INSIGHTS INTO PRIMARY BREAST ENDOCRINE CARCINOMA: A CASE STUDY

A 75-year-old woman with a medical history of hypothyroidism presented to the triple-assessment breast clinic with a 2-week history of a right-sided breast lump, no history of pain or nipple discharge, and no significant family history of breast cancer. Her clinical examination revealed 4 x 4 cm of hard, nonmobile right upper outer quadrant (10 o'clock) breast mass with multiple enlarged right axillary lymph nodes. No evidence of skin or underlying muscle involvement. No nipple discharge was noted. Her radiological assessment with mammogram and ultrasound showed two suspicious masses occupying the right upper outer and central outer breast, one at 9 o'clock and the second at 11-12 o'clock (the largest), with suspicious pleomorphic microcalcification in the mammogram. Multiple significant axillary lymphadenopathies are also detected. An ultrasound-guided core biopsy was performed, and the histopathology was in favor of a triple negative neuroendocrine carcinoma in keeping with small cell carcinoma with axillary metastasis. An extensive workup was done for the patient to detect distant metastasis (PET/CT scan) versus other primary tumors. Her PET scan demonstrated a multicenteric breast tumor with uptake in the splenic flexure; therefore, gastrocolposcopy was performed and showed adenoma with low-grade dysplasia on final histopathology. The tumor was staged as cT2N2M0. The patient started on neoadjuvant chemotherapy, and on further follow-up, the tumor size had regressed completely, and the patient will be scheduled for surgery upon finishing her chemotherapy.