Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 919-926
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.919
Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature
Yu Zhang, Di Wu, Bo Zhao, Xue-Liang Tian, Tian-Cheng Yao, Feng Li, Wei-Fang Liu, Ai-Ping Shi
Yu Zhang, Di Wu, Bo Zhao, Xue-Liang Tian, Tian-Cheng Yao, Feng Li, Wei-Fang Liu, Ai-Ping Shi, Department of Breast Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Zhang Y wrote the manuscript; Wu D contributed to paper revision and editing; Zhao B and Tian XL provided the imaging information and contributed to diagnosis; Yao TC, Li F and Liu WF collected and analyzed the data; Shi AP is responsible for the conception and revision of the manuscript; All authors have read and approved the final manuscript.
Supported by Health Specific Program of Jilin Province, China, No. 2018SCZWSZX-035; and Scientific and Technological Development Program of Jilin Province, China, No. 20190701041GH.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Ping Shi, MD, PhD, Professor, Department of Breast Surgery, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun 130021, Jilin Province, China. sap@jlu.edu.cn
Received: September 26, 2020
Peer-review started: September 26, 2020
First decision: November 8, 2020
Revised: November 16, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: February 6, 2021
Processing time: 121 Days and 8.1 Hours
Abstract
BACKGROUND

Occult breast cancer (OBC) is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast. Due to its low incidence and unique clinical manifestations, there is a lack of consensus on the diagnosis and treatment of OBC. We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib. The treatment was well tolerated, and the patient achieved a pathologic complete response.

CASE SUMMARY

A 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast. Pathological biopsy confirmed right axillary metastatic carcinoma. Immunohistochemical staining results were positive for progesterone receptor, cytokeratin 7, specific breast markers GATA3 and gross cystic disease fluid protein-15. Tumor cells were negative for estrogen receptor, human epidermal growth factor receptor-2, cytokeratin 5/6, cytokeratin 20, and villin. The patient was diagnosed with OBC, and she underwent neoadjuvant chemotherapy combined with anlotinib. Mastectomy plus axillary lymph node dissection was performed. The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes. Postoperatively, she received adjuvant radiotherapy and endocrine therapy.

CONCLUSION

Neoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.

Keywords: Occult breast cancer; Neoadjuvant chemotherapy; Anlotinib; Mastectomy; Pathological complete response; Case report

Core Tip: Occult breast cancer is a rare type of breast cancer, and there are some difficulties and confusion in its diagnosis and treatment. Biopsy and immunohi-stochemical analysis can help to make a diagnosis after excluding the possibility of other primary cancers. Because of its low incidence, there is no systematic and standard treatment plan. We first reported the application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer, and pathologic complete response was obtained after operation. This case may provide a new, suitable treatment option for these patients.