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Topic: Mucinous Carcinoma of the breast

Forum: Less Common Types of Breast Cancer — Meet others with less common forms of breast cancer, such as Medullary carcinoma, Inflammatory breast cancers, Mucinous carcinoma (colloid carcinoma), Paget's disease, Papillary carcinoma, Phyllodes tumor, Tubular carcinomas, Metaplastic tumors, Adenoid cystic carcinomas and Angiosarcoma.

Posted on: Apr 24, 2009 12:43AM

peggym wrote:

On April 21st I had a core biopsy and today I was told that I have mucinous carcinoma of the breast.  When I investigated on this website, the information given was that this is a rare type of cancer, about 2-3% of all breast cancers and usually occurs in post-menopausal women over the age of 60.  I am neither.  I am 51 years old, but still menstruate.  I have an appointment with a surgeon, but feel as though I am in the state of shock.  This "nodule" was found on routine mammogram and I convinced myself that it was nothing.

This may sound odd at my age, but I just recently started to enjoy and like 'these babies'.  The thought of losing my breast scares me tremendously, and I have not even considered the thought of this cancer metastasizing.  I won't think of that!

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Sep 30, 2010 05:07PM Bambaloos wrote:

I was diagnosed with stage 3 Mucinous/DCIS and had chemo, lumpectomy followed by radiation.  I had all my lymph nodes removed and 6 out of 28 tested positive for Mucinous, I did get clear margins at the tumor site.  My Onc thinks I have had this a very long time as it is a very low grade.  Best wishes to you all.

Mandy Dx 1/15/2010, IDC, 5cm, Stage IIIA, Grade 2, 6/28 nodes, mets, ER+/PR+, HER2-
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Oct 1, 2010 12:57AM DragonladyTina wrote:

Hi Meg,

I am in Windsor Ont. and my oncologist is at Windsor Regional Hospital Center at Metropolitan Campus here in Windsor, I feel I have gotten excellent medical care thus far. I believe that my surgeon took quite a few nodes out because at the time of my surgery they did not have the equipment to perform the sentinal node procedure then. I have had no problems with the node removal so far but I am very, very careful not to put myself at added risk for lymphedema.

Best of luck with your surgeries and keep in touch, 

Tina

Live, Laugh and Love Dx 12/2/2004, 6cm+, Stage I, Grade 1, 0/19 nodes, ER+/PR+, HER2-
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Oct 27, 2010 04:53PM - edited Aug 20, 2013 11:02AM by meglove

Had BMX on 18th. Had post-op yesterday. Except the main tumor (mucinous carcinoma) detected by mammo and US, they also found multifocal mucinous tumor and DCIS, which is not detected by tests. I am glad I had BMX. After I read the article from MD Anderson saying radiation, rather than chemo, is effective on multifocal mucinous carcinoma, I am thinking what I should do next. Wait for the appointment call from onc. Hope to hear from or connect with someone with similar diagonosis. Best wishes to all. Meg

Invasive mucinous + DCIS 3*2.8*2.5cm gr 2, dx 08/07/10 (38 ys), BMX 10/18/10, 0/1, ER+/Pr+, HER2+ DD AC 4 Tx first on Dec 9th then DD Taxol 4 Tx finished on 03/17/11. Herceptin finished in 02/12. Tamoxifen started on 04/15/11. Total hys 12/03/12.
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Oct 28, 2010 01:46AM hymil wrote:

Bump for CoopersWorkshop

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Oct 28, 2010 01:43PM meglove wrote:

Hymil, what is Coopersworkshop? Thanks! Meg
Invasive mucinous + DCIS 3*2.8*2.5cm gr 2, dx 08/07/10 (38 ys), BMX 10/18/10, 0/1, ER+/Pr+, HER2+ DD AC 4 Tx first on Dec 9th then DD Taxol 4 Tx finished on 03/17/11. Herceptin finished in 02/12. Tamoxifen started on 04/15/11. Total hys 12/03/12.
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Oct 28, 2010 03:03PM voraciousreader wrote:

I wondered also what Coopersworkshop was.  Seems Hymil saw another thread regarding a person

http://community.breastcancer.org/forum/104/topic/759928?page=1#post_2051592

 with the name "Coopersworkshop" who was making an inquiry about mucinous/colloid breast cancer.

