Mucinous Carcinoma of the breast
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Gan To Kagaku Ryoho. 2013 Nov;40(12):2357-9.
[A case of mucinous carcinoma treated by local excision after long-term serial observations].
[Article in Japanese]
Yamamuro M1, Enomoto K, Sakurai K, Amano S.
Author information
- 1Division of Breast and Endocrine Surgery, Dept. of Surgery, Nihon University School of Medicine.
Abstract
We report a case of a 45-year-old woman in whom an abnormality was identified by an examination when she was 42 years old. Breast ultrasonography revealed a cyst in the C area of the left breast. Ultrasonography performed 3 years later showed a mass lesion, 1 cm in diameter, in the C area of the left breast. Contrast-enhanced magnetic resonance imaging (MRI) showed a mass shadow. Core needle biopsy was performed, and the pathological diagnosis was mucinous carcinoma. Partial excision of the breast and sentinel lymph node biopsy were performed. The final histopathological diagnosis was mucinous carcinoma( pure type, estrogen receptor[ ER][ +], progesterone receptor[ PgR][ +], human epidermal growth factor receptor-2[ HER2][ 0], Ki67[ 10%], T1N0M0, stage I). One year after the operation, no signs of recurrence or metastasis have been observed. It was difficult to ascertain the presence of a lesion as the patient experienced pregnancy and childbirth during serial observations. An early diagnosis was made by imaging techniques such as consecutive ultrasonography, owing to which we were able to treat the patient early. The findings of this case emphasize the need for serial imaging studies
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J Cancer Res Clin Oncol. 2014 Feb;140(2):265-9. doi: 10.1007/s00432-013-1559-1. Epub 2013 Dec 5.
Clinicopathological characteristics and prognosis of mucinous breast carcinoma.
Zhang M1, Teng XD, Guo XX, Zhao JS, Li ZG.
Author information
- 1Department of Breast Surgery, Affiliated Third Hospital of Harbin Medical University, 6 Baojian Road, Harbin, 150040, China.
Abstract
PURPOSE:
The clinical features and prognosis of mucinous breast carcinoma (MBC) are unclear because of its rarity. The aim was to describe the clinicopathological features and prognosis of patients with MBC in comparison with nonmucinous breast carcinoma (NMBC). Furthermore, we described the biological behavior of pure mucinous breast carcinoma (PMBC) by comparing clinicopathological features and prognosis with mixed mucinous breast carcinoma (MMBC).
METHODS:
We reviewed the records of 5,872 consecutive patients diagnosed with breast carcinoma who were resected surgically from March 2003 to October 2010. Among them, 117 patients with MBC were compared to 5,575 patients with NMBC. Furthermore, 88 patients with PMBC were compared to 29 patients with MMBC.
RESULTS:
There were statistical differences in age, pN stage, ER level, and PR level between the patients with MBC and NMBC. There were statistical differences in pT stage and pN stage between the patients with PMBC and MMBC. The overall five-year survival of patients with MBC was 88.1 % as compared with 81.9 % for patients with NMBC. The overall five-year survival of patients with PMBC was 91.3 % as compared with 80.4 % for patients with MMBC. The overall five-year survival of patients with PMBC was 91.3 % as compared with 81.9 % for patients with NMBC.
CONCLUSIONS:
PMBC tended to have a better prognosis in comparison with other types of breast carcinoma.
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Springerplus. 2013 Sep 23;2:481. doi: 10.1186/2193-1801-2-481. eCollection 2013.
Clinical significance of the sub-classification of 71 cases mucinous breast carcinoma.
Kashiwagi S1, Onoda N, Asano Y, Noda S, Kawajiri H, Takashima T, Ohsawa M, Kitagawa S, Hirakawa K.
Author information
- 1Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
Abstract
OBJECTIVE:
Mucinous breast carcinoma (MBC) is classified into mixed mucinous breast carcinoma (MMBC) and pure mucinous breast carcinoma (PMBC) based on whether the tumor is with or without a component of invasive ductal carcinoma, respectively. PMBC is subtyped into hypocellular PMBC (PMBC-A) and hypercellular PMBC (PMBC-B).
METHODS:
Of 1,760 primary breast carcinomas, 71 were diagnosed as MBC, and were subtyped for comparison purposes.
RESULTS:
Seventy-one of all breast cancers (4.0%) were MBC, and consisted of 23 MMBC, 32 PMBC-A and 16 PMBC-B. The MBC tumors were more often hormone receptor-positive and HER2-negative than non-MBC tumors. Patients with MMBC, PMBC-B or PMBC-A, in this order, had significantly higher recurrence rates than non-MBC cases (p=0.006, log-rank).
