Mucinous Carcinoma of the breast
Comments
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Hello, I'm very new at this posting stuff, but wanted to jump in if I could. I was dx 10/27/08 with invasive ductal carcinoma, mucinous type. ER+/PR+ HER2-, 2cm and node -. I had all the testing done, biopsy, mri and the oncotype dx =20 . In 11/08 I had a lumpectomy with sentinel node, and this was followed by radiation, and have been on the Tamoxifen for the last two years. Everything went well, and I continued to have my mammograms and xrays every 6 months. I went in May, 2010 for my mammo and everything was clear, then again in 11/2010, and this to my surprise revealed 3 lumps. My surgeon took me right down stairs and they performed an ultra sound and she did a biopsy at the same time on two of the lumps. Later that week I received a call back from her saying it was cancer again, and it was Mucinous type. This time, I had a left breast mastectomy, with tissue expander at the moment and will have implant down the line. My lymph nodes were negative and was waiting to hear if I need chemo. This is the big question and am looking to see if I can get input. I realize every case is different. My surgeon did not seem to think I needed chemo, then went to see my oncologist and she didn't think I need the chemo, but to be safe she sent me to a specialist. This doctor seems to think I need the chemo because she is worried that it has come back after two years and I was even on the Tamoxifen. Any input would really be helpful.
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Ginashan - I'm sorry to hear of your latest diagnosis. With all of your questions, it seems difficult to give you some ideas without first asking more questions.
Have you had the Oncotype DX test done on these latest tumors? What was the grade on the previous and current tumors? Are they the same? I saw my oncologist last week and he told me that the Oncotype DX trumps everything when deciding to do chemo. Not sure if I totally agree with him, but thankfully, my score was a 15, low risk, so for me, it was a no-brainer, NOT to do chemo...especially since the evidence suggests that it doesn't work as well for a grade 1 tumor.
I think you need more information before making an informed decision about treatment. I think you also need to check the NCCN 2011 guidelines.
Are you also familiar with the Perkins study out of MD Anderson? Is it possible that these tumors were there before your first surgery and were missed? Mucinous breast cancers are often difficult to diagnose.
By all means, if you have met with two medical oncologists and they have different opinions, by all means, get a third opinion.
I wish you well and hope you will stay in touch and let us know about your treatment decisions. As I have said before, because there is so little research done on these types of rare favorable breast cancers, we have to give future BC survivors a road map.
Sorry, I can't give you a more definitive answer. My thoughts and prayers are with you!
VR
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=edited out
Diagnosis: 1/7/2011, IDC, Stage I, Grade 1, ER+/PR+0 -
VR has put together what little information is out there for us. Thank you. I've been dx with IDC with mucinious and tubular features. My lumpectomy is March 8th. I won't know what's all in the tumor until I get back the final pathology report. Perhaps, I'm leading the way for the alternative approach for this type of cancer. I put on the brakes after dx, and doing what VR said...getting as much info as I can before making a decision to do anything. What I learned is ...most bc surgeons and oncologist aren't aware of the Perkins Report. They pretty much treat this rare type of cancer with standard stage 1 IDC protocol. Mucinous cancer is not a typicaal stage 1 cancer
After reading that this type of tumor is very slow growing and rarely found in nodes, I asked my surgeon to not take out any nodes. If the final pathology reports a higher grade or multifocal, I would consider taking out a node for staging reasons only.
Because mucinious low grade cancer is slow growing, I chose not to do more than a lumpectomy. If it were found to be multifocal, I would seriuosly consider a mx. I prefer mx over rads or drugs.
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Thanks for your reply, My first lump in 2008 was a grade 1 and I thought the doctor told me the same with this one.. I have requested copy of all my records and will look on the path report. Now the tumors this time are the same as the first one, Mucinous, and I have not had the oncotype dx test with this round. It really scares me that this is back again, even with the Tamoxifen and Radiation. Could this come back again somewhere else? and should I have the chemo? I'm always thinking in the back of my head, about it coming back...Im trying to keep positive at the same time, I got through the mastectomy just fine, then I can get through anything.....
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ginashan, your recent mucinious was probably there when your first one was dx. Mucinious tumors are not easily found through mammo's. My doc said mine probably has been there for 8 years. If your tumor is grade 1 it is a slow moving tumor. I haven't yet heard of anyone who has died from it. There have been a few here, with higher grades who have more advanced cancer. For grade1 ??? Don't know.
I also read that chemo isn't recommended for early stage 1 cancers or stage 0. It is interesting that rad's nor tamoxifen helped you. The Perkins Report says that this type of cancer tends to be multifocal. Perhaps the best way to feel safe is to have a mx. If this mucus isn't there, it's not going to spread. Like VR says, there isn't enough research on this type of cancer and we're leading the way.
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Ginashan-
Another thought....
You mention that you were taking Tamoxifen. Are you premenopausal? If so, go back and look at your pathology reports carefully. If your tumors were highly ER positive and the Tamoxifen didn't work (according to your doctors), I think you might want to have a healthy discussion with your doctors about doing ovarian suppression. My doctors presented to me that approach because with Grade 1 slow growing breast cancers that are ER positive, there is a body of research that says ovarian suppression is effective at reducing the chances of recurrence. There's just one cavaet...the research is on going and we DO NOT KNOW definitively if it is effective. You can do a Google search of "SOFT trial" to gather more information and then bring it up with your physician. In the "SOFT trial" women were given a choice of ovarian suppression with either Tamoxifen or an AI. Again, the results of the trial are unknown at this time. So do your research carefully. And, remember, most women enrolled in the study have "traditional" breast cancers.