Hopefully, she'll find us!  :)

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Nov 1, 2010 07:18PM meglove wrote:

I have read the pathology report again after BMX, here it what says about my right breast:

A:Granulomatous and chronic inflammation and fibrosis
B: multiple residula foci of mucinous carcinoma (had lumpectomy before bilateral mastecotomy.
C: extensive intraductal carcinoma component (intermediate nuclear grade)

Now I am know my right breast is not only mixed. and I am not sure if I actually have inflammable BC? Forgot to ask surgeon just got fax from nurse.

Does anyone with mixed mucinous have MX then found something similar to mine? Thanks!

Meg

Invasive mucinous + DCIS 3*2.8*2.5cm gr 2, dx 08/07/10 (38 ys), BMX 10/18/10, 0/1, ER+/Pr+, HER2+ DD AC 4 Tx first on Dec 9th then DD Taxol 4 Tx finished on 03/17/11. Herceptin finished in 02/12. Tamoxifen started on 04/15/11. Total hys 12/03/12.
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Nov 21, 2010 01:45PM voraciousreader wrote:

One more recently noted observation regarding pathology of mucinous breast cancer and node biopsy:

http://jcp.bmj.com/content/early/2010/10/20/jcp.2010.082495.abstract

Hope this helps!

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Nov 21, 2010 02:20PM meglove wrote:

I came across this article too when I googled her2+ mucinous. It said 33% mixed mucinous were her2+. I think mine is mixed so it is not so surprising I am her2+too.

Invasive mucinous + DCIS 3*2.8*2.5cm gr 2, dx 08/07/10 (38 ys), BMX 10/18/10, 0/1, ER+/Pr+, HER2+ DD AC 4 Tx first on Dec 9th then DD Taxol 4 Tx finished on 03/17/11. Herceptin finished in 02/12. Tamoxifen started on 04/15/11. Total hys 12/03/12.
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Dec 1, 2010 11:58PM GreenTea212 wrote:

I had a breast reduction 8/2010 and my 1.7 cm ER+ mucinous bc was removed blindly by my plastic surgeon.  Path report indicated clear margin. I had mammos and ultrasounds each year for the past 10. The last was 1 month prior to this reduction.  No detection.  I am fortunate the tumor was removed. I had SNL biopsy and that was negative.  Currently receiving radiation and will follow up treatment with tamoxifen.  I'm 44 and have big concerns about tamoxifen.  Can anyone please fill me in on this drug. Did you feel sick, gain weight, have migraines, get diagnosed with edometrial cancer, have blood clot issues? Did anyone start and stop taking tamoxifen. Did anyone pass on tamoxifen and is fine today? I know the positives outweigh the negatives, but I do want to know your experience. Thank you.

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Dec 16, 2010 07:15PM JEA wrote:

Just found this link today.  I had a 1.9 cm mucinous tumor removed from my right breast in March 2010.  I followed it up with 5 and 1/2 weeks of radiation.  I am on Femara.  I am 58.  So hear is my question.   In October I had my first post mammogram.  It showed an area of calcifications in my right breast.  Since then I have had a stereotactic bx and and excisional bx.  The excisional bx showed 23 of 33 slides positive for abundant mucin but no ca cells.  My surgeon is recommending a mastectomy.  I am getting an MRI this Friday.  I want to find the breast cancer before I do something as radical as a mastectomy.   My onc feels that this is still a local issue to the breast.  She said that maybe they aren't seeing cancer cells because the radiation killed them and the mucin is still just hanging around. Have any of you ever heard of mucin being present without cancer cells?  I have a second opinion on Jan 3.  I am trying to collect information at present.  Any help or suggestions would be great.

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Jan 16, 2011 04:10AM lbivens wrote:

I'm so glad I found this forum!

I recently had a needle biopsy that came back 1/6 with this diagnosis:   multiple invasive mucinous carcinoma and intermediate stage ductal carcinoma in situ.    I've had an MRI and will go over all the results / pathology with a surgeon on Monday.

I've had other symptoms that I believe are evidence of hypothyroidism, but my thyroid levels come back as normal.   I had decided that I would go to an internist to see what was wrong with me, but now that I'm dealing with bc, maybe I'll wait.....

Then, last week I had a sonogram on my uterus (that the dr. said was 2x the normal size) and after viewing the results, she wants me to get a D&C and biopsy done on that as soon as possible.  

