BACKGROUND Secretory carcinoma is a rare, differentiated, distinct histologic type of invasive breast carcinoma. It is extremely rare, accounting for less than 0.02% of all breast cancer cases. Although it is the most common primary breast cancer in children, it is most often diagnosed in adults. To date, at least 642 cases of secretory carcinoma of the breast have been reported in the literature for the last 15 years. CASE SUMMARY A 21-year-old female, sought medical help at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of the PA Herzen Moscow Oncology Research Institute with complaints of a mass in the right mammary gland. Secretory carcinoma of the mammary gland is a malignant tumor that was first described in children in 1966 by McDivitt RW and Stewart FW and named “juvenile breast carcinoma” because it was predominantly seen in children and associated with genetic mutations. Although secretory cancer is classified as a type of basal-like triple-negative cancer, it differs significantly from it in terms of pathogenesis, clinical presentation, and treatment. Overall, it usually has a good prognosis with overall survival 5 years, 10 years, and 20 years after initial treatment of 95.79%, 93.16%, and 93.16%. CONCLUSION We present a case report and review of the literature of secretory carcinoma of the breast with low estrogen and low progesterone immunophenotype.
BACKGROUND Perforation is a rare but potentially fatal complication of upper gastrointestinal endoscopy, particularly when therapeutic maneuvers are performed. Posterior gastric wall perforation is particularly difficult to recognize because it may decompress into the lesser sac rather than the free peritoneal cavity and therefore produce subtle or atypical peritoneal signs. We report a 64-year-old male with a history of laryngectomy and radiotherapy for laryngeal carcinoma, advanced thoracolumbar scoliosis, atrial fibrillation, and a tracheoesophageal voice prosthesis who was found to have a posterior gastric wall perforation three days after an upper gastrointestinal endoscopy that included bougie dilation of an esophageal stricture and gastric biopsies. CASE SUMMARY On emergency department admission, the patient presented with a blood pressure of 84/50 mmHg, metabolic acidosis, and anuria, suggesting septic shock. Serum creatinine had risen from a documented baseline of 1.1 mg/dL to 4.18 mg/dL, corresponding to Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury (AKI). Contrast-enhanced abdominal computed tomography demonstrated discontinuity of the posterior wall of the gastric corpus, with extravasation of contrast material into the retrogastric space and lesser sac, together with widespread free intraperitoneal air and fluid. AKI was considered predominantly sepsis-associated ischemic acute tubular injury (ATI); contrast exposure seven days earlier was regarded as a possible but unproven contributory factor. The patient underwent two surgical interventions—gastric wedge resection with feeding jejunostomy and re-laparotomy with small bowel resection, double-barrel ileostomy, and surgical gastrostomy due to a jejunostomy-related bile leak. Despite maximal intensive care unit support, the patient died on the 16th day of admission. CONCLUSION Posterior gastric perforation may present with minimal peritoneal signs in patients with altered anatomy and impaired communication, and AKI in this setting is usually multifactorial, dominated by sepsis-associated ischemic ATI.
BACKGROUND Acetylcholinesterase inhibitors such as donepezil are frequently discontinued in older adults with dementia when adverse events emerge, when perceived benefit declines, or during transitions to institutional care. Abrupt discontinuation may be followed by cognitive or behavioural deterioration, although the clinical phenotype and causal mechanisms remain incompletely defined. CASE SUMMARY An 89-year-old woman with a 10-year history of Alzheimer disease had received donepezil 10 mg/day for more than 5 years. Two weeks before nursing-home admission, reduced spontaneous speech and functional decline were already noted, with Hasegawa Dementia Scale-Revised declining from 16/30 to 8/30. Donepezil was abruptly stopped on day 0 at admission. Forty-eight hours later, she developed acute agitation, verbal aggression, insomnia and new gait instability, with a positive confusion assessment method assessment on day 2-3. Infection, major metabolic disturbance and acute structural cerebrovascular disease were not identified. Donepezil 5 mg/day was restarted on day 7, while as-needed quetiapine 12.5 mg was also used during the early post-rechallenge period. Agitation and verbal aggression decreased within 5 days, quetiapine was discontinued, sleep normalized by day 12, and by day 21 she was eating independently and adapting to the facility. The clinical interpretation remained provisional because several alternative or contributing explanations could not be fully excluded. CONCLUSION The temporal sequence and improvement after donepezil rechallenge are compatible with suspected donepezil withdrawal, but the diagnosis remains provisional and causality is uncertain. Natural dementia progression, nursing-home relocation, occult pain, unrecorded over-the-counter drugs or supplements, non-convulsive seizures, and concomitant quetiapine are alternative or contributing explanations. The 48-hour onset does not imply complete drug elimination because donepezil has a long elimination half-life; rather, it is compatible with an early clinical response to a falling drug exposure, although this mechanism cannot be demonstrated in the present case. Abrupt discontinuation should therefore be approached cautiously and monitored clinically.
