Mucinous Carcinoma of the breast

obsolete · July 2023

IS THERE A ROLE FOR 21-GENE RECURRENCE SCORE IN MUCINOUS CARCINOMA OF BREAST?
"Younger age, high-grade and lack of PR expression are more likely to be associated with high RS."
https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.e12538

obsolete · July 2023

THE SPECTRUM OF MUCINOUS LESIONS OF THE BREAST
"One study showed that in mixed tumors, presence of adverse risk factors was inversely proportional to the amount of mucinous component of tumor"
https://meridian.allenpress.com/aplm/article/147/1/19/489678/The-Spectrum-of-Mucinous-Lesions-of-the-Breast

obsolete · July 2023

CLINICOPATHOLOGICAL AND MOLECULAR ANALYSIS OF 45 CASES OF PURE MUCINOUS BREAST CANCER
"The risk of LN metastasis in PMBC could increase in association with larger tumor size, a smaller proportion of mucinous component, and p53 expression"
https://www.frontiersin.org/articles/10.3389/fonc.2020.558760/full

obsolete · July 2023

obsolete · July 2023

CONSTRUCTION OF A PROGNOSTIC NOMOGRAM MODEL FOR PATIENTS WITH MUCINOUS BREAST CANCER
"The predictive importance of tumor size in MBC patients is a point of contention. Patients with tumors greater than 2 cm were previously advised to take adjuvant chemotherapy, according to NCCN recommendations. However, the recommendations have been modified so that only lymph node involvement is considered chemotherapeutic, regardless of the T stage. While tumor size has been linked to the diagnosis of less aggressive tumors, its predictive value has been questioned due to the inclusion of extensive extracellular mucins in tumor size measurement [18]."
https://www.hindawi.com/journals/jhe/2022/1230812/

obsolete · July 2023

So sorry, BaskInTheSun, life is not fair. Getting BC at 31 is not fair.
Please know your path report intimately while advocating for yourself as you do your due diligence. Know exactly on the Mucinous spectrum where it is you fall. Ultimately it's your decision. Best wishes 😍

obsolete · July 2023

Reference old data: 1995-2002

MUCINOUS BREAST CANCER – CLINICAL CHARACTERISTICS AND TREATMENT RESULTS IN PATIENTS TREATED AT THE ONCOLOGY CENTRE IN KRAKÓW BETWEEN 1952 AND 2002

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4068815/

kotchaj · July 2023

obsolete,

Thank you for all of the reports that you are sharing regarding Mucinous breast cancer.

It is helpful to read them and gives me some peace of mind as I am sure it does others.

lumpybobcat · January 30

I've gone in for my 6-month follow up mammogram since my surgery. A mix-up about whether to have or not a ultra sound. The mammo never picked up the mucinous cancer through the years. It was only when I had an ultra sound they discovered a suspicious area that needed a biopsy. My question to all of you is: Did they find the mucinous cancer on your mammogram or was there other circumstances like a lump that needed biopsy or an ultra sound that led to the diagnosis?

pinger2474 · January 30

I had multiple mammograms that didn’t find the tumor. Five months after a mammogram in late 2019, I felt a palpable lump in my left breast. That led to a biopsy which was revealed to be invasive mucinous cancer. I had a mastectomy in mid 2020. Now I rotate an ultrasound and an MRI 6 months apart.

lumpybobcat · January 30

pinger2474 … I'm in contact with my surgeon regarding the ultra sound order. Unfortunately, my surgeon is out on maternity leave. I could change course and contact my primary, but she, too, is on maternity leave. I'll be curious to hear what others have to say about how their mucinous cancer was diagnosed. Having had breast cancer prior to this newest discovery, I consistently had mammograms every year with no detection.

kotchaj · January 30

Mine wasn't found until I had my mastectomy. They had found IDC during the needle biopsy, but not the mucinous.

rain88 · February 5

Hi ladies, Mammogram also missed mine... Because I have very dense breasts I've had regular mammograms since I was 29. Nothing was detected until I was 48, in 2019, when, in fact, I found the lump myself. They couldn't get a clear view of it on mammogram. On ultrasound, the lump looked well circumscribed, more like a cyst. I recall they were almost sure it was something benign. Fortunately, the radiotherapist put it down as a BIRADs 4a, which, while it was low suspicion of malignancy, allowed for a biopsy to be ordered. Long story short, it turned out to be invasive mucinous carcinoma (1.1 cm, grade 1, no lymph nodes involved). The follow up here (Canada, Ontario) once back in my family doctor's care, is annual mammogram/ultrasound every 2 years. Thank you for sharing your story.