CONCLUSIONS:
In the NCCN guidelines, MBC is also regarded as "a histological type with a favorable prognosis" in a uniform manner, and "treatment for a histological type with a favorable prognosis" is recommended. However, the results of this study suggest that sub-classification-based, individualized therapeutic strategies should be considered.
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Oman Med J. 2013 Sep;28(5):350-3. doi: 10.5001/omj.2013.100.
Mucinous breast cancer with solitary metastasis to humeral head: a case report.
Aljarrah A1, Al-Hashmi M, Malik KA, Sukhpal S, Hussein S, Al-Riyami M, Al-Moundhri M.
Author information
- 1Breast Unit, Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, P.O. Box 912, PC 111, Muscat, Sultanate of Oman.
Abstract
Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed
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VR,
Thanks for the research. I just checked my original biopsy back in February 2011 and there was associated DCIS which was described as "papillary cribriform" but it sounds as if the article was talking about papillary forms in the mucinous portion. When the tumors were tested after the mx in Nov 2012, it was mentioned that the DCIS was less than 10%. I certainly had plenty of lymph nodes involved, along with the metastatic pleural nodules, but biopsies on the nodes and nodules just described mucinous tumors. My KI67 was 25% (high) which led me to expect more rapid progression than I have had but I'm certainly not complaining that my doctors describe my cancer as "indolent" lately.
I've been reading about types of bc and wondered if you knew how mucinous tumors fit in. They seem to be pretty much all hormone positive, but I'm not sure that the luminal A and luminal B categories apply. Again, the early results (ER+ 100%, PR+ 20%, HER2 2+ but neg by FiSH, and high KI67 sounded more like luminal B than the more typical mucinous tumor, but since I'm still here mine can't have been that aggressive.
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Hi Everyone, Thanks VR for all this collection of detailed Mucinous Breast Cancer articles. One day in the near future I shall study them up. I have been super busy so have not logged in for quite a while. My 90 year old stepmother who has dementia is needing increased care, she had an agressive breast cancer (I dont know which type as she never obtained that info) at 74 years old so has done superbly well with no consequent problems after having both breasts removed. In these last few weeks my two closest older friends, both 80 yrs old, died with 10 days of each other. As I agreed to help them both with their funeral arrangements and did their Eulogies its been a very busy time. Now I have Executor duties to do but hopefully that wont take too long. This is such a great forum I don't want to fade out of it all, its always great to hear how you are progressing.
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Tricianne...My,my,my! I'm so sorry to hear how things are going for you down under! Losing two close friends must make your heart ache...And your stepmom's condition must also be so difficult for you! And her too!
And to be also thinking of all of us?! Going forward, I wish you, and our sisters much strength and happiness.
And don't worry about catching up on reading those articles. I hadn't posted articles in awhile...there wasn't anything MAJOR to report....so I just got around to posting them for any newbie sisters...
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carpe...I'm not certain how mucinous BC fits in. I think most highly er/PR positive tumors would probably be classified as luminal A. However, IMHO, this new classification system is silly. I think due to the complexity of the disease, we should do a better job in describing tumors in more specific ways...relating more to genetics....
Furthermore, you are correct in making the distinction between the characteristics in the DCIS and the invasive mucinous cells. They are two very different animals. My DCIS portion was Grade 2, while my mucinous cells were Grade 1.
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Thanks VR for your kind thoughts. Emotionally while its been rather a roller coaster I am coping well now as both friends were as well prepared for dying as one can be and they both had a deep faith which has made it much easier. I get a lot of info from the research articles and find it a fascinating process. Love and prayers Tricianne.
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Type of chemo for pure mucinous????
I thought I was done with this breast cancer thing and found a lump in my armpit 8 months after my mastectomy and sentinel node biopsy of 4 nodes that were supposedly negative. Was told the lump was nothing via ultrasound-but it wasn't and last month was told by my surgeon, "we made a mistake". The biopsy report stated mucinous er/pr+ her- and surgeon said that it is too soon for it to show up to be a recurrence. It's in at least 3 nodes.
If I have to have chemo -want to make sure its going two have a chance to work-dont't want a flame thrower type chemo that won't do anything except fry my liver, etc. Alsonis just tamoxifen and surgefy done? (Didn't take tamoxifen after initial mastectomy/node removal). When my armpit lumps were discovered, a PET scan was not ordered as my type of cancer would not show up because it grows so slow and doesn't suck up sugar like other cancers. (Had to have 5 tests to make sure it did not spread-MRI, CAT scan-chest and abdomen, bone scan, liver ultrasound. Any sugggestions to get all the toxins from the tests out of my body would be nice too.)
