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Breast-malignant, males, children
Cystic hypersecretory carcinoma - invasive
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 15 September 2009
Last major update: September 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Not part of WHO breast classification
● First described in 1984 (AJSP 1984;8:31)
● Very rare (<100 cases reported); DCIS or hyperplasia is more common
Clinical
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● Usually low grade for several years but may metastasize
Case reports
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● 40 year old woman with painful breast mass (Archives 2005;129:e79)
● 45 year old woman #1 (The Internet Journal of Pathology 2008;7(1), #2(J Korean Med Sci 2004;19:149)
● Invasive lobular carcinoma in opposite breast 10 years after diagnosis (Archives 1999;123:1108)
● With Paget’s disease of nipple (Int J Surg Pathol 2008;16:208)
Gross description
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● Numerous cysts with mucoid or gelatinous secretions
Microscopic description / grading
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● 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
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AFIP Third Series
Poorly differentiated carcinoma Low power shows prominent cysts
invades stroma next to cyst with no apparent ducts containing carcinoma
Associated micropapillary DCIS, Associated micropapillary DCIS with no evident
invasion elsewhere secretion in tumor cells, which have a hobnail
appearance; nuclei are relatively clear with small,
discrete nucleoli
Associated micropapillary DCIS with sparse Cysts lined by flat cuboidal epithelium contain
secretion that is retracted from epithelium 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
Epithelium of cyst wall shows High grade invasive component
atypia and possible invasion
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
Cytology description
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● 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
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● Androgen receptors, HER2 (Ceska Gynekol 2005;70:73)
● Variable p53, ER and PR (Histopathology 2005;46:43)
Differential diagnosis
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● Secretory carcinoma - predominantly microcysts, t(12;15)(p13;q25) in most cases
● Mucinous/colloid carcinoma - extracellular mucin, not intracystic secretions
● Hyperplasia - no invasion present
Additional references
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End of Breast – Malignant, Males, Children > Cystic hypersecretory carcinoma - invasive
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