If your doctor thinks you've failed Tamoxifen, ovarian suppression and an AI, or just ovarian suppression, might do the trick. I'm going to go out on a limb and say, as I said before, those tumors might have been there BEFORE...only too microscopic for the MRI, Mammo and Sonos to find...and removing them...might still be enough treatment. The bottom line for you is...the Tamoxifen DID NOT shrink them...SO, it's obvious, that Tamoxifen is of little benefit to you.
Having a local recurrence is not as serious as a distant recurrence. With your previous tumor's Oncotype DX score of 20, it puts you at an approximately 14% chance of distance recurrence...that is based on taking the Tamoxifen. Since the Tamoxifen didn't work, you should focus your discussion on minimizing your chances of distant recurrence. And remember one more thing...Pure Mucinous breast cancers rarely metastisize and the fact that you had clean lymph nodes both times is the BEST prognostic when it comes to our type of breast cancer.
If you've read some of my other posts...keep in mind that the folks who make the Oncotype DX test are further validating the test for "rare" favorable breast cancers. Baehner and colleagues found that for mucinous breast cancer the recurrence score is in the 15 range. Your 20 score is higher than the average low risk 15, but remember....the test hasn't been as strictly validated for our type of breast cancer as it has for traditional breast cancers. I have asked the question to my doctor..."While we may have THOSE specific genes that make it likely to spread, doesn't our type also have other genes YET TO BE DISCOVERED that make ours less likely to spread?" I'm pleased there are a few researchers studying rare favorable breast cancers. Maybe they will be able to find the genes that make our tumors favorable...and find a successful treatment for us, as well as those with traditional breasts cancers, that one day, might even lead to a cure.
Thoughts and prayers to all of my BC sisters!
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Here is an update on my situation. I finally got in to see one of the top oncologists. His first comment to me was, "Boy, I'm about to make your day." He told me that my cancer was slow moving and non-agressive. He had sent out for the oncotype DX but before even seeing it he said he felt comfortable enough to tell me that it would be VERY unlikely that he would think I would benefit from chemo. He told me further that the homone treatments only benefit 5% of the people who take them and the other 95% are wasting their time. So I am declining the homones. He told me that if I had a recurrance that it would likely be the same slow moving kind as this time. Since I will be having mams 2x/yr for awhile and since I will now be more vigilant, i am going to take my chances. He would not give me much guidance on radiation treatment but told me that I would get a straight answer from the rad dr. that I was to meet with later.
Met with the rad dr. and got a different story. She couldn't believe that I would even consider skipping radiation. Told me that the only way skipping would be OK would be to have a procedure where they preserved my breast skin and nipple but removed everything underneath and put in an implant. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! WHAT'S UP WITH THAT? For a relatively "rare" slow moving cancer? She told me that I had to have the whole breast radiated, and that there was a risk of destroying part of the opposing lung. She really lost me there. I am not going to kill healthy body cells and organs wholesale to avoid the risk of the recurrance of something so rare. My Onc said, "this is about as benign as you can get without being benign."
I am currently 56. I have relatives in their 90's. It doesn't look like fun. My father lived to mid-80's but lost his mind in his late 70-'s. I'm only looking for another good 20 years and I will be happy with that. If I were younger, I would be less risk tolerant, but as it is, it seems my odds are pretty good on my own.
I went back to the onc's ARNP and told her what the rad. dr. said and she seemed to agree with me that it was an over-reaction and overkill. Apparently what we have is so rare that they hve never been able to compile stats on survival rates with and without so all the medical guidance is based entirely on data for people with the regular, aggressive BC. I have since learned about partial breast radiation and have a call in the the rad dr. to ask why that wasn't offered to me. I know that I meet the standards of at least one reputable cancer center per their website (over 50, node neg, Est +, < 3 cm). The ARNP told me to sit tight until we got the Oncotype score. If it looked like I should be able to get the partial breast rads and if they feel that I shouldn't skip radiation she told me that they would help me find a place that would work with me if the rad dr. I met with will not.
I feel things are going relatively well, but I am already sick of this ride and ready to get off!
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Hi,
I finally got the results of the oncotype test and seem to have a completely predictable score of 17. From what I have read, this is pretty typical. My question is this, and perhaps, Voracious Reader, you might some insight.
The oncotype test (if I have this right) does not discriminate between types of tumours, so saying that there is an 11% chance of distant recurrence must therefore be for the general population of breast tumours. I wonder what the stats would be if only the mucinous types were counted... any idea?
In any case, the low score means no chemo, which is great. Like tampagirl, I was told about the directed radiation trial but do not qualify because their cutoff size is 3cm and mine was bigger. I started the tamoxifen yesterday and so far so good.
I am still waiting to have an MRI on a lump on my clavicle, which I thought was arthritis, but which a CT scan says is a soft tissue mass. Maybe I'm growing a new boob...