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NLR...I'm not sure where you are being treated. I would do the following.....make sure you get a second opinion at a teaching hospital. Look for a center that is a comprehensive breast cancer facility. Also ask for your case to be presented by a tumor board. That is a weekly meeting where numerous oncology specialists gather to discuss cases.
Since mucinous BC is rare, it is hard to define the perfect regimen. Hopefully, the tumor board and/or second opinion will be able to help you.
I wish you well. Please let us know how you are doing!
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Thank you Voracious for your input!
I am in Houston now and just getting tests and recommendations before I leave for Atlanta in less than 2 weeks. Right now just researching to find any oncologists in the Atlanta area that have any experience in treating mucinous and targeting stem cells. Also eating as many brocolli sprouts that I can
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Since you are going to Atlanta, if I were you, I would contact Dr. Otis Brawley at Emory. Perhaps he can give you the name of someone to see once you arrive there. His # is 404 778 1235. Be sure to tell his office that you have mucinous bc and you need someone with experience. Good luck!
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NLR - I echo VR's suggestions, her advice is always good. One other thing is to ask for a second opinion on your pathology slides as well. Look back on this thread for comments made by Red Sunshine (probably around November 2011) for more information on why it is important to have it done. Good luck to you.
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Golden...The correct pathology is paramount, especially for the rare breast cancers. That's also why a tumor board is so valuable. Tumor board meetings include multi discipline specialists that include pathologists. When I was diagnosed, my pathology report was signed by two pathologists. The pathology report drives the treatment plan. Another point that is concerning regarding pathology reports....the margin of disagreement can vary up to 20%. Not good. However, the better news is that thanks to genomic testing, treatment plans are getting better. The only concerning note is, the genomic testing is not as strongly validated for our type of tumors.
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Thanks for the info! I had a second opinion on my biopsy the first time by MD Anderson in January 2013. Same diagnosis and the recent biopsy of 2 lymph nodes has same diagnosis. I am premenapausal and have pure mucious breast carcinoma. Cannot wait to get to Atlanta to have the buggers removed....
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My ILC was treated with neo-adjuvant chemo in early 2012, followed by BMX & rads. When my BS called a few days after surgery to give me my path results, she said "I was surprised to find a second type of cancer..." I didn't ask about it and didn't give it another thought for the next year or so. Then when I was gathering stuff for my taxes this year, I came across my reports and decided to read them again. The second type was MC.
Does this mean it's not "pure" since I also had ILC? Since I'd already finished chemo when the MC was found, I guess there wasn't anything to be done about it after the fact. I'm just wondering if the MC should be an added worry or can I assume my treatment would've taken care of it along with the ILC?
Also (dumb question alert!!) is this (ILC and MC) considered "mixed type", or is mixed type when you have, say, some cancer that is ER+ and some that is ER-? Over 2 years later, and I'm still not clear on all the terminology!
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vora...Thanks for the great information. Are you part of the study?
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Georgia...you ask great questions....unfortunately, I can't answer them...The best person to answer would be your oncologist or pathologist. Keep in mind, the treatment plan is based on the most "aggressive" cells.
Maddie....I'm not part of any clinical trial. However, what I do, from time to time, is place here on this thread current mucinous breast cancer studies. If you read further back on this thread, you will see dozens of small studies...
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Voracious....Thank you for all the info that you share! Please keep it coming! Maddie
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Thanks, varocious - I appreciate your response (and all the info you post here).
I think I already know the medical answer (i.e. we removed it all, we threw everything we had at it, your prognosis is good, yada yada yada), but was curious about opinions/experiences of others who might have had a similar diagnosis. Maybe my question should go in the "Mixed Type" forum but, as I said, I'm not exactly sure what is meant by "mixed type" here on BCO.
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georgia...if you had two types of cells in the tumor, it would be mixed. However, if you have two different areas, one can be pure mucinous, while the other area could be something else. I had one small area of DCIS next to my pure mucinous tumor. That's why you need to take a careful look at the pathology report. Mine indicates TWO specimens.
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Very helpful; thanks! I'll dig the report back out & look at it again.
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Hi Everyone
Thank you for the recent posts and information on how everyone is travelling.
I've been continuing to have difficulties with the tamoxifen of which I'm still only able to manage 3/4 of a tablet. I'm experience terrible mood swings between high and low venturing on hypomania and then low bouts. I've discussed this with a psychiatrist who is assisting me with a mood stabiliser but I'm still not quiet there yet. During my recent oncologist visit he has now told me to stop taking tamoxifen that I've had enough treatment and I don't need it with all the side effects I'm getting. As I'm only 10 months in on it and 3 months post herceptin completion I'm not sure I can make myself stop taking it for fear of an issue even though I'm suffering with side effects (I've given up work again for the time being as my moods were erratic).
