Salivary gland tumor: atypical presentation of breast cancer

Breast cancer is a heterogeneous disease with various histological and molecular subtypes. Among them, salivary gland tumors are rare and can be divided into three groups: pure myoepithelial differentiation, pure epithelial differentiation and myoepithelial with mixed epithelial differentiation. In the last group, adenoid cystic carcinoma stands out, a rare entity with low malignant potential. It represents less than 0.1­3% of breast cancer cases and has the most frequent clinical presentation as a palpable mass. The diagnosis is confirmed by histology and immunohistochemistry. Classically, they are low-aggressive triple-negative tumors, with overall survival and specific cancer survival at five and ten years greater than 95%. However, there are rare reports of aggressive variants with a risk of distant metastasis and death. Treatment is based on surgical resection with margins. Lymphatic dissemination is rare, and there is no consensus regarding the indication of an axillary approach. Adjuvant radiotherapy is indicated in cases of conservative surgery and should be discussed in other cases. The benefit of chemotherapy remains uncertain, as most tumors are indolent. We report a case that required individualized decisions based on its peculiarities of presentation, diagnosed in an asymptomatic elderly patient during screening, in which mammography showed heterogeneous gross calcifications clustered covering 1.6 cm. Stereotacticguided vacuum-assisted biopsy was performed, and the area was marked with a clip. The anatomopathological examination led to a diagnosis of salivary gland-type carcinoma, triple-negative. The patient underwent segmental resection of the right breast and sentinel lymph node biopsy. The final anatomopathological result was similar to that of the biopsy, with an immunohistochemicalprofile of the adenoid cystic type and two sentinel lymph nodes free of neoplasia. Considering age and histological subtype, adjuvant therapy was not indicated. Follow-up for three years showed no evidence of disease

Cáncer de mama metastásico oculto: a propósito de un caso / Hidden Metastatic Breast Cancer: A Case Report

El cáncer de mama triple negativo es un tumor agresivo que, muy pocas veces en la clínica, se presenta con un síndrome neurológico paraneoplásico asociado a un carcinoma metastásico de origen desconocido. Este artículo reporta una paciente con tal asociación y que su caso fue discutida en Clínica Patológica Institucional(AU)

Triple negative breast cancer is an aggressive tumor that, in the clinic, rarely presents with a paraneoplastic neurological syndrome associated with a metastatic carcinoma of unknown origin. This article reports a patient with such an association and that was discussed in Institutional Pathological Clinic(AU)

Cáncer de mama triple negativo: una enfermedad de difícil diagnóstico y tratamiento / Triple negative breast cancer: a difficult disease to diagnose and treat

El cáncer de mama triple negativo (CMTN) es una neoplasia maligna caracterizada por la ausencia de la expresión de los receptores de estrógeno, de progesterona y HER2. Estudios recientes han señalado que el CMTN es un grupo heterogéneo de distintas neoplasias, con pronósticos diferentes. Sin embargo, debido a que la realización de perfiles genéticos no es una práctica estándar para el diagnóstico convencional del cáncer de mama, se dificulta la apropiada identificación de este subtipo de cáncer de mama. El CMTN se caracteriza por tener patrones epidemiológicos de alta incidencia en poblaciones afroamericanas y latinas, y de menor incidencia en población caucásica y constituye un problema de salud pública por su elevada morbilidad y mortalidad. Ante la ausencia de blancos terapéuticos, la quimioterapia cumple un rol importante en el tratamiento, y muchos esfuerzos están destinándose a buscar otras combinaciones de quimioterapia y nuevas drogas, mientras que las actuales guías no especifican un tratamiento para este tipo de cánceres. En el presente documento se hace una revisión sobre las características epidemiológicas y clínicas, los posibles factores pronósticos y sobre algunas estrategias terapéuticas contra el CMTN.

Triple negative breast cancer (CMTN, Spanish acronym) is a malignant neoplasm characterized by the absence of expression of estrogen, progesterone and HER2 receptors. Recent studies have shown that CMTN is a heterogeneous group including different neoplasm with different prognosis. However, because genetic profiles are not a standard practice in conventional diagnosis of breast cancer, it is hard to properly identify this breast cancer subtype. CMTN is characterized by its high-incidence epidemiological patterns in African-American and Latin people, and lower incidence in Caucasian people, and constitutes a public health issue due to its high morbidity and mortality. Due to the absence of therapeutic targets, chemotherapy has a key role in treatment, and many efforts are being deployed to seek other combinations of chemotherapy and new drugs, while the current guides do not specify treatment for this type of cancer. This document reviews the epidemiological and clinical characteristics, the potential prognosis factors and some therapeutic strategies against CMTN.