Breast
Other carcinoma subtypes, not WHO classified
Cystic hypersecretory


Topic Completed: 1 October 2012

Minor changes: 21 June 2020

Copyright: 2001-2019, PathologyOutlines.com, Inc.

PubMed search: cystic hypersecretory [title] carcinoma breast invasive

Monika Roychowdhury, M.D.
Page views in 2019: 580
Page views in 2020 to date: 420
Cite this page: Roychowdhury M. Cystic hypersecretory. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantcystichypersecretoryinvasive.html. Accessed August 7th, 2020.
Definition / general
  • 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 features
  • Usually low grade for several years but may metastasize
Case reports
Gross description
  • Numerous cysts with mucoid or gelatinous secretions
Gross images

Contributed by Dr. Okechukwu C. Okafor

Mastectomy with 12 cm multicystic tumor



Images hosted on other servers:

Numerous cysts with a gelatinous secretion

Microscopic (histologic) 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
Microscopic (histologic) images

AFIP images

Poorly differenti-
ated 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 micropap-
illary DCIS with sparse
secretion that is re-
tracted 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


Axillary nodal
metastases, with
some cells exhib-
iting clear nuclei

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



Contributed by Dr. Okechukwu C. Okafor

12 cm tumor



Images hosted on other servers:

Various images

Fig 1: increased vascularity on power color Doppler imaging
Fig 2: sparse cellular smears; finely granular background; cells in 3D clusters; 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

Cytology description
Differential diagnosis
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