- First described in 1984 by Rosen and Scott (Am J Surg Pathol 1984;8:31)
- Rare (< 100 cases described); usually large palpable mass with pain
- Mean age 55 years, range 32 - 79 years
- 20% are associated with an invasive component, usually poorly differentiated ductal carcinoma with solid growth pattern and no secretory features
- 40 year old woman with cystic, ill-defined breast mass and invasive carcinoma (Arch Pathol Lab Med 2005;129:e79)
- 54 year old woman with large breast mass (Case of the Week #35)
- Excision with careful search for invasive component
- May recur as in situ or invasive disease (Ceska Gynekol 2005;70:73, Cancer 1988;61:1611)
- Single, irregular, spiculated mass with occasional calcifications
- Numerous cysts with sticky, mucoid or gelatinous secretions
- Dilated ducts and cysts containing homogenous eosinophilic secretions resembling thyroid colloid
- Secretions may retract from epithelium, causing smooth or scalloped margin
- Lining epithelium usually grows as micropapillary DCIS
- DCIS is usually low grade
Images hosted on PathOut server:
Variably sized cysts
Cysts lined by flattened epithelium
Intraluminal
secretions show
cracks and shrinkage
of cyst content with
peripheral scalloping
Cysts lined by
micropapillary
projections with
atypical cells containing
pleomorphic nuclei
Micropapillary type pattern
with prominent secretion
Hobnail type cells
Micropapillary
intraductal carcinoma
and sparse secretion
retracted from epithelium
Images hosted on other servers:
Fig 1: color Doppler is suggestive of cancer
Fig 2: FNA shows sparsely cellular smears with groups of cells in 3 dimensional clusters, papillary formation and granular background (inset: hyperchromatic cell with increased N/C ratio)
Fig 3: core biopsy shows dilated ducts with papillary proliferation
Fig 4: excision shows dilated ducts with micropapillary architecture and eosinophilic colloid-like material
- Distinct granular, colloid-like material in background
- Often reported as negative or suggestive of malignancy
Images hosted on PathOut server:
33 year old woman
- Epithelial cells: EMA, androgen receptor (Histopathology 2005;46:43), variable ER and PR
- Myoepithelial cells: S100, smooth muscle actin, p63, CD10, heavy chain myosin, calponin
- Secretions: EMA, PAS, Alcian blue (focal)
- Secretions: thyroglobulin
- ER / PR: usually negative
- Cystic hypersecretory hyperplasia: lining cells are flat cuboidal or columnar without atypia
- Fibrocystic disease with microcyst formation: apocrine metaplasia, benign epithelial lining, no micropapillary formation or colloid-like secretions within cysts, no atypia
- Juvenile papillomatosis: teenagers with "Swiss cheese" pattern of ductal papillomatosis, papillary hyperplasia, sclerosing adenosis; variable atypia
- Metastatic thyroid carcinoma: history, thyroglobulin+
- Mucocele-like lesions: mucin containing cysts that often rupture, with extravasation of mucin into surrounding stroma
- Mucinous cystadenocarcinoma: at least focal invasion, no prominent secretions
- Secretory / juvenile carcinoma: invasive, usually no prominent cystic areas