A functional cure for chronic hepatitis B remains uncommon despite effective viral suppression. Phase 3 bepirovirsen trials reported functional cure in 19%-20% of selected noncirrhotic patients who were receiving stable nucleos(t)ide analog therapy and had baseline hepatitis B surface antigen levels above 100 IU/mL and up to 3000 IU/mL. A lower baseline antigen level is associated with response across several regimens, but heterogeneous eligibility criteria and endpoints preclude attributing efficacy to selection alone. This narrative minireview examines serum biomarkers, selected prediction models, treatment-related harm, and residual hepatocellular carcinoma (HCC) risk after antigen loss. It distinguishes sustained off-treatment functional cure from antigen loss during continued background therapy, and separates pretreatment selection from on-treatment response prediction and post-clearance risk assessment. Existing models provide useful prognostic information; however, no integrated biomarker or machine learning model has been validated to allocate curative regimens. Observational evidence identifies substantial variation in HCC risk after antigen loss but does not establish the safety of surveillance withdrawal. Current society guidelines should govern clinical monitoring, whereas prospective studies should assess risk-based refinement. Diagnostic biomarker performance across genotypes does not establish transferable prediction of cure; external validation, calibration, assay standardization, and demonstrated clinical benefit remain prerequisites for implementation.
BACKGROUND Mixed metaplastic breast cancer (MMBC) is an extremely rare subtype of breast malignancy characterized by aggressive biological behavior and a poor prognosis. Most patients with MMBC exhibit a triple-negative immunophenotype (ER-, PR-, HER2-), rendering them unresponsive to conventional endocrine therapy. Currently, no mature and effective targeted therapeutic agents are available for MMBC, and a universally accepted standard adjuvant chemotherapy regimen has not been established worldwide. Pathologically, most MMBC lesions contain only two histological components, whereas cases involving three or more distinct tumor components are extremely rare and have seldom been reported. Given its low incidence, high malignancy, limited clinical data, and lack of standardized treatment guidelines, we report a rare case of metaplastic breast cancer with three invasive components plus associated ductal carcinoma in situ (DCIS) components were identified. The patient underwent modified radical mastectomy for breast cancer and received 8 cycles of sequential chemotherapy: Pirarubicin plus cyclophosphamide, followed by docetaxel plus cisplatin. Herein, we share the relevant data regarding the patient’s diagnosis, individualized treatment, and prognosis. CASE SUMMARY A 60-year-old postmenopausal woman presented in August 2024 with a painless left breast mass noticed 3 days previously, without other symptoms. Preoperative ultrasonography indicated a breast lesion highly suspicious for malignancy. She underwent segmental mastectomy, and intraoperative frozen-section analysis confirmed high-grade invasive carcinoma, followed by modified radical mastectomy. Permanent pathological examination confirmed high-grade mixed metaplastic breast carcinoma. All 23 dissected axillary lymph nodes were negative for metastasis (0/23). Immunohistochemical analysis revealed a triple-negative phenotype (ER-, PR-, HER2-) and a Ki-67 index of 60%. Genetic testing identified TP53 and AKT1 mutations; however, no actionable targeted therapeutic options were identified. The patient received 8 cycles of sequential chemotherapy with Pirarubicin plus cyclophosphamide followed by docetaxel plus cisplatin, and grade 2-3 chemotherapy-related adverse reactions were alleviated with symptomatic treatment. No local recurrence or distant metastasis was observed during the 20-month postoperative follow-up, and the patient remains under regular surveillance. CONCLUSION This rare case of MBC with three invasive components plus associated DCIS components components expands the limited clinical evidence available for multicomponent metaplastic breast carcinoma. It also provides valuable clinical insights into the diagnosis, individualized comprehensive treatment, and long-term prognostic assessment of this rare and aggressive malignancy.
