Treatment of breast adenocarcinoma metastasis to the neck: dedifferentiation of the tumor as suggested by hormone markers.

BACKGROUND Breast carcinoma rarely metastasizes to the neck, and its management in this area is controversial. There is little published data about whether hormone receptor status changes between primary breast tumors and neck metastasis and whether this influences management. METHODS We evaluated the demographics and treatment of 13 patients presenting with neck metastasis. We used immunochemistry to assess estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 in the primary and metastatic neck nodes. RESULTS Hormone receptor status changed in some patients (23% for estrogen receptor, and 31% for progesterone receptor). Three patients had complete excision of their neck disease and subsequent good local control. None of our patients survived despite treatment. CONCLUSION The change in hormone status could suggest tumor dedifferentiation. Surgical resection, where possible, achieves good local control for these patients, but, because survival is poor, it is only recommended when it results in little significant morbidity.