Neuroendocrine Neoplasms of the Breast: The Latest WHO Classification and Review of the Literature

Breast tumors with neuroendocrine (NE) differentiation comprise an uncommon and heterogeneous group of tumors, including invasive breast cancer of no special type (IBC-NST) with NE features, neuroendocrine tumors (NETs), and neuroendocrine carcinoma (NEC). The most recent World Health Organization (WHO) classification in 2019 defined neuroendocrine neoplasms (NENs) of the breast (Br-NENs) as tumors in which >90% of cells show histological evidence of NE differentiation, including NETs (low-grade tumors) and NEC (high-grade). Due to the low prevalence of these tumors and successive changes in their diagnostic criteria over the years, only limited evidence of these tumors exists, derived mainly from case reports and retrospective case series. Breast tumors with NE differentiation are usually treated like the more commonly occurring IBC-NSTs. Immunohistochemistry (IHC) of breast tumors with NE differentiation usually shows a hormone receptor (HR)-positive and human epidermal growth factor type 2 (HER2)-negative profile, so that hormonal therapy with cyclin-dependent kinase (CDK)4/6 inhibitors or other targeted agents would be reasonable treatment options. Herein, we present a review of the literature on breast tumors with NE differentiation as defined in the latest WHO 2019 classification, and discuss the clinical management of these tumors

Impact of inability to turn in bed assessed by a wearable three-axis accelerometer on patients with Parkinson's disease.

Difficulty turning over in bed is a common night-time symptom in Parkinson's disease (PD). We aimed to quantitatively evaluate overnight turnover movements using a three-axis accelerometer and to investigate whether inability to turn in bed is related to daytime sleepiness, sleep quality, and depressive mood in PD patients.We examined 64 patients with PD (mean age, 73.3±8.21 years; modified Hoehn-Yahr [mH-Y] stage, 3.0±1.0; disease duration, 7.2±6.3 years; unified Parkinson's disease rating scale [UPDRS], 36.9±18.3). Overnight monitoring of turnover movements using a wearable three-axis accelerometer was performed in all patients. Nocturnal kinetic parameters including total time recumbent, total time supine, number of turnover movements, and mean interval between turnover movements were obtained. Daytime immobility was assessed using the Barthel index (B-I), UPDRS, and mH-Y stage. Patients were also assessed with the Epworth Sleepiness Scale (ESS), Parkinson's Disease Sleep Scale-2 (PDSS-2), and Beck Depression Inventory (BDI).Number of turnover movements in bed correlated negatively with disease duration (r = -0.305; p<0.05), L-dopa-equivalent dose (r = -0.281; p<0.05), mH-Y staging (r = -0.336; p<0.01), total score of UPDRS (r = -0.386; p<0.01) and positively with B-I score (r = 0.365; p<0.01). Number of turnover movements in bed was generally inconsistent with awareness of turnover movement impairment as evaluated by PDSS-2 Item 9 scores, but patients who were never aware of impaired turnover movements showed ≥5 turnover movements overnight. Multivariate logistic regression analyses revealed no correlations between number of nocturnal turnover movements in bed and BDI, ESS, or PDSS-2. Use of anti-psychotic drugs was associated with ESS (p = 0.045). UPDRS was associated with PDSS-2 (p = 0.016).Decreased number of turnover movements may not be a direct determinant of daytime sleepiness, sleep disorders, or depressive mood in PD patients. Use of anti-psychotic drugs and higher UPDRS score are factors significantly associated with daytime sleepiness and uncomfortable sleep, respectively

Three-axis accelerometer sensor axes in the recumbent position.

<p>X axis: from right to left; Y axis: from caudal to rostral; Z axis: from back to front.</p

Subjective awareness of difficulty turning in bed as evaluated by PDSS-2 item 9 and nocturnal kinetic parameters.

<p>Subjective awareness of difficulty turning in bed as evaluated by PDSS-2 item 9 and nocturnal kinetic parameters.</p

Multivariate logistic regression analyses.

<p>Multivariate logistic regression analyses.</p