Here's my question:   some of my other symptoms are getting worse and I wanted to see if anyone else with bc and lymph node involvement have experienced these symptoms:

Burning just under the skin in the armpit / down the arms, forarms, hands and behind the knees, down the legs and feet AND itching armpits, breasts and groin.

I haven't been able to find this in any symptoms list under any other disease.  Along with my really bad headaches, this is driving me crazy!  LOL   Of course I'll talk to the dr about it, but I want to be as educated on as much as I can so I can have an intelligent conversation.

Thank you all for your help in advance!   Blessings...

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Jan 16, 2011 12:35PM voraciousreader wrote:

Ibivens - I am sorry to hear about your diagnosis. I can't help answer any of your questions.  However, I would suggest that, despite having mucinous breast cancer, you might want to post your question on the "Just Diagnosed" thread.

May I suggest that you do a search on this website for mucinous breast cancer as well, and read up on what I and others wrote about specific to our mucinous/colloid diagnosis.

Good luck.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jan 25, 2011 01:18AM Linda-Renee wrote:

Hi,

I found this forum just a couple of days after I was diagnosed (Dec. 21, 2010) but felt that if I put anything in writing, it would make it true, and I wasn't ready for that. Now I am. I had surgery on Jan. 7 and they removed a 3.5cm tumour. I have the prelimanary pathology report but don't really understand it. They did a senitinel node biopsy that was clear. I met with my BC surgeon on Friday and he said I might not need to have chemo, only radiation and hormone therapy (ER 100%, PR 75%). I will find out on Monday when I meet with an oncologist. Meanwhile, I feel like I have been sucked into a parallel universe and I am overwhelmed by the number of caring, supportive, wonderful people! What an adventure...

Linda-Renee Dx 12/21/2010, IDC: Mucinous, Left, 3cm, Stage IIA, Grade 1, 0/1 nodes, ER+/PR+, HER2- (FISH) Surgery 1/6/2011 Lumpectomy: Left; Lymph node removal: Left, Sentinel Hormonal Therapy 3/6/2011 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 4/11/2011 Breast Dx 7/8/2011, IDC: Mucinous, Left, 1cm, Stage IIA, Grade 1, 0/0 nodes, ER+/PR+, HER2- (FISH) Surgery 7/14/2011 Lumpectomy: Left Hormonal Therapy 10/6/2011 Arimidex (anastrozole)
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Feb 6, 2011 03:13AM Hindsfeet wrote:

This is a great thread on mucinous breast cancer. I'm not sure if mine is pure or mixed...but think my doc said mixed. How can they know before the final pathology report? Exactly what does mix mean? One, two or three cancers together? It is frustrating how little information is out there about mucinious b.c.

Questions floating in my head are? 

I read that mucinious tumors are squeshy...mucusy. Is this true? Or does it feel like a cysts?

I have very lumpy breast, and a few lumps were said to be fatty tissue. Should I ask to have these biopsy. If I knew there were multiple tumors, I would seriously consider a mx. I don't want to remove my breast w/out knowing. I prefer to keep my breast.

If I am producing mucus tumors in my breast is it possible that other parts of my body are producing mucus type tumors. 

Why is this type of cancer unlikely to met or be found in nodes? It just seems like a weird type of tumor. 

I looked up images of mucinious cancer cells and they don't have the appearance of a grade 1 dcis cell. It's lots of black dots swimming in pools. 

Why does this type of cancer not respond to chemo?

If this is an estrogen positive tumor, why is it more often found in older women, who aren't as likely to have as much estrogen?

Do you think it is possible to leave a mucinious tumor in the breast for several months before surgery? Is it possible that this type of tumor would disappear if estrogen wasn't a factor, or if the ph factor became alkaline?  I read that if our bodies acidic levels dropped, body ph was more alkaline that cancer would die.

Can you clarify the A & B types of mucinious breast cancer?

Thanks :) EB

Dx 6/13/2014, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2+
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Feb 15, 2011 08:03PM tampagal wrote:

I was diagnosed on January 27th, 2010 after my December mammogram showed a mass.  That was followed by a second mammogram and a sonogram, which was then followed by a sonogram assisted core biopsy.  After the diagnosis, I had an MRI to confirm that I had nothing other than this mass which was in my right breast on the outer side below my armpit.  It was removed on 2/2/11 in outpatient surgery.  I also had a SNB during surgery which was negative and the surgeon got good clean margins. 

