Metastatic Gastrinoma in the Breast Mimicking Primary Solid Papillary Carcinoma

• Published in: Human pathology Vol. 56; pp. 143 - 146
• Main Authors: Burt, Michael, BA, Madan, Rashna, MBBS, Fan, Fang, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016; Elsevier Limited
• Subjects: Biomarkers, Tumor - analysis; Biopsy; Breast; Breast Neoplasms - chemistry; Breast Neoplasms - secondary; Carcinoma, Papillary - chemistry; Carcinoma, Papillary - pathology; Chromogranins - analysis; Diagnosis, Differential; Estrogen receptor; Female; Gastrinoma - chemistry; Gastrinoma - secondary; Gastrins - analysis; Humans; Immunohistochemistry; Liver; Lymphatic system; Magnetic Resonance Imaging; Medical prognosis; Metastasis; Metastatic gastrinoma; Middle Aged; Mortality; Neuroendocrine tumor; NMR; Nuclear magnetic resonance; Pancreatic Neoplasms - chemistry; Pancreatic Neoplasms - pathology; Pathology; Predictive Value of Tests; Receptors, Estrogen - analysis; Receptors, Progesterone - analysis; Rodents; Solid papillary carcinoma; Synaptophysin - analysis; Tumors; Neuroendocrine tumor; Breast solid papillary carcinoma; Metastatic gastrinoma; Breast; Estrogen receptor; Solid papillary carcinoma
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2016.05.024

We report a case of metastatic gastrinoma to the breast morphologically mimicking solid papillary carcinoma of the breast. A 59-year-old woman presented with a hypoechoic right breast mass that histologically revealed solid nests of small monotonous tumor cells, fibrovascular cores, and round to oval nuclei with fine chromatin and small prominent nucleoli. Immunohistochemistry demonstrated chromogranin and synaptophysin positivity. Tumor prognostic markers showed weak positivity for estrogen receptor and negativity for progesterone receptor. Although an initial diagnosis of solid papillary carcinoma was rendered, subsequent identification of the patient's clinical history of pancreatic gastrinoma and an additional immunohistochemical stain for gastrin supported a diagnosis of metastatic gastrinoma. We report this rare case to increase awareness of metastatic neuroendocrine tumors in the breast. Multiple breast lesions and lack of expression of estrogen/progesterone hormone receptors should prompt careful review of the patient's clinical history to rule-out metastatic neuroendocrine disease.