Mucinous carcinoma of breast: Cytodiagnosis of a case

Gray Lesions of the Breast and its Diagnostic Significance: A Retrospective Study from Rural India

Background:

Breast lesions extend from benign to malignant ones. The National Cancer Institute recommended categories for the diagnosis of breast cytology. There are some lesions in the breast which are called intermediate or gray lesions. It includes C3 (atypical, probably benign) and C4 (suspicious, favor malignant) which needs to be evaluated.

Materials and Methods:

This study was conducted in the Department of Pathology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah (Uttar Pradesh). Fine-needle aspiration cytopathology (FNAC) was the diagnostic tool. The present study was undertaken to determine the gray lesions of the breast and its correlation with histopathology and other associated parameters. Immunohistochemistry was applied where ever necessary. One hundred and fifty one cases of gray lesions of the breast were included.

Results:

C3 was seen in 85 (56.29%) and C4 in 66 (43.70%) patients. The maximum number of patients was of 31–40, (33.77%) years age group, the youngest patient was 12-year-old female, whereas the oldest was 86 years male. Histopathology evaluation confirmed malignancy in 35 (23.17%) cases, and infiltrating ductal carcinoma was the frequent malignancy (24 [68.5%]). Sensitivity, specificity, positive predictive value, and negative predictive value of C4 category for the diagnosis of malignancy were, respectively, 81.48%, 50%, 68.7%, and 64.2%.

Conclusion:

FNAC is an excellent diagnostic tool. It has some limitations, especially with the gray lesions, which may lead to miss interpretation in diagnosis, so a scope of mistake to the cytopathologist is always there. These lesions need to be evaluated because of the risk of malignancy. However, gray lesions can be reduced by cytology followed by histopathology examination along with ancillary radiological investigations such as mammography and ultrasonography.

A Case of Pure Mucinous Breast Carcinoma in a 25-Year-Old Female Who Showed Complete Pathological Response to Neoadjuvant Chemotherapy despite Poor Clinical Response

Introduction

Mucinous breast carcinoma is a rare histologic subtype of primary breast cancers accounting for 1-6%. It is a rare histological variant in young patients and usually presents without lymph node involvement, and its pathological response to neoadjuvant chemotherapy is rarely reported.

Case Presentation

Pure mucinous breast carcinoma in a 25-year-old female was treated with neoadjuvant chemotherapy every 3 weeks for 8 cycles. After the fifth cycle, the mass size showed no change. We performed modified radical mastectomy in the left breast and axillary lymph node clearance. However, the pathological report showed a complete elimination of both the breast tumor and axillary lymph nodes, which were filled with mucus but did not contain malignant cells.

Discussion

Chemotherapy was profoundly effective against the tumor cells, but ineffective against large amounts of extracellular mucus. Even though the cancer cells were sensitive to chemotherapy, the volume of mucinous cancer couldnot be reduced.

Conclusion

In summary, the evaluation criteria of tumor response to chemotherapy based on maximum diameter only should be considered insufficient for mucinous carcinoma.

HER2-positive pure mucinous breast carcinoma: A case report and literature review

INTRODUCTION

Pure mucinous carcinoma is a rare type of breast carcinoma, but it usually has a favorable prognosis. Tumors of pure mucinous carcinoma are typically positive for both estrogen receptor (ER) and progesterone receptor (PR), and they do not commonly overexpress human epidermal growth factor receptor 2 (HER2). However, when tumors have HER2 overexpression and are progesterone receptor negative, the prognosis is worse.

PATIENT CONCERNS

A 59-year-old female reported a slow growth mass of 3 years, which was radiologically diagnosed as fibroadenoma at another institution. The patient came to our institution for treatment and follow-up. She had no salient past history.

DIAGNOSIS

Excisional biopsy revealed a pure mucinous breast carcinoma that was ER (100%, moderate-strong intensity), PR(-), 5% Ki-67 (+), and HER2(3+) by immunohistochemistry. The HER2 gene was found to be amplified by fluorescence in situ hybridization (FISH). The clinical staging was T2N0M0, with pathological grade I, subtype luminal B.