The tumor was described as 2.4cm.  My surgeon told me that radiation therapy would be MANDATORY and that my oncologist would decide whether I had chemo or hormone treatment.  I don't want any of it.  Based on comments I found on the internet, I got a second opinion on the pathology from surgery.  I am lucky because I have a friend who is a pathologist and so is her husband.  They told me that the initial report failed to put my tumor into one of 5 sub-categories.  In their opinion mine is "well-differentiated."  They told me that the 5-10 yr. survival for this type of cancer is usually 60-80%, which is better than for most BC, and that the survival stats for my particular sub-type is even better than that.  the only wrinkle (isn't there always at least one) is that the size puts it at the "lower end of stage 2" however that is much less signficant with this particular kind of cancer.  The tumor also had 1% of DCIS, but it appears that it was all removed.

I had already made an appt with a radiation doc and an onocologist but the oncologist couldn't get me in until about a week after the radiation doc.  They told me it would be better if I re-scheduled the radiation appt after meeting with the oncologist because he may not think I even need radiation.  If I do, they said it will probably be because of the DCIS and not the mucinous carcinoma.  After reading all of the posts above, it appears that a diagnosis of BC is really highly complex and involves a lot of different factors.  I am 56 and in excellent health.  I ran a marathon last November.  I never ever thought that this would happen to me as I have no family history of BC and have always been particularly careful about my health and lifestyle.  In retrospect I can see what an arrogant point of view that was.  I wish that they had found something benign, but after getting a second opinion, I am at least comfortable that my diagnosis is accurate.  I am greatly concerned about being "over-treated" for anything.  I am not interested in making myself sick with drugs or treatments that don't significantly improve my odds.  I think I'd rather enjoy the rest of my life, whatever that may be, than spend a big chunk of it feeling rotten.  I will know much more in a couple of weeks after I meet with the oncologist, but I feel fine for now. 

I wish everyone on this board good luck and long lives.  This news was initially devastating, but the more I learn about BC the more I think that I should count my blessings, move humbly forward with my life and start looking for opportunites to help and support my less fortunate sisters out there. 

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Feb 16, 2011 05:55AM JEA wrote:

For those who might be interested.  I had a follow-up with a very good surgeon. She told me that it looked like I had a second tumor when they found the primary one.  The radiation got the cancer cells and what everyone is seeing in my breast is mucinous debris.  She did not recommend a mastectomy.  So I had a mammogram and an ultrsound about a month ago to set a base line and will closely watch this for the next year.  It is hard to have a "rare" and "interesting" and "unique" type of bc.

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Feb 16, 2011 12:31PM - edited Feb 16, 2011 12:47PM by hymil

JEA i just looked back, and in December you asked about mucin without tumour cells. Sorry i only just spotted it. I had that too, in my first lymph node. I had been on tamoxifen four months before surgery and they called the node clear but my belief is that some tumour had been there (else how else did the mucin get there, huh?) but regressed under the tamox, which is good because if there was any somewhere else in my body then that probably shrunk too, it shows it had been working, Seems like the primary didnt shrink because those cells which were still alive, kept on making more mucin. I think that's how it must have been. Or maybe all the mucin made it harder for the tamox to reach the bad cells? Your radiation may have done what the tamox did for me. Hope that helps. I did ask the onco, but didn't seem able to communicate what I meant. They had needled the node earlier and found nothing, but as it makes the difference on treatment planning post-op, they took it out anyway, that's how we know this. I'm coming up for my first mammogram in a few weeks, will let you know if they see anything suspect.

PS Welcome, Tampagal.

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Feb 16, 2011 12:56PM - edited Feb 16, 2011 12:58PM by voraciousreader

Tampagal --

Sorry to hear about your diagnosis.  I hope you will be following up soon with the medical oncologist because the prognosis statistics you quote, IMHO seem very low.  Unlike other breast cancers, the size of a mucinous tumor, especially when it is "pure" is NOT as great of a risk factor.  More importantly is the pathology of the tumor...and if it has "favorable" characteristics, "pure," node negative, highly ER/PR+, Her2-...and then, UNDER 3cm...then the prognosis is considered "Excellent."

While you're waiting to see your medical oncologist, check out the NCCN 2011 breast cancer treatment guidelines. 

Hymil -  I was hoping someone would chime in about JEA.  Good luck to both of you!  I'm off to the radiologist this week for my 6 month ultra sound and mammogram.  I'm also told I'll be getting an annual MRI afterwards.

