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Breast malignant, males, children

Carcinoma subtypes

Cystic hypersecretory carcinoma - invasive

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 22 April 2014, last major update October 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.


● Not part of WHO breast classification
● First described in 1984 (Am J Surg Pathol 1984;8:31)
● Very rare (<100 cases reported)
● DCIS or hyperplasia is more common

Clinical description

● Usually low grade for several years but may metastasize

Case reports

● 40 year old woman with painful breast mass (Arch Pathol Lab Med 2005;129:e79)
● 43 year old woman (Jpn J Radiol 2011;29:660)
● 45 year old woman (J Korean Med Sci 2004;19:149)
● 48 year old woman with Pagetís disease of nipple (Int J Surg Pathol 2008;16:208)
● 49 year old woman with invasive lobular carcinoma in opposite breast 10 years after diagnosis (Arch Pathol Lab Med 1999;123:1108, free full text)

Gross description

● Numerous cysts with mucoid or gelatinous secretions

Gross images

Numerous cysts with a gelatinous secretion

Mastectomy with 12 cm multicystic tumor

Micro description

● Cystic dilation of ducts containing colloid-like eosinophilic material that often retracts from epithelium
● Epithelium focally has micropapillary DCIS
● Also invasion of surrounding stroma by nests of carcinoma, which may be high grade, usually without hypersecretory characteristics
● Extravasation of cyst material into stroma is not invasion

Micro images

Poorly differentiated carcinoma invades stroma next to cyst

Low power shows prominent cysts with no apparent ducts containing carcinoma

Associated micropapillary DCIS, invasion elsewhere

Associated micropapillary DCIS with no evident secretion in tumor cells, which have a hobnail appearance,
nuclei are relatively clear with small, discrete nucleoli

Associated micropapillary DCIS with sparse secretion that is retracted from epithelium

Cysts lined by flat cuboidal epithelium contain homogeneous secretions,
these cysts are nonspecific - they can be found in cystic hypersecretory hyperplasia or carcinoma

Note transition in cyst epithelium with plaque of tumor cells in bottom half, micropapillary pattern
is obscured where carcinoma nearly fills ducts, but traces of retracted secretion remain (arrows),
clear nuclei are also evident, even at this magnification

Axillary nodal metastases, with some cells exhibiting clear nuclei

Other images:

Fig 1: increased vascularity on power color Doppler imaging
Fig 2: sparse cellular smears with finely granular background and cells in 3D clusters and papillary formation with rare single hyperchromatic degenerating cell with increased N/C ratio (inset)
Fig 3: core needle biopsy
Fig 4: dilated ducts with eosinophilic colloid-like material with occasional scalloping at luminal borders and micropapillary proliferations

Various images

12 cm tumor, contributed by: Dr. Okechukwu. C. Okafor, University of Nigeria Teaching Hospital (Nigeria)

Cytology description

● Orange to gray-green colloid-like background with cracking artifact (Pap stain), clusters of malignant cells
● Also histiocytes and apocrine cells (Acta Cytol 1999;43:273, Acta Cytol 1997;41:892)

Positive stains

● Androgen receptors, HER2 (Ceska Gynekol 2005;70:73)
● Variable p53, ER and PR (Histopathology 2005;46:43)

Differential diagnosis

Secretory carcinoma: predominantly microcysts, t(12;15)(p13;q25) in most cases
Mucinous/colloid carcinoma: extracellular mucin, not intracystic secretions
Cystic hypersecretory hyperplasia: no invasion present (Cancer 1988;61:1611)

End of Breast malignant, males, children > Carcinoma subtypes > Cystic hypersecretory carcinoma - invasive

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