Endocrine Abstracts

Introduction: Breast neuroendocrine carcinoma is a rare aggressive neuroendocrine tumour (NET) and the research on this subject is poor. Only seven studies were cited in the literature. Incidence in the population has not been reported, but the prevalence is under 0.1% of all breast carcinomas.

Case report: AV, 72, is hospitalised for bone pain and significant weight loss (15 kg in 2 months). Patient’s previous history are: diabetes, hypertension, nodular goitre and suspected pulmonary sarcoidosis in 2011 treated 6 months with corticosteroids. In 2013 abdominal CT revealed in the pancreas an area of 21/20 mm at the isthmus. CA-50 was found negative 14 U/ml (n<25 IU/ml), without any further specific exploration until January 2014 when intense bone pain lead to spinal MRI and bone scintigraphy that objectified secondary dissemination at the lumbar-sacral level and dorsal vertebrae. Abdominal CT reevaluation described: an intraductal pancreatic lesion, secondary disseminations in the liver, spleen and bone. The appearance was suggestive for pancreatic NET, confirmed by high tumoural markers. From the patient’s history, we found that she had a left breast fibroadenoma (2013-benign image on mammography). The breast ultrasound identified in the left breast multiple solid nodules with coarse calcifications. Breast cancer markers were increased ACE=31.5 ng/ml (n: 0–1.5), CA 15.3=160 IU/ml (n=0–38.4). A biopsy was performed from the lesion in the liver revealing metastasis of poorly differentiated carcinoma, immunohistochemical data showing carcinoma of the mammary gland with neuroendocrine features. The oncology evaluation staged the tumour in cT2N0M1, ECOG performance status 4 and recommended treatment with Sandostatin LAR, along with initiating treatment with zoledronic acid and aromatase inhibitors.

Conclusions: The peculiarity of the case is the association of a probably pancreatic neuroendocrine tumour with breast carcinoma with neuroendocrine features, probably evolving for a long time in the past, which was initially considered and treated as sarcoidosis.