Below, I'm including the latest medical study on mucinous breast cancer.  For sure, these are very challenging tumors to diagnose as the title mentions.

I think we have to be vigilant in our care.  I think the most important person in the equation is the diagnostic radiologist. Then the pathologist....and finally...the medical oncologist who can make an informed opinion on how to treat us...once s/he has the best possible information.



Challenging breast lesions: Pitfalls and limitations of fine-needle aspiration and the role of core biopsy in specific lesions.Author(s)Simsir A, Cangiarella J InstitutionNew York University School of Medicine, Department of Pathology, New York, New York. aylin.simsir@nyumc.org.SourceDiagn Cytopathol 2011 Feb 9.AbstractCore biopsy rapidly replaced fine needle aspiration (FNA) over the past decade in evaluation of diseases of the female breast in many centers in the USA. We continue to heavily utilize FNA for the initial evaluation of breast masses in our institution. In this article, we discuss the cytologic and core biopsy findings in challenging breast lesions such as papillary and mucinous proliferations, fibroepithelial neoplasms, and low grade cancers. We specifically focus on the pitfalls and limitations of both diagnostic modalities in these selected specific lesions. Diagn. Cytopathol. 2011; © 2011 Wiley-Liss, Inc.LanguageENGPub Type(s)JOURNAL ARTICLE
PubMed ID21309013
Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 16, 2011 08:13PM Hindsfeet wrote:

To add...not sure if this is accurate. My bc surgeon said that these types of tumors tend to grow back or recur even after a lumpectomy.

Dx 6/13/2014, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2+
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Feb 16, 2011 08:54PM - edited Feb 17, 2011 01:15PM by voraciousreader

According to the literature there have been a few late occurrences of mucinous bc.... Twenty or thirty years down the road. The recommendation is for long term surveillance. But once you get diagnosed you will always be closely followed, so if you do recur, it will probably caught early.  Most mucinous bc are extremely slow growing. So it makes sense that, a recurrence might show up much later than a more aggressive bc.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 17, 2011 01:00AM - edited Feb 17, 2011 01:25AM by hymil

Sorry to sound rude, VoraciousReader, but I disagree, in my own experience Mucinous BC is NOT always slow growing. It can grow quite quickly, mine went from not palpable to 6cm+ in under 3months. And yes, it often shows up in older ladies, but there are youngies here too. I'm relatively young, Raili is undeniably young. Like the triple negs (which i'm very grateful that i'm not), there are more of us now bucking the trends, not fitting the boxes, and reading the reports and saying Nope, that doesn't fit for me. That doesn't help the docs, but it also doesn't help if we ourselves perpetuate stereotypes.

Could you repost the reference in your previous post please, because the link doesn't seem to be working. Thanks.

And could you also clarify what you mean by "might show up later". Do you mean later as in when the patient is older, or later when the tumour is larger and more developed? I can understand the first reading but not the second. The ratio for age (over 70) : (under 50) in the UK for the last figures i saw were 4:1 but that doesn't OF ITSELF mean all the tumours were larger. It does reflect that in the UK we don't start routine mammos till 50, so as a consequence of that policy, a diagnosis of BC under 50 is rarely screen detected, it had been felt by the patient (or she is in a high risk group and being monitored earlier than usual) so any lump in a younger lady is likely  to be much larger than the screen detected ones of the 50-70 group. The younger patients (under 50) present earlier in age but later in stage ie with bigger lumps.

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Feb 17, 2011 01:27AM voraciousreader wrote:

Hymil, you are correct that some mucinous breast cancers can be fast growing just like some can be slow growing and remanifest late. While most will show up in postmenapausal women, some will show up in young women and women like myself in my early 50s and still premenopausal. When the characteristics are node negative, under 3 cm, er/pr+, her2 neg, and grade1, which the majority are, then they are usually slow growing. Are there fast growing mucinous breast cancers? Absolutely! Just like there are some that are slow growing and reappear late.

What links are you referring to? I get most of my information from pubmed.org. The latest study hasn't been fully published yet. It is only in abstract form. I emailed the lead author and she promised to email the study when it is finally published. Until then, what I posted is all that there is.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 17, 2011 01:41AM voraciousreader wrote:

This is from Rosen's Diseases of the Breast:

Mucinous carcinoma (also known as colloid carcinoma) is another special-type
cancer that is associated with a relatively favorable prognosis. The reported
incidence of mucinous carcinoma varies depending on the histologic criteria.
Most studies have indicated that fewer than 5% of invasive breast carcinomas
have a mucinous component, and of these, fewer than one-half represent pure
mucinous carcinomas.

