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Breast-malignant, males, children
Morphologic variants of DCIS
Cystic hypersecretory DCIS
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 15 August 2009
Last major update: August 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● First described in 1984 by Rosen and Scott (AJSP 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 (Archives 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
Microscopic description / grading
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● Dilated ducts and cysts mixed with micropapillary carcinoma in epithelium lining cystic spaces
● Cysts contain eosinophilic secretions resembling colloid
● Secretions may retract from epithelium, causing smooth or scalloped margin
● Associated with cystic hypersecretory hyperplasia with or without atypia
● DCIS is usually low grade
Micro images
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Variably sized cysts Cysts lined by flattened epithelium
Intraluminal secretions show cracks and Cysts lined by micropapillary projections
shrinkage of cyst content with peripheral scalloping 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 Micropapillary type pattern
sparse secretion retracted from epithelium 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
● Secretions - EMA, PAS, Alcian blue (focal)
Negative stains
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● Secretions - thyroglobulin
Differential diagnosis
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● Cystic hypersecretory hyperplasia - no 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
● Mucinous cystadenocarcinoma
● Secretory/juvenile carcinoma - invasive
End of Breast – Malignant, Males, Children > Cystic hypersecretory DCIS
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