Linda
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Linda-Renee -- Here's exactly the same question that you are asking that I ASKED over at the Johns Hopkins Ask the Expert website and the answer that Lillie Shockney gave regarding the Oncotype DX test validation for Mucinous breast cancer:
Regarding my earlier question about pure mucinous breast cancer you mentioned that the Oncotype DX test isn't validated for this type of cancer. I've been searching the internet for more info and cannot find any. What I have found is how the test WAS validated. Since they identified the "genes" taken from the pathologies of 600+ tumors, would you say that since pure mucinous breast cancer accounts for 2% of tumors, the "genes" they chose weren't statistically significant for my cancer? I'm wondering that since pure mucinous breast cancer is less likely to metastisize, that despite the presence of the Onctotype identifying "genes" for likely distant recurrence, there exists ADDITIONAL UNIDENTIFIED "genes" that make it more stable and less likely to recur?
When I initially met with my medical oncologist to discuss my Oncotype DX score of 15 which put me in the 10% category of distant recurrence, he agreed with you that the test wasn't validated for pure mucinous breast cancer and thought that, from his experience, the figure looked too high. He thought the number was closer to 7%. I met with my surgeon yesterday and while he agreed with the medical oncologist, he went even further by saying, from his 30 years of experience, he thought my chances of distant recurrence were "slim at best."
I have confidence in my physicians and my therapy and recognize that the Oncotype test was simply one more tool in the equation that was used in making a decision about therapy. However, I'm left wondering how much significance the test was for my type of cancer?
Any further thoughts? Thank you.Replied JHU's Breast Center Reply 4/9/2010 mucinous is an uncommon form of breast cancer. and it would require thousands of cases of mucinous to be oncotypeDX tested to validate it for that type. it is a type that has a lower incidence of mets too which is good in your case. so you need to rely more on the medical opinion of the medical oncologist and less perhaps on the oncotypeDx score. L 0 -
Below is a study regarding post marketing surveillance numbers for favorable subtypes by the folks who make the Oncotype DX test :
Genomic Signatures in Pathologically Favorable Breast Cancer Subtypes
Baehner and colleagues[10] reported the postmarketing experience regarding the Oncotype DX RS in patients with favorable histologic breast cancer subtypes. Of the 25,475 tumors tested over nearly a 2-year period and reviewed by academic breast pathologists, about 80% were pure ductal histology: most (94.5%) were either ductal, lobular, or mixed histologies and about 5% were less common subtypes. Compared with the median RS for ductal carcinoma (18.2), median RS was significantly lower for classic lobular (17.5), solid/alveolar lobular (16.1), mixed ductal/lobular (17.4), tubular (15.2), cribiform (13.7), mucinous (16.6), and papillary (7.8) subtypes. It was higher for the medullary-like (33.1) subtype. RS ranged in most subtypes from a low of < 10 (usually ≤ 3) to a high of approximately 60 to 90 in most subtypes, except tubular cancers, which rarely had high RS. Although tubular cancers exhibited somewhat lower median quantitative ER expression than ductal cancers (9.2 vs 9.7), their proliferation scores were substantially lower (4.3 vs 5.3). This report provides some insight into the biologic characteristics of less common breast cancer subtypes.
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Tampagal- I was offered Mammosite but refused after reading the Perkins report out of MD Anderson and chose whole breast radiation instead.
Favorability of Rare Breast Cancer Type Questioned
Mucinous Carcinoma Patients May Need More Treatment
Researchers have identified an association between breast cancer patients
with mucinous carcinoma - a rare form of invasive ductal carcinoma - and
multiple tumors undetected by mammography or ultrasound.The study, conducted at MD Anderson, is the first to observe this negative
association. It was presented at Cancer Therapy and Research Center-American
Association for Cancer Research San Antonio Breast Cancer Symposium in
December.Significance of results
This rare type of breast cancer has long been associated with a favorable
prognosis, but the association has been based on studies with small patient
numbers and short follow-up time. The current study proves this assumption of
favorability can be misleading.Background
Mucinous breast cancer, also known as colloid carcinoma, is a rare type of
invasive breast cancer formed by mucin-producing cancer cells.The disease accounts for approximately 2% of all breast cancers diagnosed.
The prognosis for mucinous carcinoma is thought to be better than for the more
common types of invasive breast cancers.Research methods
Researchers reviewed charts of 264 mucinous carcinoma patients treated at
MD Anderson between 1965 and 2005. The median age and follow-up was 57 years and
168 months, respectively.Of the patients:
- 86% were stage T2 (a palpable tumor confined to the breast) or less
- 80% had no lymph node involvement
- 15% had one to three positive nodes
- 5% had four or more
Breast-conserving therapy was received by 44% of the women. The rest
underwent a mastectomy, and 51% of the women had radiation.Primary results
While 10% of the women first presented with more than one tumor, after
surgical resection and complete pathological review, the actual rate of
multifocal or multicentric (found in more than one location) disease was 38%.
These tumors were not detected by mammography or ultrasound."This actual rate of multifocal disease was a tremendous surprise and of true
concern," says Geroge Perkins, M.D., associate professor in the Department of
Radiation Oncology and the study's first author. "We also are concerned that the
age of disease presentation appears to be decreasing in this population."Mucinous carcinoma patients may need more, not less, therapy and additional
screening. This could not only require more radiographic evaluation, such as
MRI, but also intraoperative collaboration with radiology and pathology.
