Recurrent pure mucinous carcinoma of the breast with mediastinal great vessel invasion: HER-2/neu confers aggressiveness.
ABSTRACT Mucinous carcinoma of the breast, also known as colloid carcinoma, is a less common variant of breast cancer constituting less than five per cent of breast cancers. We report the case of a 42-year-old premenopausal female who presented with a palpable chest wall recurrence 4 years after simple mastectomy, axillary node dissection, and TRAM flap reconstruction for pure mucinous carcinoma. The recurrent neoplasm was a pure mucinous carcinoma and was found to be invading the mediastinum into the great vessels. The tumor was estrogen receptor positive, progesterone receptor negative, and HER-2/neu positive, which is an unusual finding for mucinous carcinoma. The fact that this tumor demonstrated HER-2/neu positivity may explain the uncharacteristic aggressive nature of this normally indolent type of breast tumor. To our knowledge, this is the first reported case of any mucinous breast cancer invading the mediastinal great vessels and its subsequent en-bloc resection.
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ABSTRACT: The human epidermal growth factor receptor (HER-2) oncogene encodes a transmembrane tyrosine kinase receptor that has evolved as a major classifier of invasive breast cancer and target of therapy for the disease. The validation of the general prognostic significance of HER-2 gene amplification and protein overexpression in the absence of anti-HER-2 targeted therapy is discussed in a study of 107 published studies involving 39,730 patients, which produced an overall HER-2-positive rate of 22.2% and a mean relative risk for overall survival (OS) of 2.74. The issue of HER-2 status in primary versus metastatic breast cancer is considered along with a section on the features of metastatic HER-2-positive disease. The major marketed slide-based HER-2 testing approaches, immunohistochemistry, fluorescence in situ hybridization, and chromogenic in situ hybridization, are presented and contrasted in detail against the background of the published American Society of Clinical Oncology-College of American Pathologists guidelines for HER-2 testing. Testing issues, such as the impact of chromosome 17 polysomy and local versus central HER-2 testing, are also discussed. Emerging novel HER-2 testing techniques, including mRNA-based testing by real-time polymerase chain reaction and DNA microarray methods, HER-2 receptor dimerization, phosphorylated HER-2 receptors, and HER-2 status in circulating tumor cells, are also considered. A series of biomarkers potentially associated with resistance to trastuzumab is discussed with emphasis on the phosphatase and tensin homologue deleted on chromosome ten/Akt and insulin-like growth factor receptor pathways. The efficacy results for the more recently approved small molecule HER-1/HER-2 kinase inhibitor lapatinib are also presented along with a more limited review of markers of resistance for this agent. Additional topics in this section include combinations of both anti-HER-2 targeted therapies together as well as with novel agents including bevacizumab, everolimus, and tenespimycin. A series of novel HER-2-targeting agents is also presented, including pertuzumab, ertumaxomab, HER-2 vaccines, and recently discovered tyrosine kinase inhibitors. Biomarkers predictive of HER-2 targeted therapy toxicity are included, and the review concludes with a consideration of HER-2 status in the prediction of response to non-HER-2 targeted treatments including hormonal therapy, anthracyclines, and taxanes.The Oncologist 05/2009; 14(4):320-68. DOI:10.1634/theoncologist.2008-0230 · 4.54 Impact Factor
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ABSTRACT: Aim: Our purpose is to describe a new case of pure mucinous carcinoma in a man, to put emphasis on the rarity of this histologic subtype and the problems of management due to the fewer reported cases in the literature and to compare it with the female counterpart. Observation: We report the case of a 79- year-old man presenting as a nodular mass of the right breast. The clinical symptoms weren’t specific and the diagnosis was based on histological and immunohistochemical findings. Conclusion: Male breast carcinoma is rare compared to its female counterpart representing less than 2% of male breast carcinomas and 1% of all breast carcinomas. Pure mucinous carcinoma in male is an extremely rare histological subtype. It is a variety of carcinoma of the breast which is characterized by the production of an abundant extra-cellular and/or intra-cellular mucin. It has been regarded as one of the more benign forms of breast carcinomas. To our knowledge, about 30 cases of mucinous breast carcinoma in male have been reported in the English literature and only 10 cases of pure mucinous carcinoma have been described. In general, pure mucinous carcinomas have a favorable prognosis. Numerous studies have shown that breast carcinomas in male behave more aggressively compared to those in females. Further research is needed on male carcinomas as they are becoming more frequent.