engleski

Merkel cell carcinoma mimicking breast cancer - a rare presentation of Merkel cell carcinoma originating from breast skin

Background: Breast metastases from extramammary malignancies are extremely rare. Metastasis to the breast is the first sign of malignancy in approximately 10 - 30% of patients, and because of similar morphological features with the primary breast tumor, they represent a major diagnostic challenge. Merkel cell carcinoma (MCC) may occur primarily in breast skin or metastasize to the breast. MCC is a rare and highly aggressive neuroendocrine skin cancer characterized by a high incidence of local recurrences and metastasis and a high mortality rate. Surgery followed by radiation therapy represents first- line treatment for primary or loco-regional MCC while advanced forms are treated with chemotherapy. Checkpoint inhibitors have shown a significant advancement in the treatment of advanced MCC. Case: A 79-year-old woman presented with a right nipple induration and two painless masses in the right breast. Breast ultrasound revealed an oval hypoechoic mass located in the right upper outer quadrant and another retro-areolar with skin infiltration. Digital breasts tomosynthesis demonstrated well defined oval hyperdense masses of the right breast. Core biopsy showed neuroendocrine carcinoma of unknown origin. Histopathological examination after a radical mastectomy and axillary lymph node dissection showed primary tumor situated right underneath the skin with in-transit breast metastasis close to the right axillary breast tail. Immunohistochemical studies of both primary tumor and transit breast metastasis were characteristic for MCC. Conclusion: A multidisciplinary team approach is essential for distinguishing between primary breast carcinoma and metastasis to the breast, which has implications for patient treatment and prognosis.

Merkel cell carcinoma, Breast metastases, Breast cancer

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