moderators · February 6

Thank you for sharing your story, @rain88!

katethecat · April 20

Has anyone had their pure mucinous cancer spread to the brain?

obsolete · June 12

Hi KateTheCat,
Sorry to learn about your brain spread concerns. Apparently we're not aware of any mucinous breast cancer mets to the brain. How have you been doing? Sending you healing energy & best wishes…

"Late distant metastases may occur in pure mucinous carcinoma."

Source: Toikkanen S, Kujari H. Pure and mixed mucinous carcinomas of the breast: a clinicopathologic analysis of 61 cases with long-term follow-up. Hum Pathol. 1989 Aug;20(8):758-64
https://pubmed.ncbi.nlm.nih.gov/2545592

On metastatic issues: "Correlate with clinical and radiologic history, such as colorectal, lung and gynecologic. Expression profile dependent on origin."

https://www.pathologyoutlines.com/topic/breastmalignantmucinous.html

obsolete · June 14

"Although PMBC is considered a favorable subtype, recurrence can occur."

"Approximately half of recurrences in PMBC were distant (48.7%), and this was lower than corresponding percentages for IDC (67.3%) and ILC (80.6%)..."

"...14 (35.9%) of the patients with relapsed PMBC had received prior chemotherapy."

"LN positivity, adjuvant radiotherapy and ET were the only significant independent prognostic factors for RFI of PMBCs on multivariable analyses."

MUCINOUS BREAST CARCINOMA
"Late distant metastases may occur in pure mucinous carcinoma. [21]"
Faten Limaiem; Faran Ahmad.
https://www.ncbi.nlm.nih.gov/books/NBK538334/

BREAST OTHER INVASIVE CARCINOMA SUBTYPES, WHO CLASSIFIED MUCINOUS
Metastatic: "Correlate with clinical and radiologic history, such as colorectal, lung and gynecologic. Expression profile dependent on origin."
https://www.pathologyoutlines.com/topic/breastmalignantmucinous.html

OUTCOMES IN NONMETASTATIC HORMONE RECEPTOR–POSITIVE HER2-NEGATIVE PURE MUCINOUS BREAST CANCER: A MULTICENTER COHORT STUDY
May 14 2024
https://jnccn.org/view/journals/jnccn/aop/article-10.6004-jnccn.2023.7121/article-10.6004-jnccn.2023.7121.xml

"Compared with IDC, PMBC demonstrated superior RFI, RFS, and OS, whereas ILC had similar survival outcomes."
"Overall, our data support the classification of PMBC as one of the favorable histologies in the current NCCN Guidelines, with de-escalation of treatment recommendations."
"LN negativity, adjuvant radiotherapy, and ET were associated with superior RFI. However, adjuvant chemotherapy was not associated with better outcomes in exploratory subgroup analyses on patients with node-positive tumors, those with larger tumor size, or those aged <50 years."

First, with regard to chemotherapy, we did not find better outcomes with the use of chemotherapy in our multicenter cohort for any patient subgroup defined by age group and by nodal stage and tumor size as per NCCN Guidelines..."

"Use of ET appeared to be associated with superior outcomes across all subgroups except for LN-negative or N1mic PMBC <1 cm."

"These results need to be interpreted with caution given the limitations regarding the small number of patients who did not receive ET and the low event rate with this favorable histology."

"Moreover, a significant association for inferior BCSS with chemotherapy was seen in the SEER subgroup of LN-negative tumors ≥3 cm."

rain88 · June 30

Thank you, Obsolete. ♥️

sarona · July 2

obsolete

I can’t understand this

"Moreover, a significant association for inferior BCSS with chemotherapy was seen in the SEER subgroup of LN-negative tumors ≥3 cm."

This puts me on unease coz my tumor was 3.5 cm and no nod involvement and I wasn’t recommended chemo but did take radiotherapy

I am 34 years old

obsolete · July 18

Hi rain, hope your summer is spectacular & you're always most welcome 💜 Wishing you all a safe & healthy 🍀 year.

obsolete · July 18

Sarona, very sorry you find yourself here with us at such a young age. MC is reportedly extremely rare at <35

Please feel encouraged your assays were favorable & didn't need chemo. Clear nodes is a plus. Radiotherapy likely took care of any stray naughty cells.

