Breast malignant, males, children - Cystic hypersecretory DCIS

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Breast malignant, males, children

In situ carcinoma

Cystic hypersecretory DCIS

Reviewer: Dina Kandil, M.D. (see Reviewers page)
Revised: 12 January 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● First described in 1984 by Rosen and Scott (Am J Surg Pathol 1984;8:31)

Epidemiology
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● 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

Treatment and prognosis
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● Excision with careful search for invasive component
● May recur as in situ or invasive disease (Ceska Gynekol 2005;70:73, Cancer 1988;61:1611)

Case reports
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● 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)

X-ray
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● Single, irregular, spiculated mass with occasional calcifications

Gross description
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● Numerous cysts with sticky, mucoid or gelatinous secretions

Micro description
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● 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

Micro images
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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

Cysts contain colloid type material, and epithelium has changes of DCIS

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

Micropapillary intraductal carcinoma and sparse secretion retracted from epithelium

Micropapillary type pattern with prominent secretion

Hobnail type cells

Cytology description
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● Distinct granular, colloid-like material in background
● Often reported as negative or suggestive of malignancy

Virtual slides
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33 year old woman

Positive stains
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● 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)

Negative stains
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● Secretions - thyroglobulin
● ER/PR - usually negative

Differential diagnosis
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● 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

End of Breast malignant, males, children > In situ carcinoma > Cystic hypersecretory DCIS

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