Standard radiation treatment, rather than the minimal effective therapy, might
also be necessary.Additional results
The rates for overall survival (OS), disease-free survival (DFMS) and
local-regional control (LRC) were respectively at:Five years:
- 95% (OS)
- 88% (DFMS)
- 83% (LRC)
Ten years:
- 97% (OS)
- 95% (DFMS)
- 92% (LRC)
Fifteen years:
- 97% (OS)
- 94% (DFMS)
- 85% (LRC)
When analyzing surgical options, there was no statistically significant
difference in overall OS, DFMS or LRS. Likewise, there was no improvement in OS
or DMFS in patients who received whole breast radiation.There was a trend, however, for improved LRC in patients who received
radiation when compared to patients who underwent surgery without radiation.What's next?
"It's imperative that we continue to research personalized treatment options
for this subtype and that patients receive their treatment based on actual
presentation rather than the assumption that this is always a favorable
disease," Perkins says.Researchers also are evaluating a subtype of mucinous breast cancer thought
to be exceedingly aggressive in hopes of establishing specific screening and
treatment guidelines.0 - 86% were stage T2 (a palpable tumor confined to the breast) or less
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Thanks VR for the oncotype scores. I need to come back to it when the oncotype scores come in, which is about two weeks. I had my surgery yesterday, so Friday, I should have the final pathology report. I will know then how much of the tumor is mucinious, tubular or IDC.
I asked my surgeon to read the Perkins Report. I don't think she has yet. When I see her in a week, I will bring it to her, because like VR said, those with mucinious cancers need to be screened every six months with the Perkins guidelines.
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breast carcinoma;mucinous
Nineteen cases of mucinous carcinoma of the breast were studied. Twelve tumours were of the pure type, and seven were mixed. All had abundant neutral and acidic mucin, and stained strongly with CAM 5.2. Of the 12 pure mucinous tumours, six were devoid of argyrophilic granules and were S-100 negative, and only one was CEA positive. All six patients are alive with no evidence of recurrence (mean follow-up 42 months). The other six pure mucinous tumours were rich in argyrophilic granules. Five of these showed S-100 positivity and all were CEA positive. One patient developed local recurrence and one died of myocardial infarction with no evidence of tumour recurrence (mean follow-up 80 months). Of the seven mixed tumours, only one contained an occasional cell with argyrophilic granules and four had variable degrees of CEA positivity. Two patients died and one developed bony metastasis (mean follow-up 40 months).
Our findings emphasise the microscopic and prognostic differences between the three subtypes of mucinous carcinoma of the breast, and support the concept of dividing pure mucinous tumours into two distinct subtypes. We suggest that the latter subtyping can be qualitatively made on the basis of the presence or absence of argyrophilic granules in the tumour cells.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2559.1989.tb01627.x/abstract
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This is the most recent postmarketing surveillance of the Oncotype DX scores presented at the 2010 ASCO meeting for the "favorable" breast cancers...including mucinous:
Background: ER+ special histologic
breast cancer subtypes are reported to be prognostically significant. Here we
report the special histologic subtypes of ER+ breast carcinoma and associated
patterns of observed gene expression as measured by the 21 gene Oncotype DX assay.
Methods: All tumors from 6/1/04-3/31/10 were included in the analyses.
Central path used WHO criteria. Ductal NOS (DC), tubular (TC), cribriform (CC),
mucinous (MC) and papillary (PC) carcinomas were included. Quantitative
expression of 16 cancer related genes was measured on a scale from 0 to 15
(relative to reference genes) where a 1 unit increment is associated with
~2-fold change in expression. Recurrence Score (RS) was calculated as published
(Paik, NEJM 2004). Descriptive stats for the RS and individual genes [ER, PR,
invasion gene group (IGG) and proliferation gene group (PGG)] among the
different subtypes were obtained. Results: DC accounted for 94.6% of
127,364 cases, TC 0.9% , CC 0.3%, MC 3.3% and PC 0.9%. For all types a large
continuous range of RS was observed. DC had the highest RS. PC had the lowest
RS. The RS between PC, TC, and CC were not different. PC had the highest ER and
PR. TC had the lowest ER (may reflect bias in submission for RS testing). ER
was not different between CC and MC however PR was. The proportion with ER+/PR-
phenotype was different among the subtypes: TC (8.8%) and CC (8.4%) had the
lowest incidence whereas MC (14.0%) and PC (14.2%) were more similar to DC
(15.0%). TC had the lowest PGG expression. MC had lower IGG expression compared
to other subtypes. Conclusions: Special histologic subtypes are
characterized by differential gene expression and tend to have higher ER/ PR
and lower PGG/IGG expression but outlier cases are not infrequent w/in each of
the special subtypes in this large observational cohort. The variation in gene
expression, noted by histologic subtype, will be presented in detail.Subtype n % of cases RS (median) ER (median) PR (median) ER+/PR- Proliferation (median) Invasion (median) Ductal 120,449 94.6 17.5 9.9 7.5 15.0% 5.4 7.1 Tubular 1,097 0.9 14.9 9.4 7.5 8.8% 4.4 6.6 Cribriform 441 0.3 13.4 10.2 8.1 8.4% 5.1 6.6 Mucinous 4,182 3.3 15.2 10.4 7.5 14.0% 5.2 6.4 Papillary 1,195 0.9 9.9 11.4 8.5 14.2% 5.8 6.5 0 -
The table didn't print. Here are the median RS scores:
Tubular: 14.9
Mucinous: 15.2
Cribriform: 13.4
Papillary: 9.9
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Voraciousreader, thank you SO much for all of the information you post! It's very helpful, especially because mucinous breast cancer is so rare and thus rarely studied or talked about!