Clinical Presentation

The mean age at
presentation for patients with mucinous carcinoma is in the seventh decade in
most studies (range, 21 to 94 years) and is older than that for patients with
breast cancers of no special type. Most patients with mucinous carcinoma
included in published reports presented with palpable tumors. Some reports,
however, suggest that a substantial proportion of patients with mucinous
carcinoma (30% to 70%) present with nonpalpable mammographic
abnormalities.

On mammography, mucinous carcinomas are most often poorly
defined or lobulated mass lesions that are rarely associated with calcification.
Wilson et al. reported that pure mucinous carcinomas were more often associated
with a circumscribed, lobulated contour than with the irregular borders
characteristic of tumors with a mixture of mucinous and nonmucinous components
(mixed mucinous tumors).In addition, mammographically occult mucinous carcinomas
are not infrequent, accounting for 4 of 23 cases (17%) in one study. On
ultrasonography, mucinous carcinomas are typically hypoechoic mass
lesions.

Gross Pathology

Mucinous carcinomas average approximately
3 cm in size, with a wide range reported in the literature. In some studies,
tumors composed exclusively of mucinous features are smaller, on average, than
mixed tumors.Mucinous carcinomas have a distinctive gross appearance. These
lesions are typically circumscribed and have a variably soft, gelatinous
consistency, and a glistening cut surface. Lesions with a greater amount of
fibrous stroma may have a firmer consistency,
however.

Histopathology

The hallmark of mucinous carcinomas is
extracellular mucin production. The extent of extracellular mucin varies from
tumor to tumor, however. Typically, tumor cells in small clusters, sheets, or
papillary configurations are dispersed within pools of extracellular mucin. This
characteristic histology should comprise at least 90% of the tumor (or 100%,
according to some)6 for the tumor to qualify for the diagnosis of mucinous
carcinoma. Mucinous neoplasms intermixed with other nonmucinous histologic
features are classified as mixed mucinous tumors. The cellularity of mucinous
carcinomas is variable. Some tumors are relatively paucicellular; in these
cases, the differential diagnosis includes mucocele-like lesions, which are
benign lesions characterized by cystically dilated ducts associated with rupture
and extravasation of mucin into the stroma.

The expression of various
biological markers in mucinous carcinomas generally reflects the good prognosis
associated with these lesions. Estrogen-receptor positivity has been reported in
86% to 90% of tumors and progesterone-receptor positivity in 63% to 67%. DNA
studies of 26 pure mucinous carcinomas revealed that 25 (96%) were diploid,
compared with only 8 of 19 mixed tumors (42%). The rate of diploidy among the
mixed tumors was comparable to that seen in breast cancers of no special
type.155 In a review examining the karyotypic analysis of 20 mucinous
carcinomas, 17 exhibited chromosomal aberrations that were simple in comparison
with the complex aberrations typically associated with breast cancers of no
special type.128 In addition, mucinous carcinomas usually do not overexpress the
HER-2/neu oncoprotein (0% to 4% of cases) or show p53 protein accumulation (18%
of cases).

Clinical Course and Prognosis

The incidence of axillary
lymph node metastases in pure mucinous carcinomas, although variable (range, 4%
to 39%; average, 15%), is significantly less than the incidence of node
positivity seen in mixed mucinous tumors (38% to 59%) or in breast cancers of no
special type (43% to 63%).Some investigators have questioned the necessity of
performing lymph node dissections in patients with mucinous carcinoma,
particularly if 100% of the tumor shows typical mucinous histology.

