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      Tumor neuroendocrino de la mama: Presentación de un caso Translated title: Breast neuroendocrine tumor: A case presentation

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          Abstract

          Se presenta el caso del primer tumor neuroendocrino de la mama diagnosticado en el Hospital Ginecoobstétrico Docente de Guanabacoa. Se trata de una paciente de 77 años de edad, con una tumoración exofítica de la mama izquierda y antecedentes referidos de hipertensión arterial. El diagnóstico fue realizado por histología y confirmado con técnicas de inmunohistoquímica; fueron positivos las pruebas de enolasa, cromogranina y receptores de estrógeno. Se destaca la baja malignidad del tumor, su forma de crecimiento exofítico, el patrón histológico neuroendocrino puro y las manifestaciones clínicas sistémicas en posible relación con el tumor.

          Translated abstract

          This paper presents the case of the first breast neuroendocrine tumor diagnosed in the Teaching Gynecobstetric Hospital of Guanabacoa. It is a 77 years-old female patient having an exophytic tumor in her left breast and history of hypertension. The diagnosis was made using histology immunohistochemistry techniques; enolase, chromogranine and estrogen-receptors tests were positive. The low malignity of the tumor, its exophytic growth, its pure histologic neuroendocrine pattern and the systemic clinical manifestations that may be related to the tumor are underlined.

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          Endocrine ductal carcinoma in situ (E-DCIS) of the breast: a form of low-grade DCIS with distinctive clinicopathologic and biologic characteristics.

          Endocrine ductal carcinoma in situ (E-DCIS), first characterized by Cross et al. in 1985, is an uncommon entity, and there is little information on its pathobiologic features and natural history in the literature. This report describes the largest series of 34 cases: 14 cases were pure in situ (group A), and 20 were accompanied by an invasive component (group B). All except three patients were over the age of 60 years, with the mean being 69.5 years for group A and 72.6 years for group B. Except for six patients in group A who had nipple discharge, all had a breast mass. On follow-up, one of five group A patients developed local recurrence 5 years after mastectomy, and two of seven group B patients developed another invasive primary in the contralateral breast. Histologically, E-DCIS showed expansile intraductal growths forming solid sheets and festoons traversed by delicate fibrovascular septa. Accumulation of basophilic mucin might be found within the growth and the fibrovascular septa. There were variable degrees of stromal sclerosis. In some cases, the solid intraductal cellular proliferations were focally punctuated by microglandular spaces and rosettes. Comedo necrosis was absent. Intraductal papillomas were found in the immediate vicinity of the tumors in 18 cases and invariably showed pagetoid involvement by E-DCIS. Pagetoid spread into the adjacent ducts and ductules was also a common feature (17 cases). The tumor cells were polygonal, oval, or spindly, often with eccentrically placed, bland-looking, ovoid nuclei and abundant eosinophilic granular cytoplasm. Intracellular mucin was commonly demonstrable. Immunostaining for myoepithelium using muscle-specific actin antibody confirmed the in situ nature of the E-DCIS component. The majority of tumor cells showed strong staining with the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase (monoclonal). Immunostaining also dramatically highlighted the pagetoid spread into the papillomas and ductules by outlining the tumor cells between the negatively stained residual ductal epithelium and myoepithelium. All cases were immunoreactive for estrogen and progesterone receptor, but not p53 and c-erbB2. The Ki-67 index was < 5%. Ultrastructural studies on four cases showed many dense-core neurosecretory granules and larger mucigen granules. In group B cases, the invasive component, which comprised 5-95% of the tumor, included colloid carcinoma, 12; "carcinoid" tumor, 3; mixed "carcinoid"/colloid carcinoma, 4; and small cell neuroendocrine carcinoma, 1. Neuroendocrine markers were also consistently demonstrable in the invasive component. In conclusion, E-DCIS is predominantly a disease of older women that is frequently accompanied by papillomas in the vicinity and may present as nipple discharge (an uncommon presentation in the usual forms of DCIS). It can mimic epitheliosis histologically, but the pagetoid spread is a helpful clue to its neoplastic nature. The bland nuclear morphology, lack of necrosis, and biologic marker profile suggest that E-DCIS is a form of low-grade DCIS despite its solid growth pattern. The invasive carcinomas associated with E-DCIS are also neuroendocrine programmed rather than the usual types of ductal carcinomas, suggesting that E-DCIS represents a biologically distinctive category of DCIS.
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            Neuroendocrine primary small cell carcinoma of the breast.

            M R Shetty (1996)
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              Sex steroid receptor expression in 'carcinoid' tumours of the breast.

              Nine 'carcinoids' of the breast (argyrophilic carcinomas) were examined for the presence of estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR), using immunohistochemistry. The tumours were selected on the basis of their histo-morphological appearance and positive Grimelius stain. All cases were immunoreactive for neuron-specific enolase (NSE). In one case the tumour cells were intensely chromogranin A positive. All cases were ER positive, while 5 cases expressed AR and 5 cases PR. Immunostaining for ER and simultaneous demonstration of argyrophilia or chromogranin A expression in chromogranin A positive argyrophilic carcinoid tumour of the breast provided further evidence that neuroendocrine cells in breast tumours express sex steroid receptors. The similarity in sex steroid receptor expression pattern in 'carcinoids' of the breast and the more common categories of breast cancer suggests an identical responsiveness to endocrine therapy.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gin
                Revista Cubana de Obstetricia y Ginecología
                Rev Cubana Obstet Ginecol
                Editorial Ciencias Médicas (Ciudad de la Habana )
                1561-3062
                December 1999
                : 25
                : 3
                : 194-196
                Affiliations
                [1 ] Hospital Ginecoobstétrico Docente de Guanabacoa Cuba
                Article
                S0138-600X1999000300010
                92714944-1776-4c19-a370-9cf8c0597eae

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0138-600X&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                BREAST NEOPLASMS,NEUROENDOCRINE TUMORS,NEOPLASMAS DE LA MAMA,TUMORES NEUROENDOCRINOS

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