And I can't believe how similar our cancers were - I think it says all this in my sig, but I was diagnosed 16 months ago with pure mucinous breast cancer, stage 1, grade 2, and had no positive nodes (2 taken), and I'm highly ER+ and PR+ and HER2-, and my Oncotype score was a 15, too! I can't remember anymore how big my tumor was...somewhere between 1 cm and 1.5 cm, I think. Oh, and I also had about 3cm of DCIS very close to the mucinous tumor (one lumpectomy for both areas). [Edited to say: my sig says "0/3 nodes" - I think I had 3 nodes removed but only 2 were tested, which is why I sometimes say 0/2 and sometimes 0/3!!]
I've been on Tamoxifen for about 9 months, and haven't had any problems with it so far. I'm now in excellent health. My MRI last month was normal, and I had a great check-up with my oncologist in Jan., and a great check-up with my BS this month. They say I'm super healthy and they're not worried about recurrence. With cancer, you really never know, but I'm hoping they're right and I'm not worried about recurrence, either.
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Raili... As you well know, like the rest of the sisters who get a diagnosis of a rare breast cancer that is usually "favorable," finding information to make an informed treatment decision is difficult.
Teasing information has become my forte since I come to this board with almost two decades of experience of finding information about my beloved husband's extremely rare, genetic metabolic muscular dystrophy. When I was diagnosed with the rare mucinous breast cancer and was told it represented 2% of annual breast cancers.... I had to laugh because I thought the number seemed like an epidemic compared to my husband's illness. When he was diagnosed in 1996, there were fewer than 500 people worldwide known with his illness.
Raili... I hope you are doing well. It always upsets me whenever I read about younger women dealing with breast cancer. My daughter is close to your age and I know what a special time it is in your lives. I hope and pray that every woman gets to plan and realize their dreams. I also recognize the need for a cure. Until then, I guess posting as much information as possible is the best I can do until there is a cure. I hope you will do the same. Keep posting so we can give other women a roadmap that helps them make decisions.0 -
Hi I am new to this board. Let me fill you in on my situation. In July of 2009 my 20 year old daughter was diagnosed with mucinous carcinoma of the breast. Of course, mammography and ultrasound showed a benign cyst. I demanded they do a biopsy, luckily they conceded. The radiologist said he would bet a million dollars that it was benign. Then biopsy came back, positive. She had a lumpectomy and then was told there was still cells in the margins. She then decided to have a double mastectomy because of her age everybody thought this was a good idea. She had the double and seven lymph nodes and they were all negative. After visting with the oncologist she was told that her oncotype DX was 11. Being very cautious my daughter decided to undergo four treatments of chemo (wanted to give herself all chances of cancer not returning). After chemo she is now on five years of tamoxifen. She had all genetic testing and nothing came up, no family history, nothing. So no matter what they say the average age is remember there is a 20 year old with it.
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Mucinous carcinoma of breast: Cytodiagnosis of a case
Sangeeta Sharma1, Rani Bansal1, Anjali Khare1, Nivesh Agrawal2,
1 Department of Pathology, Subharti Medical College, Subhartipuram, Meerut - 250 002, Uttar Pradesh, India
2 Department of Surgery, Subharti Medical College, Subhartipuram, Meerut - 250 002, Uttar Pradesh, IndiaCorrespondence Address:
Sangeeta Sharma
Department of Pathology, Subharti Medical College, Subhartipuram, Delhi-Haridwar Bypass Road, Meerut - 250 002, Uttar Pradesh
India
Abstract
Mucinous carcinoma of the breast is a relatively rare, pure form accounting for 2% of all breast cancers. Pure mucinous carcinoma of the breast has a favorable prognosis. The common age is postmenopausal group. Here, we report a 30-year-old female patient diagnosed on cytology as mucinous carcinoma of the breast with lymph node metastasis and subsequently confirmed by histopathology. In 1 year follow-up, the patient did not show pulmonary or distant metastasis and received adjuvant chemotherapy at every 3 weeks interval.How to cite this article:
Sharma S, Bansal R, Khare A, Agrawal N. Mucinous carcinoma of breast: Cytodiagnosis of a case.J Cytol 2011;28:42-44How to cite this URL:
Sharma S, Bansal R, Khare A, Agrawal N. Mucinous carcinoma of breast: Cytodiagnosis of a case. J Cytol [serial online] 2011 [cited 2011 Mar 12 ];28:42-44
Available from: http://www.jcytol.org/text.asp?2011/28/1/42/76952
Full TextIntroduction
Mucinous carcinoma of the breast is uncommon, the reported incidence of pure mucinous carcinoma being 2% of all breast cancers. [1],[2] Traditionally, pure and mixed variants of mucinous carcinoma have been described. [2],[3] Pure mucinous carcinoma has a far better prognosis than the mixed variety noted in several studies. [2],[3] We report a case diagnosed as pure mucinous carcinoma breast on fine needle aspiration cytology (FNAC) in a female of reproductive age group.Case Report
A 30-year-old female presented with a large firm lump in upper quadrant of right breast for 4 years, which was gradually increasing in size and was associated with pain. The mass measured 10Χ10 cm and was fixed to the underlying structures. The overlying skin was normal and nipple was not retracted. No axillary lymph node was palpable. The clinical diagnosis of carcinoma right breast was made. FNAC of mass was advised.