Those patients who you asked about, who needed chemotherapy, presumably were higher grades and less favorable genetics expressed in assays (Oncotype, etc). Some have mutations. Some have family history of BC. Quantitative data is sometimes skewed due to small scale studies with few MC patients. You might find the following study interesting. Best wishes.

EVALUATION OF EFFICACY OF CHEMOTHERAPY FOR MUCINOUS CARCINOMA: A SURVEILLANCE, EPIDEMIOLOGY & END RESULTS COHORT STUDY

"Predictors for receiving chemotherapy were younger age, estrogen receptor-negative, progesterone receptor-negative & human epidermal growth factor receptor 2-positive status, higher grade, larger tumor size, lymph node involvement, radiation reception, and mastectomy. Further subgroup analysis verified that regardless of the hormone receptor (HR) and lymph node (LN) status, patients did not benefit from chemotherapy."

https://journals.sagepub.com/doi/full/10.1177/1758835920975603

sonialand · August 9

I write from Spain. I'm glad to find this mucinous carcinoma forum.

I was diagnosed with this carcinoma a few days ago and I have positive estrogen and progesterone receptors, and negative HER2.

In my case, I have 5 nodules, one 3.3 cm, another 13 mm, another 10 mm and two smaller ones.

Has anyone here had several nodules like me? I would like to know what he has done and what his evolution has been.

I am very interested in knowing if anyone has done only surgery and hormonal treatment and has not done radiotherapy. I know that chemotherapy is not recommended if you are HER2 negative, so they are not going to give it to me.

And I also want to know if it is common for this cancer to return after a while or not. With the number of years this forum has been around, we could already know this. I'm reading the forum little by little.

Thank you for reading me and for making the fórum posible.

obsolete · August 10

Hola Sonia de España, cálida bienvenida. So very sorry you presented with multiple mucinous nodules, but please have no incremental fear. I had several mixed mucinous or Hypercellular Type B tumors of luminal A molecular subtype almost 11 years ago. Everybody is a little different.

Imaging didn't identify all tumors, but pathology from mastectomy surgery found more hypoechoic masses. I also had scattered multi-centric DCIS too. I had bilateral mastectomy due to poor margins found after my first lumpectomy.
I had surgery twice and hormonal treatment, but I declined radiotherapy twice due to my history of lung issues. My Oncotype score did not indicate chemotherapy, so there was never the question.

Sonia, did any of your nodules have any fixation to your skin or chest wall?

Please see Part 2 also which hopefully will not be too overwhelming for a new patient.
We wish you well and please let us know how you are doing. Hugs to you.

obsolete · August 10

Part 2

"Some authors have stated that adjuvant chemotherapy can be omitted in cases with favorable risk factors [20]."

"Mucinous carcinoma has a favorable prognosis and infrequent lymphatic metastasis compared to invasive ductal carcinoma. Axillary lymph node metastases occur in 12%-14% of the cases [19].

"Isoechoic masses are found in pure mucinous carcinoma, whereas hypoechoic masses are found in mixed mucinous carcinoma."

MUCINOUS BREAST CARCINOMA
Faten Limaiem; Faran Ahmad.
https://www.ncbi.nlm.nih.gov/books/NBK538334/

Most common are Hypocellular Type A or Pure Mucinous breast cancer. The 2 types are explained in link below.

MUCINOUS CARCINOMA OF THE BREAST (2024)
https://radiopaedia.org/articles/mucinous-carcinoma-of-the-breast

OVERALL SURVIVAL IN PATIENTS WITH MUCINOUS CARCINOMA OF BREAST: A POPULATION-BASED STUDY
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8702984/

OUTCOMES IN NONMETASTATIC HORMONE RECEPTOR-POSITIVE HER2-NEGATIVE PURE MUCINOUS BREAST CANCER: A MULTICENTER COHORT STUDY
https://pubmed.ncbi.nlm.nih.gov/38744306/

MUCINOUS ADENOCARCINOMA
https://www.cancercenter.com/adenocarcinoma/mucinous-adenocarcinoma

sonialand · August 12

Thank you very much, Obsolete.

You are now cancer free, right? I am very happy to hear about your case and I thank you very much for responding to me. It seems that this thread is no longer as active as it was years ago.

