title: Breast adenocarcinoma recurring as small cell carcinoma in a patient with a germline BRCA2 mutation: clonal evolution unchecked.
abstract: BACKGROUND
  Because up to 30% of breast cancer cases may relapse, understanding the biology of recurrent breast cancer is imperative in preventing these poor outcomes. Thus, we present this unusual case of a BRCA2 carrier who presented seven years after her initial diagnosis of breast adenocarcinoma with a new lump in the left axillary tail, which proved to be small cell carcinoma. The second cancer bore no morphologic or immunohistochemical resemblance to the first. However, we aimed to understand whether the two cancers could have been related.
  
  
  METHODS
  We performed targeted Next Generation Sequencing on both cancer specimens in order to determine whether there was a genomic relationship between the two cancers.
  
  
  RESULTS
  We found that the initial breast adenocarcinoma was positive for a heterozygous mutation in PIK3CA (c. 1624 G > A, p.E42K) and a heterozygous 13-basepair deletion in TP53 (c.639-651del, p.H214fs). The small cell cancer was positive for the same mutation in PIK3CA, but negative for the mutation in TP53.
  
  
  CONCLUSIONS
  We concluded that the small cell cancer may have arisen from a clone within the initial cancer, since they carried an identical genetic mutation. Furthermore, we postulate that the unusual morphology of the second cancer may be due, in part, to the patient's germline BRCA mutation.
authors: Lester & Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, BCM 660, Houston, Texas 77030 USA.
authors: Polly
authors: P
authors: Niravath
authors: Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, BCM 320, Houston, TX 77030 USA.
authors: Tanya
authors: T
authors: Eble
authors: Department of Pathology, Baylor College of Medicine, One Baylor Plaza, BCM 660, Houston, TX 77030 USA.
authors: Alejandro
authors: A
authors: Contreras
authors: Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, BCM 320, Houston, TX 77030 USA.
authors: Marilyn
authors: M
authors: Li
authors: Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, BCM 320, Houston, TX 77030 USA.
authors: Luis M
authors: LM
authors: Franco
authors: Lester & Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, BCM 660, Houston, Texas 77030 USA.
authors: Mothaffar
authors: M
authors: Rimawi
keywords: BRCA2 mutation; PIK3CA mutation; Small cell carcinoma of the breast; Therapeutic stress