Pathological findings
Fine needle aspiration was done from right breast mass. Smears showed abundant pink mucoid material. There were numerous moderately pleomorphic epithelial cells lying either discretely forming loose clusters or entrapped within stromal material [Figure 1]. At places, the cells were forming tubular structures. Mitotic figures were also seen. The cytological findings were suggestive of mucus secreting carcinoma. The patient underwent a radical mastectomy with axillary lymph node clearance.{Figure 1}
Right mastectomy specimen with axillary tail measuring 20 cmΧ14 cmΧ4 cm was received. Overlying skin measured 20 cmΧ11 cm, and the axillary tail measured 9 cmΧ6 cmΧ2 cm. Cut surface revealed circumscribed mass with variegated appearance, grey brown in color, and solid to cystic with areas of necrosis and hemorrhage. Tumor mass measured 7 cmΧ6 cmΧ5 cm, and extended from subepidermal tissue to posterior resected margin.
Four lymph nodes were identified in axillary tail, with the largest measuring 3 cmΧ2 cmΧ1 cm and the smallest measuring 1 cmΧ0.5 cmΧ0.5 cm. Cut surface of the largest was gelatinous and necrotic. Three axillary lymph nodes with fibrofatty tissue received separately ranged from 0.5 to 1.5 cm, and had unremarkable cut surface.
Sections from different areas of specimen were studied. Sections from tumor mass revealed large areas of necrosis, myxoid degeneration and lakes of mucoid material [Figure 2]. The tumor cells were round to polyhedral, exhibiting mild pleomorphism but frequent mitotic figures. These cells were mostly arranged in thin trabeculae, single rows and few solid cellular areas. Stroma was delicate in the form of fibrous bands. At places, tubular and cribriform patterns were present. Adjacent breast tissue showed suppurative inflammatory reaction. Tumor was reaching close to posterior resected margin but was separated by a thin rim of uninvolved fibroadipose tissue. All other resected margins were free. Microscopically, seven lymph nodes were identified of which the largest was almost completely replaced by tumor metastasis. Other lymph nodes showed non-specific reactive lymphoid and sinusoidal hyperplasia. Histopathological diagnosis of mucinous carcinoma (cellular variant) was given. Tumor tissue was negative for estrogen receptor (ER) and progesterone receptor (PR).{Figure 2}Discussion
Mucinous carcinoma of the breast is an uncommon entity seen in postmenopausal females, accounting for only 2% of all breast carcinomas. [1],[2] However, we are reporting a case of mucinous carcinoma in a young female aged 30 years. The behavior of the tumor tends to be less aggressive, so it has a better prognosis than other breast malignancies. The pure mucinous carcinomas are further subdivided into cellular and hypocellular variants. As soon as another pattern becomes evident as a component of tumor mass, the lesion qualifies as a mixed tumor. The most common admixture is with regular invasive duct carcinoma. Our case was the cellular variant of pure mucinous carcinoma breast.
Two lesions most likely to be confused with mucinous carcinoma are mucoid fibroadenoma and mucocele like lesion. [4] Mucinous carcinoma is ER positive, and in less than 70% cases, it is PR positive. [5],[6] However, in our case, it was both ER and PR negative. Nearly all pure mucinous carcinomas are diploid, while over 50% of mixed variety is aneuploid. Only 3-15% of pure variety shows axillary node metastasis compared to 33-46% of the mixed type. [3],[7] In the present case, one axillary node was positive for tumor deposits. Late distant metastases may occur. [2],[8] The present case did not show any distant metastasis either at the time of diagnosis or during the 1 year of follow-up. Adjuvant chemotherapy containing cyclophosphamide, adriamycin and 5 fluorouracil (5 FU) was given at every 3 weeks interval. Histochemically, the mucins secreted by this tumor are distinct O-acylated forms of sialomucin. [9] Immunohistochemically, there is strong MUC (mucin) 2 cytoplasmic immunoreactivity and decreased MUC I immunoreactivity compared with ductal carcinoma not otherwise specified (NOS). One-fourth to nearly one-half shows features consistent with endocrine differentiation. [10]Conclusion
We have reported a case of pure mucinous carcinoma in a young female emphasizing the role of FNAC in its early diagnosis0 -
The above recently published study concerns a 30 year old woman diagnosed with a PURE mucinous breast cancer that was ER/PR NEGATIVE. A very unusual presentation.
