C, Arnold R, Klimstra DS, Klöppel G, Komminoth P, Solcia E, Rindi G (2010) Neuroendocrine neoplasms of the small intestine. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO classification of tumours of the digestive system. IARC Press, Lyon, pp 102–107
Rindi G, Arnold R, Bosman FT, Capella C, Klimstra DS, Klöppel G, Komminoth P, Solcia E (2010) Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) WHO classification of tumours of the digestive system. IARC Press, Lyon, pp 13–14
La Rosa S, Rigoli E, Uccella S, Chiaravalli AM, Capella C (2004) CDX2 as a marker of intestinal EC-cells and related well-differentiated endocrine tumors. Virchows Arch 445:248–254
Chopin-Laly X, Walter T, Hervieu V, Poncet G, Adham M, Guibal A, Chayvialle JA, Lombard-Bohas C, Scoazec JY (2013) Neuroendocrine neoplasms of the jejunum: a heterogeneous group with distinctive proximal and distal subsets. Virchows Arch 462:489–499
Chodoff RJ (1965) Solitary breast metastasis from carcinoid of the ileum. Am J Surg 109:814–15
Schurch W, Lamoureux E, Lefebvre R, Fauteux JP (1980) Solitary breast metastasis: first manifestation of an occult carcinoid of the ileum. Virchows Archiv A 386:117–124
Ahlman H, Larsson I, Gronstad K, Tisell LE, Dahlstrom A (1986) A case of midgut carcinoid with breast metastasis and cellular localization of serotonin and substance P. J Surg Oncol 31:170–173
Lozowski MS, Faegenburg D, Mishriki Y, Lundy J (1989) Carcinoid tumor metastatic to breast diagnosed by fine needle aspiration. Case report and literature review. Acta Cytol 33:191–194
Di Palma S, Andreola S, Lombardi L, Colombo C (1988) Ileal carcinoid metastatic to the breast. Report of a case. Tumori 74:321–327
Stiglich F, Barbonetti C, Di Lorenzo E, Gherardi G, Bottinelli O, Bottinelli G, Campani R (1991) Breast metastasis of ileal carcinoid tumor. A case report. Radiol Med 82:362–363
Kaltsas GA, Putignano P, Mukherjee JJ, Satta MA, Lowe DG, Britton KE, Monson JP, Grossman AB, Besser GM (1998) Carcinoid tumours presenting as breast cancer: the utility of radionuclide imaging with 123I-MIBG and 111In-DTPA pentetreotide. Clin Endocrinol 49:685–689
Mosunjac MB, Kochhar R, Mosunjac MI, Lau SK (2004) Primary small bowel carcinoid tumor with bilateral breast metastases. Report of 2 cases with different clinical presentations. Arch Pathol Lab Med 128:292–297
Upalakalin JN, Collins LC, Tawa N, Parangi S (2006) Carcinoid tumors in the breast. Am J Surg 191:799–805
Gupta C, Malani AK, Rangineni S (2006) Breast metastasis of ilial carcinoid tumor: case report and literature review. World J Surg Oncol 4:15
Shahrokni A, Rajebi MR, Saif MW (2009) Breast metastasis of small bowel carcinoid tumor misdiagnosed as primary breast cancer. Ann Saudi Med 29:320–321
Geyer HL, Viney J, Karlin N (2010) Metastatic carcinoid presenting as a breast lesion. Curr Oncol 17:73–77
Soga J, Tazawa K (1971) Pathologic analysis of carcinoids; histologic reevaluation of 62 cases. Cancer 28:990–998
Lee A, Sahin A (2012) Metastases from extramammary malignancies to the breast. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijer MJ (eds) WHO classification of tumours of the breast. IARC Press, Lyon, pp 162–163
Tavassoli FA, Eusebi V (2009) Tumors of the mammary gland. AFIP Atlas of Tumor Pathology, series 4. American registry of Pathology, Washington DC
Alvarado Cabrero I, Pérez Montiel D, Tavassoli FA (2003) Metastases to the breast. Eur J Surg Oncol 29:854–855
Glazebrook KN, Jones KN, Dilaveri CA, Perry K, Reynolds C (2011) Imaging features of carcinoid tumors metastatic to the breast. Cancer Imaging 11:109–115
Williams SA, Ehlers RA 2nd, Hunt KK, Yi M, Kuerer HM, Singletary SE, Ross MI, Feig BW, Symmans WF, Meric-Bernstam F (2007) Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer 110:731–737
Perry KD, Reynolds C, Rosen DG, Edgerton ME, Albarracin CT, Gilcrease MZ, Sahin AA, Abraham SC, Wu Y (2011) Metastatic neuroendocrine tumour in the breast: a potential mimic of in-situ and invasive mammary carcinoma. Histopathology 59:619–630
Pavel M, Baudin, E, Couvelard A, Krenning E, Oberg K, Steinmuller T, Anlauf M, Wiedenmann B, Salazar R, et al. (2012) ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 95:157–176
Bussolati G, Badve S (2012) Carcinomas with neuroendocrine features. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijer MJ (eds) WHO classification of tumours of the breast. IARC Press, Lyon, pp 62–63
Viale G, Doglioni C, Gambacorta M, Zamboni G, Coggi G, Bordi C (1992) Progesterone receptor immunoreactivity in pancreatic endocrine tumors. An immunocytochemical study of 156 neuroendocrine tumors of the pancreas, gastrointestinal and respiratory tracts, and skin. Cancer 70:2268–2277
Harrist TJ, Kalisher L (1977) Breast metastasis: an unusual manifestation of a malignant carcinoid tumor. Cancer 40:3102–3106
Wozniak TC, Naunheim KS (1998) Bronchial carcinoid tumor metastatic to the breast. Ann Thorac Surg 65:1148–1149
Choi JJ, Buch KE, Warner RR, Divino CM (2011) Atypical lung carcinoid metastasis to breast: a case report. Pancreas 40:487–488
Hawley PR (1966) A case of secondary carcinoid tumours in both breast following excision of primary carcinoid tumour of the duodenum. Br J Surg 53:818–820
Adams RF, Parulekar V, Hughes C, Kadour MJ, Talbot D (2009) Radiologic characteristics and management of screen-detected metastatic carcinoid tumor of the breast: a case report. Clin Breast Cancer 9:198–192
La Rosa S, Chiaravalli AM, Placidi C, Papanikolaou N, Cerati M, Capella C (2010) TTF1 expression in normal lung neuroendocrine cells and related tumors: immunohistochemical study comparing two different monoclonal antibodies. Virchows Arch 457:497–507
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La Rosa, S., Casnedi, S., Maragliano, R. et al. Breast Metastasis as the First Clinical Manifestation of Ileal Neuroendocrine Tumor. A Challenging Diagnosis with Relevant Clinical Implications. Endocr Pathol 26, 145–151 (2015). https://doi.org/10.1007/s12022-015-9371-x
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DOI: https://doi.org/10.1007/s12022-015-9371-x