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Table of Contents
Definition / general | Terminology | Epidemiology | Case reports | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Electron microscopy description | Electron microscopy images | Molecular / cytogenetics description | Molecular / cytogenetics images | Differential diagnosis | Additional referencesCite this page: Secretory carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantjuvenile.html. Accessed September 24th, 2017.
Definition / general
- Tumor cells with granular eosinophilic cytoplasm and prominent intracellular and extracellular milk-like secretion
- First described in 1966 as juvenile carcinoma by McDivitt and Stewart (JAMA 1966;195:388)
- A type of basal-like carcinoma (triple negative with expression of basal cytokeratins, Mod Pathol 2009;22:291)
Terminology
- Also called juvenile carcinoma
Epidemiology
- Rare, usually children (most common form of breast carcinoma in children), but can occur in adults
- Rare in males
Case reports
- 7 year old girl with axillary nodal metastases (Ethiop Med J 2012;50:89)
- 17 year old boy with recurrent breast swelling (World J Surg Oncol 2004;2:17)
- 23 year old man with unilateral gynecomastia (Am J Surg Pathol 1988;12:150)
- 27 year old woman with recurrent tumor after mastectomy (Am J Surg Pathol 1993;17:715)
- 33 year old woman with positive sentinel node (World J Surg Oncol 2006;4:88)
- 40 year old woman with tumor arising within radial scar (Indian J Pathol Microbiol 2009;52:83)
- 46 year old woman with axillary tumor (Arch Pathol Lab Med 2001;125:1372)
- 52 year old man with recurrent tumor at chest wall and lung metastases (World J Surg Oncol 2005;3:35)
- 52 year old woman with breast mass and two positive axillary lymph nodes (Case of the Week #8)
- 60 year old woman with tumor ulcerating through skin (Arch Pathol Lab Med 2006;130:1073)
- 61 year old woman with tumor exhibiting apocrine differentiation (Arch Pathol Lab Med 2006;130:e50)
- Young girl with axillary tumor (Am J Surg Pathol 2009;33:950)
Clinical images
Images hosted on other servers:
17 year old boy with breast mass and skin involvement
Flickr images:
7 year old Ethiopian girl with breast mass present for 2 years
Gross description
- Small, well circumscribed and often near areola
Microscopic (histologic) description
- Sheet-like growth, usually circumscribed, pushing margins, occasional foci of infiltration (Stanford University - Secretory Carcinoma of the Breast)
- Tubuloalveolar and focally papillary formations composed of relatively bland cells with uniform, low grade nuclei
- Abundant pale to eosinophilic, often vacuolated cytoplasm, but little pleomorphism
- Prominent nucleoli
- PAS+ diastase resistant eosinophilic secretions
- Also prominent hyalinization centrally, in situ component
- No atypia, no / rare mitotic figures
- May be difficult to differentiate in situ from invasive disease
Microscopic (histologic) images
Images hosted on PathOut server:
Courtesy of Dr. Mark R. Wick
Case of the Week #8
AFIP images:
Intraductal component with microcystic features
Microcystic pattern below, solid apocrine pattern above
Secretion tends to shrink
toward center of lumen,
may have a scalloped bor-
der in larger microcysts
Images hosted on other servers:
H&E, PAS
Intracytoplasmic lumen, H&E
Arising within radial scar
Various images
Well differentiated but invasive glands
PAS, S100, E-cadherin
S100+
PAS+ diastase resistant secretions
S100, EMA, pan cytokeratin, ER
Various images
Cytology description
- Cohesive sheets of monotonous cells with intracytoplasmic vacuoles, round nuclei and small nucleoli (Diagn Cytopathol 2005;32:47)
Positive stains
- Keratin, EMA, S100, alpha-lactalbumin and mucicarmine
- Variable GCDFP-15 and CEA
- Secretions are Alcian blue+, PAS+
- Variable intranuclear or cytoplasmic p63 (Int J Surg Pathol 2012;20:367)
Electron microscopy description
- Numerous membrane bound, intracytoplasmic secretory vacuoles
Electron microscopy images
Images hosted on PathOut server:
Large irregular cytoplasmic vacuoles lined by villi (AFIP)
Molecular / cytogenetics description
- Usually t(12;15)(p13;q25), producing ETV6-NTRK3 fusion gene that is also seen in cellular mesoblastic nephroma and infantile fibrosarcoma (Hum Pathol 2003;34:1299, Semin Cancer Biol 2005;15:215, Genes Chromosomes Cancer 2004;40:152, AtlasGeneticsOncology.org)
Molecular / cytogenetics images
Images hosted on other servers:
FISH shows t(12;15)
t(12;15) in 6 year old girl
Differential diagnosis
- Acinic cell carcinoma: no t(12;15) (Histopathology 2008;52:840)
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