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Isn't it strange that such a rare type of BC that's only been associated with post-menopausal women is now being found in pre-menopausal women now? When I was give my dx I was told that it's rare, usually not aggressive, rarely spreads to the lymph nodes, and is typically found in woman 48-82 (or something like that) so my prognosis was really good........although I thought it was strange since I'm 36..........so while I felt I was going to be just fine, I didn't want to be as cavelier about my dx. I mean, what's going on in my body hormonally to give me a form of cancer that is found in women who's hormone profiles should be different from mine???
To me, there's too much crap in the environment (and food and products) that is fooling around with our endocrine systems......JMO
Happy to find a thread for this type of BC, thanks for all of the info!
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Sherbear, I know, it's strange that supposedly mucinous breast cancer is mainly found in post-menopausal/older women, but it seems like in this thread, MOST of us dx'd with mucinous were much younger. I don't know if that means that it's becoming more common for younger women to have mucinous cancer, or if it's a "sampling bias" because there might be more older women with this type of cancer but they are less likely to be on Internet forums than we are?? I don't know.
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Raili, that could totally be, I'm not sure either. All I know is that it comforted my family doctor that I had this type although like I said, I thought it was strange that it's usually in PM women.....I guess she never thought of that, lol. It didn't stop my onc's from throwing everything at me though, due to my age. Originally my doc thought I'd just have a lumpectomy and a few lymph nodes out and that was it.....little did she know ha!
When I had my 'dye' for my SNB done I ended up knowing the technician and she told me that since she's worked there (at the hospital) she's totally noticed the age of BC patients dropping dramatically over the last 15 years. Used to be ladies in maybe 50's and 60's/70's, then 40's, now she regularly sees women in their 20's and 30's. Kinda scary.
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Thankyou to all of you for your very informative posts on mucinous cancer. I am just learning all I can so I read and absorb the information but this is my first post. I live in South Australia and was diagnosed with pure mucinous cancer on the 20th October 2010 following a mammogram then fine needle biopsy. The Specialist initially doubted the mucinous cancer diagnosis but once the full pathology report was in front of him had to agree that was what it was. Obviously at the 2% stastical incidence and sometimes getting a false initial diagnosis due to mucinous material in the biopsy his scepticism is understandable.The treatment here is totally free in the public health system so I am very appreciative of all the top professonal care that I am able to receive. I had a lumpectomy in Nov 2010 started tamoxifen 6th December then Radiotherapy is now starting the 3rd week.
My GP thinks there is a link with a recently assessed Vitamin D deficiency so we are working on rectifying that. I had a very close friend die of malignant melanoma cancer and as its a prevalent cancer here in Australia I have been meticulous with my sun protection.Maybe I have tried too hard. Do any of you have any additonal info on Vit D deficiency links with breast & colon cancer? Look forward to hearing from you.
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Hi again so soon, how do I get the diagnosis box to accept Mucinous Breast DCIS. and Progesterone postive, I tried to update it in diagnosis box but ???? nothing happened. Thanks. Well I played around with the edit section & wow I fixed it.
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Institute of Medicine from the National Academies:
Report Brief
- Released:
- 11/30/2010
- Download:
Dietary Reference Intakes for Calcium and Vitamin D
Calcium and vitamin D are two essential nutrients long known for their role
in bone health. Over the last ten years, the public has heard conflicting
messages about other benefits of these nutrients-especially vitamin D-and also
about how much calcium and vitamin D they need to be healthy.To help clarify this issue, the U. S. and Canadian governments asked the
Institute of Medicine (IOM) to assess the current data on health outcomes
associated with calcium and vitamin D. The IOM tasked a committee of experts
with reviewing the evidence, as well as updating the nutrient reference values,
known as Dietary Reference Intakes (DRIs). These values are used widely by
government agencies, for example, in setting standards for school meals or
specifying the nutrition label on foods. Over time, they have come to be used by
health professionals to counsel individuals about dietary intake.The committee provided an exhaustive review of studies on potential health
outcomes and found that the evidence supported a role for these nutrients in
bone health but not in other health conditions. Overall, the committee concludes
that the majority of Americans and Canadians are receiving adequate amounts of
both calcium and vitamin D. Further, there is emerging evidence that too much of
these nutrients may be harmful.Health Effects of Vitamin D and Calcium Intake
The new reference values are based on much more information and
higher-quality studies than were available when the values for these nutrients
were first set in 1997. The committee assessed more than one thousand studies
and reports and listened to testimony from scientists and stakeholders before
making its conclusions. It reviewed a range of health outcomes, including but
not limited to cancer, cardiovascular disease and hypertension, diabetes and
metabolic syndrome, falls, immune response, neuropsychological functioning,
physical performance, preeclampsia, and reproductive outcomes. This thorough
review found that information about the health benefits beyond bone
health-benefits often reported in the media-were from studies that provided
often mixed and inconclusive results and could not be considered reliable.
However, a strong body of evidence from rigorous testing substantiates the
importance of vitamin D and calcium in promoting bone growth and
maintenance.Dietary Reference Intakes
The DRIs are intended to serve as a guide for good nutrition and provide the
basis for the development of nutrient guidelines in both the United States and
Canada. The science indicates that on average 500 milligrams of calcium per day
meets the requirements of children ages 1 through 3, and on average 800
milligrams daily is appropriate for those ages 4 through 8 (see table for the
Recommended Dietary Allowance-a value that meets the needs of most people).