I don't know if any of my nodules have any attachment to the skin. One of them I can notice very well, the others can't, but I haven't asked that. And I think none of them have fixation to the chest wall.

They have talked to me about having a mastectomy, which saddens me. I had the idea that they could remove the nodules and leave my breast behind. They also want to remove the sentinel lymph node for analysis. Is this necessary to know if the cancer has advanced or for something else? Is there no way to know otherwise?

Now I want to get a second opinion, but I honestly don't know where to turn.

Is Ki67 really important? How big are our tumors? Mine have had ki67 of 15 and 22. Seems a little high I think.
Thank you very much for continuing to keep this thread alive. Good luck and Good luck to all.

moderators · August 13

Hola @sonialand, y bienvenida a Breastcancer.org! We're glad you found us and decided to re-bump this thread with your story.

Sometimes, seeking a second opinion is a very wise step, especially if you have doubts or just want to explore all your options. Also, talking to another specialist might offer a different perspective and offer comfort. Here's more information on how to do that, from the main Breastcancer.org site:

https://www.breastcancer.org/treatment/second-opinion/when

Y aquí el mismo artículo en español:

https://www.breastcancer.org/es/tratamiento/segunda-opinion/cuando

Best wishes, and we hope this helps! Come back to let us know how you're doing. We're thinking of you!

The Mods

obsolete · August 13

Y un gran saludo, @Sonialand 😃. Thank you for your kind words. As the mods astutely suggested, please ask for a 2nd opinion. You could seek out a dedicated breast specialist. You may also ask for a pre-surgical MRI. The Anderson Cancer Center study linked below, which is of significance, explains why, so you may wish to discuss with your doctor.

MUCINOUS BREAST CARCINOMA: OCCULT MULTIFOCALITY/ MULTICENTRICITY IN A FAVORABLE DISEASE
"However, this is the first known report of an association with significant occult multicentricity/multifocality."
"10% of [pure mucinous] patients had an initial multicentric/ multifocal presentation. However, a detailed pathology review revealed a 38% multifocal/multicentric disease rate after surgical resection. The occult tumors were NOT initially detected by mammography or ultrasonography."
"MRI should be a consideration in efforts to identify potential occult disease."
https://aacrjournals.org/cancerres/article/69/24_Supplement/4117/551031/Mucinous-Breast-Carcinoma-Occult-Multifocality

What were your preliminary ER % and PR % ? After your final surgical pathology, you'll be given more details on your tumors characteristics. Oncotype or Mammaprint gene assays can be enormously helpful. If your ER%/ PR% was lower than expected, please consider genetic testing to give you some insight from testing because genes and genetic mutations do matter. I never had Ki67 testing because it's reportedly controversial in some cases.

Removal of sentinel lymph nodes is standard protocol because your medical team needs to know if the horse has left the barn or if any malignant cells infiltrated your lymph nodes. Probably NOT in your case. Please don't worry because I also had a 3cm tumor and my lymph node was enlarged, shotty & matted, although clear of malignant cells. MRI can identify enlarged lymph nodes and some infiltration, so you can discuss this with your doctor.

Medical science has since recognized Mucinous Carcinoma as a rare spectrum of disease. This thread has evolved in the same fashion, giving those of us, although fewer in number, a voice on the far end of the spectrum with multiple tumors, larger tumors & varying mixed subtype rarer presentations.

I've been NED (no evidence in of disease) or in remission almost 11 years, but I don't want to jinx myself 😤 We're here for you. Mis mejores deseos para navegar a tu manera en España.

-------------

SPECTRUM OF MUCIN-CONTAINING LESIONS OF THE BREAST: MULTIMODALITY IMAGING REVIEW WITH PATHOLOGIC CORRELATION
https://pubs.rsna.org/doi/10.1148/rg.230015

THE SPECTRUM OF MUCINOUS LESIONS OF THE BREAST
https://meridian.allenpress.com/aplm/article/147/1/19/489678/The-Spectrum-of-Mucinous-Lesions-of-the-Breast

moderators · August 17

@sonialand We're just checking in on you — how are you managing since diagnosis? Thinking of you!

sonialand · August 21

Oh, he dado a publicar un mensaje y no aparece publicado ni puedo recuperar el mensaje.

moderators · August 21

¡Hola @sonialand! Sorry for that! We've sent you a private message to see if we can help.

Mucinous Carcinoma of the breast

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