Any thoughts on to do or not do tamoxifen with mucinous BC and node negative?
Wishing everyone well.
Kind Regards
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Aust....I am so sorry to hear how difficult your journey has been. First off I want to tell you, you are not alone on this journey! So many sisters have had difficulties! Recently, my dear cousin was diagnosed with BC and ended up in the hospital following her first chemo!
And mood issues and sensitivities to meds? VR has had second hand experience with that one too! DH has a genetic metabolic muscular dystrophy and heart disease AND mood issues too! IMHO, the mood issues are the worst of the three issues to have. Unless a person has experienced a mood issue or witnessed a loved one with the illness, no one can ever appreciate how devastating the illness is.
So you ask today about what to do with the Tamoxifen. Well, I would begin by asking first, what is it that you can do to make yourself emotionally better? My experience dealing with the DH's illnesses has taught me that with mental illness, one needs patience in finding the right cocktail. What do I mean by that? It can take months or even years ( 😥) to find the potion that "works.". That is, the meds that make the anxiety and blue feeling relent with the fewest side effects. If you are comfortable with the psychiatrist, then continue to work with her or him and be resolute that your patience with pay off!
I can understand and appreciate your reluctance to discontinue your Tamoxifen. Your mucinous breast cancer was aggressive. Tamoxifen should be your friend and not your enemy! I would work closely with the psychiatrist, or find another psychiatrist who specializes in pharmacology. There are some great meds out there that should mitigate your sensitivity to the Tamoxifen.
If all else fails, maybe you can try ovarian suppression for a few months along with the Tamoxifen. If you tolerate the side effects from being in menopause, then you might consider surgical removal of your ovaries and then try an AI. There are several different AI, such as Letrozole, that might be kinder to your mind and body.
I know I've given you a lot to chew on....but now I have one more thing for you to consider as well. Please try to devote some minutes or hours in the day to do things that you love to do. It is not selfish to give yourself the precious time of day to do what you love to do. It's part of your therapy! Feeling better requires finding the things that you enjoy doing and doing them! VR loves to read and take daily walks and finds the time EVERY DAY to do them! No excuses and no shame!
Time to be in warrior mode! I promise you will find a protocol that works! Wish you well!
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One more idea to try, my MO always starts Tamoxifen with 10 mg tablets, two times a day. He feels side effects are somewhat decreased. After a few months, he gave me the option of going to a 20 mg tablet or sticking with my two times a day. I stuck with the twice a day because if I forget to take my morning pill, I can catch it in in the evening.
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Hello Ladies!As you can tell I have just joined your group. I am 44 (soon to be 45) and was diagnosed with mucinous carcinoma on March 27th. I had surgery exactly one week ago today and I seem to be tolerating the partial masectomy well. I had two areas removed, one was the MC which was estimated at less than 10mm and the other was ALH. I did have a sentinel biopsy and only one node was removed, the surgeon said all went and looked well. My follow up and final path results are in two days and I'll also meet my MO at this time. I am so nervous that I've lost 15lbs since I was diagnosed. My moods are crazy to say the least. I go from crying to blissfully unaware in an instant. I just cannot seem to eat or function. I am chunky so losing weight is a good thing since intial pathology showed mine as 100% ER & PR and Her-. I suspect all the fat hiding in my abdomen is feeding this cancer.
Anyhow, I just wanted to say hello and let you know that I've read this entire thread and it's given me hope and courage that my life is not always going to be this crazy.
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welcome sunshine! Hopefully now, the worst is behind you. Gather your info from here and from the NCCN guidelines for breast cancer. Hopefully once you meet with your medical oncologist, they will be able to answer all your questions and you will be able to choose a treatment plan that is right for you. Then, you can begin your journey at finding your new normal. So far, from what you mention, this will just be a bump in the road of a bright future....
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Thank you VR! I had hesitated to post back until I finally got confirmation on an error in my path report!
I am stage 1 grade 1 PURE mucinous! It was like beating it out of the pathologist but after they realized how important it was to me they finally told me. Now I'm waiting on my oncotype test which they feel will be a low score to move ahead with treatment. I'm excited to start tamoxifin since I think this will be my best line of defense!
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Sun....good for you being persistent! Hopefully, you have made the journey easier for the next sister! I wish there was more uniformity in the way pathologists write their reports! Seems like you are feeling a little more at ease since the last time you posted. I think knowledge is power and the more power....the more control we have...or at least we THINK we have! I wish you and all our sisters well.
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