Adolescents need higher levels to support bone growth: 1,300 milligrams per day
meets the needs of practically all adolescents. Women ages 19 through 50 and men
up to 71 require on average 800 milligrams daily. Women over 50 and both men and
women 71 and older should take in 1,000 milligrams per day on average to ensure
they are meeting their daily needs for strong, healthy bones.Determining intake levels for vitamin D is somewhat more complicated. Vitamin
D levels in the body may come from not only vitamin D in the diet but also from
synthesis in the skin through sunlight exposure. The amount of sun exposure one
receives varies greatly from person to person, and people are advised against
sun exposure to reduce the risk of skin cancer. Therefore, the committee assumed
minimal sun exposure when establishing the DRIs for vitamin D, and it determined
that North Americans need on average 400 International Units (IUs) of vitamin D
per day (see table for the Recommended Dietary Allowances- values sufficient to
meet the needs of virtually all persons). People age 71 and older may require as
much as 800 IUs per day because of potential changes in people's bodies as they
age.
Report Brief
- Released:
- 11/30/2010
- Download:
Questions About Current Intake
National surveys in both the United States and Canada indicate that most
people receive enough calcium, with the exception of girls ages 9-18, who often
do not take in enough calcium. In contrast, postmenopausal women taking
supplements may be getting too much calcium, thereby increasing their risk for
kidney stones.Information from national surveys shows vitamin D presents a
complicated picture. While the average total intake of vitamin D is below the
median requirement, national surveys show that average blood levels of vitamin D
are above the 20 nanograms per milliliter that the IOM committee found to be the
level that is needed for good bone health for practically all individuals. These
seemingly inconsistent data suggest that sun exposure currently contributes
meaningful amounts of vitamin D to North Americans and indicates that a majority
of the population is meeting its needs for vitamin D. Nonetheless, some
subgroups-particularly those who are older and living in institutions or who
have dark skin pigmentation-may be at increased risk for getting too little
vitamin D.Before a few years ago, tests for vitamin D were conducted infrequently. In
recent years, these tests have become more widely used, and confusion has grown
among the public about how much vitamin D is necessary. Further, the
measurements, or cut-points, of sufficiency and deficiency used by laboratories
to report results have not been set based on rigorous scientific studies, and no
central authority has determined which cut-points to use. A single individual
might be deemed deficient or sufficient, depending on the laboratory where the
blood is tested. The number of people with vitamin D deficiency in North America
may be overestimated because many laboratories appear to be using cut-points
that are much higher than the committee suggests is appropriate.Tolerable Upper Levels of Intake
The upper level intakes set by the committee for both calcium and vitamin D
represent the safe boundary at the high end of the scale and should not be
misunderstood as amounts people need or should strive to consume. While these
values vary somewhat by age, as shown in the table, the committee concludes that
once intakes of vitamin D surpass 4,000 IUs per day, the risk for harm begins to
increase. Once intakes surpass 2,000 milligrams per day for calcium, the risk
for harm also increases.As North Americans take more supplements and eat more of foods that have been
fortified with vitamin D and calcium, it becomes more likely that people consume
high amounts of these nutrients. Kidney stones have been associated with taking
too much calcium from dietary supplements. Very high levels of vitamin D (above
10,000 IUs per day) are known to cause kidney and tissue damage. Strong evidence
about possible risks for daily vitamin D at lower levels of intake is limited,
but some preliminary studies offer tentative signals about adverse health
effects.Conclusion
Scientific evidence indicates that calcium and vitamin D play key roles in
bone health. The current evidence, however, does not support other benefits for
vitamin D or calcium intake. More targeted research should continue. Higher
levels have not been shown to confer greater benefits, and in fact, they have
been linked to other health problems, challenging the concept that "more is
better."0 - Released:
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Tricianne- Sorry to hear about your diagnosis. Glad you found this thread. I hope, once women are diagnosed with this rare breast cancer, they will find their way here and get information that will help them make an informed treatment decision. Furthermore, I hope they will find support here as well.
Raili - Glad to hear you're doing well. I recall you had trepediation about taking the Tamoxifen. I, too, have been very fortunate to not have side effects. I have a uterine polyp and fibroid that are being monitored with six month vaginal ultrasounds. Thus far, they are stable. If all goes well after my next six month ultrasound, the gynocologist will move me to annual ultrasounds. A year before my breast cancer diagnosis, I had surgery for polyps. Unfortunately, they do have a tendency to grow back. Thankfully, this time, I don't have any issues associated with the polyps and fibroids. Anyway, I feel terrific too! Shall we celebrate?
Regarding the above post, this study is a meta-analysis of most of the current research regarding Vitamin D. The bottom line is that they think there needs to be MORE research. Ya think? Until then, they are telling the public to be aware that too much Vitamin D might cause damage, so I think the takeaway message is those of us who are taking it, myself included, have to be monitored carefully.
Tricianne - Check out the search box in the upper right hand corner. You can search for Vitamin D and see all of the threads here at breastcancer.org on the subject. There are too many to recommend. Happy reading!
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Bump for Jude 58
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Bump
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