Addition of platinum salts to neoadjuvant chemotherapy in triple-negative breast cancer: a new standard of care?

Breast acinic cell carcinoma with weak progesterone receptor expression: a case report and literature review

Rationale

Acinic cell carcinoma (AcCC) of the breast is an extremely rare malignant epithelial tumor characterized by acini cell differentiation, clinical low-grade malignancy, and a molecular triple-negative subtype.

Patient concern

A 47-year-old female presented with a 1-month history of a painless mass in her right breast.

Diagnosis

Ultrasound imaging, mammography and magnetic resonance imaging revealed a lesion, approximately 3.0cm×1.5cm in size, in the right breast, which was considered to be a malignancy. After the surgery, the AcCC of the breast was confirmed histologically.

Interventions

Right breast mastectomy and sentinel lymph node biopsy were performed. Adjuvant chemotherapy included 4 cycles of doxorubicin hydrochloride (Adriamycin) and cyclophosphamide followed by 4 cycles of docetaxel (Taxotere).

Outcomes

The patient was discharged from the hospital after surgery. There was no sign of recurrence during a 9-month follow-up period.

Lessons

Acinic cell carcinoma (AcCC) of the breast is an extremely rare malignant epithelial tumor that can be accurately diagnosed based on histopathologic morphology and immunohistochemistry. The weak positive progesterone receptor (PR) expressed in this case is extremely rare, which may provide a new research direction for the endocrine therapy of AcCC. Both AcCC and microglandular adenosis(MGA) exhibit microglandular growth, and the relationship between them remains unclear. Differentiation between them not only relies on histomorphology and pathological immunohistochemistry but also depends on clinical manifestations and other presentations. Optimal treatment of AcCC is the same as that for invasive breast cancer. The prognosis is generally good, with adjuvant therapy after surgery.

Primary acinic cell carcinoma of the breast is associated with a poor outcome: A case report and literature review

Primary acinic cell carcinoma (AcCC) is a rare histological type of malignant breast cancer. AcCC was first identified as an entity in 1996, and since then 51 cases have been reported in the literature. The first early case reports and reviews suggested a relatively favourable prognosis for patients with AcCC; however, reports of AcCC recurrent disease have been more recently described in a subset of patients with high-grade disease. The present case report describes an unusual case of estrogen receptor-negative AcCC of the breast in a 59-year-old woman who did not respond to neoadjuvant chemotherapy (NACT), despite imaging revealing a large reduction in tumour volume. Furthermore, 14 months after NACT completion, the patient presented with disease progression comprising peritoneal involvement and linitis plastica. The patient started on first-line chemotherapy with carboplatin and paclitaxel combination, achieving a notable and prolonged response. After 2.5 years and while still on carboplatin and paclitaxel, the patient developed leptomeningeal carcinomatosis disease (LD) and died 6 weeks after LD presentation. The present report is the third case of AcCC in which cancer-associated death was registered. As studies on large series are lacking, further investigations are required to identify predictors of poor outcome. Notably, the prolonged response achieved to first-line chemotherapy suggested that platinum and taxane compounds may offer a potential therapeutic benefit for patients with AcCC. Moreover, the present case report highlights the importance of careful interpretation of follow-up imaging, as an apparent positive response to treatment may not always be a true representation of disease.

CHARACTERISTICS AND PROGNOSIS OF TRIPLE-NEGATIVE BREAST CANCER PATIENTS: A CROATIAN SINGLE INstitution RETROSPECTIVE COHORT STUDY

Triple-negative breast cancer (TNBC) occurs in around one-sixth of all breast cancer (BC) patients, with the most aggressive behavior and worst prognosis of all BC subtypes. It is a heterogeneous disease, with specific molecular characteristics and natural dynamics of early recurrence and fast progression. Due to the lack of biomarkers or any valid treatment targets, it can only be treated with classic cytotoxic chemotherapy. We analyzed a cohort of 152 patients, median age 58 years, diagnosed with and treated for early stage TNBC at the University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, during the 2009-2012 period. Patients were treated with primary surgical approach, adjuvant chemotherapy and adjuvant irradiation. We observed a relatively large proportion of locally advanced TNBC at diagnosis, with large tumor size and nodal involvement, with high grade and high proliferation index Ki67. Patient age, tumor size and lymph node involvement, as expected, were significant and clinically most important prognostic factors for 5-year disease-free survival (67%; 95% CI 60%-75%) and overall absolute survival rate (74%; 95% CI 66%-81%).