INTERVENTIONS

After a modified radical mastectomy, she received four 21-day cycles of intravenous docetaxel (75 mg/m), intravenous cyclophosphamide (600 mg/m), and intravenous trastuzumab (8 mg/kg) (loading dose) on day 1 followed by 6 mg/kg every 3 weeks to complete a full year of treatment. She then received 2.5 mg of letrozole daily for 5 years.

OUTCOMES

After following up for 2 years, the patient's outcome was survival without recurrence. Cardiac ultrasounds were performed every 3 months and there was no change in the left ventricular ejection fraction (LEVF).

CONCLUSION

It is essential to correctly diagnose the ER(+), PR(-) HER2(+) subtype in mucinous carcinoma. This type should be treated with chemotherapy and anti-HER2 therapy, as well as aromatase inhibitor endocrine therapy.

Clinicopathological Study of Mucinous Carcinoma of Breast with Emphasis on Cytological Features: A Study at Tertiary Care Teaching Hospital of South India

Introduction  Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS.

Materials and Methods  MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software.

Results  In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status.

Conclusion  PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.

Pure mucinous breast carcinoma in a 25-year-old female, a case report

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Young patient.

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Mucinous carcinoma.

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Prognosis.

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Hormone receptor.

Introduction

Mucinous carcinoma is a variant of invasive breast carcinomas representing 2% of them. These tumors frequently develop in postmenopausal females; it is a rare histological variant in young patients.

Case presentation

A 25-year-old female refers a slow growth mass of 2 years of evolution. Excisional biopsy reveals a pure mucinous carcinoma with positive hormone receptors and negative HER2. She was treated with hormone therapy and surgical resection.

Discussion

Mucinous carcinoma is a rare variant reported in young patients. Many series report that is frequently found in postmenopausal patients. We present a case of a pure mucinous carcinoma in a 25-year-old female with the importance of being a low-frequency malignancy in young patients.

Conclusion

Due to its benign course, it is important to know that this lesion can also present in young patients. The importance underlies in the multidisciplinary management at the right time in a proper way.

Mucinous carcinoma of the male breast with axillary lymph node metastasis: Report of a case based on fine needle aspiration cytology

Pure mucinous carcinoma of the male breast is an uncommon malignant breast neoplasm and extremely rare is its metastasis in axillary lymph nodes. Most of these cases have been diagnosed after surgical resection with only a few cases diagnosed on fine needle aspiration cytology (FNAC). Although FNAC is well established in the evaluation of breast masses in females there are few reports in males. We are presenting a case of pure mucinous carcinoma of the male breast with metastasis in axillary lymph nodes in a 75-year-old male diagnosed by FNAC and confirmed on histopathology.

A cytomorphological study of secretions in breast cancer

Background:

Secretions are seen in a range of breast cancer that includes invasive ductal carcinoma, mucinous carcinoma and secretory carcinoma. Evaluation of the quantity and location of secretions and the contours of the cell clusters complement cell morphology could improve diagnostic cytopathological criteria.

Aim:

To identify the range of breast carcinomas with secretions on fine-needle aspiration.

Materials and Methods:

A retrospective study of 160 patients with breast carcinoma was carried out. The tumors were typed by evaluating the quantity and location of secretions, cellularity and nuclear grade.

Results:

Secretions were seen in 16 of 160 breast carcinomas. Eleven were invasive ductal carcinoma (IDC), three were mucinous and two were secretory carcinomas. In IDC, minimal intracytoplasmic secretions were seen in 10, nuclear grades of 2 and 3 in 9, cell clusters with irregular margins in 6, and necrosis in 4. All mucinous and secretory carcinomas were nuclear grade 1. Extensive extracellular secretions and cell clusters with rounded contours were seen in mucinous carcinomas. In secretory carcinomas, the secretions were predominantly intracellular; stringy vasculature was a unique feature.

Conclusion:

Secretions in breast cancer are seen in a range of lesions that include IDC, mucinous, and secretory carcinomas. The quantity and location of secretions in breast cancer offer clues to differentiating these.