With
regard to survival, 38 patients with mucinous carcinoma were enrolled in the
NSABP B-06 trial, and they experienced the same significantly increased survival
rate as patients with tubular carcinoma, particularly those in the node-negative
group.Similar results were reported by Ellis et al. in their retrospective
series; however, the patients in their study were not stratified by nodal
status. Survival data reported in most other retrospective reports suggest that,
to a variable degree, patients with mucinous carcinoma experience lower
recurrence rates and greater short- and long-term survival than patients with
mixed mucinous carcinomas and breast cancers of no special type.Several studies
have noted that a significant number of late recurrences are seen in patients
with mucinous carcinoma138,143,157; one report documented a recurrence 30 years
after initial treatment. Results from the SEER database were published comparing
20-year survival data from 3,356 patients with mucinous carcinoma and  patients
with invasive ductal carcinoma diagnosed between 1973 and 1990. Similar to the
studies cited earlier, this report indicated that patients with mucinous
carcinoma present with localized disease more commonly than patients with
invasive ductal carcinoma (78.1% versus 53.1%). In addition, even after
prolonged follow-up, only 25.1% of patients with mucinous carcinoma died as a
consequence of breast cancer, compared with 58.3% of patients with invasive
ductal carcinoma. These results were highly statistically significant, even
after correction for potentially confounding variables, such as age, year of
diagnosis, race, stage, and grade.147 In addition, two series-one examining
node-negative early-stage breast cancer patients treated with mastectomy (with a
20-year follow-up) and the other examining early-stage patients treated with
breast-conserving therapy (with a 10-year follow-up)-reported that patients with
mucinous carcinoma had significantly lower rates of distant recurrences compared
with patients with invasive ductal carcinoma.

Three studies have examined
the use of conservative surgery and radiation therapy in a total of 38 patients
with mucinous carcinoma and report no significant differences in local
recurrence rates for these patients compared with patients with invasive ductal
carcinoma. Given the relatively good prognosis of patients with mucinous
carcinoma, some authors have raised the question of whether radiation therapy
can be safely omitted after breast-conserving surgery in patients with this
tumor type.At this time, however, not enough data exist to support such a
recommendation.

Mucinous carcinomas have rarely been associated with
unusual metastatic manifestations, including mucin embolism resulting in fatal
cerebral infarcts and pseudomyxoma peritonei.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 17, 2011 01:52AM voraciousreader wrote:

Hymil - What I'm trying to say is...once you've finished treatment...if you've had a slow growing tumor...and it were to recur...it would take longer.  That's why there is evidence of recurrences 20 and 30 years later of mucinous bc, since the majority of them ARE slow growing.  Likewise, I would think that if you had a more aggressive form of mucinous breast cancer, and you had a recurrence, it would show up sooner.  Either way, you would be followed carefully.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 17, 2011 09:36AM voraciousreader wrote:

Below is a long term examination of pure mucinous breast cancer.  I think the survival curves are no longer relevant because the data extends back to 1973...before Tamoxifen or an AI was in general use.

2008 Oct;111(3):541-7. Epub  2007 Nov 18.

A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma.

Di Saverio S, Gutierrez J, Avisar E.

Department of Surgery, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA. salo75@inwind.it

Abstract

BACKGROUND: Pure mucinous breast carcinoma (PMBC) is a rare histologic type of mammary neoplasm. It has been associated with a better short-term prognosis than infiltrating ductal carcinoma (IDC) but identical long-term survival curves have been reported. The value of tumor size for TNM staging has been challenged because of the mucin content of the lesions. This study presents a large PMBC series with 20 years follow up as compared to IDC. The relative significance of a variety of common prognostic factors is calculated for this uncommon histology.

MATERIALS AND METHODS: A retrospective analysis of all PMBC cases reported in the SEER database between 1973 and 2002 was conducted. Overall survival (OS) and disease specific survival (DSS) were calculated at 5, 10, 15 and 20 years of follow up. Those curves were compared with all the IDC cases reported into the database during the same period. The prognostic significance of gender, race, laterality, age at diagnosis, T and N status, estrogen and progesterone receptors and administration of radiation therapy was calculated by univariate and multivariate analysis.

RESULTS: There were 11,422 PMBC patients reported. The median age at diagnosis was 71 years (Range 25-85). Fifty three percent of the tumors were well differentiated, 38% were moderately differentiated and the remaining 9% were poorly differentiated or anaplastic. The majority of the tumors were located in the upper outer quadrant (44%) the other 56% were roughly evenly divided between the upper inner, lower inner, lower outer and central quadrants. Eighty six percent of the patients had only localized disease at the time of surgery without nodal or distant disease while 12% had regional nodal involvement and 2% had distant metastases. The PMBC cases showed a better differentiation with lesions of lesser grade and more frequent ER/PR expression, smaller size and lesser nodal involvement when compared to the IDC cases of the same period. Kaplan Meier survival curves revealed a 5 years. breast cancer specific survival rate of 94%. Although slowly decreasing with time, 10, 15 and 20 years survival were 89%, 85% and 81% respectively compared to 82% (5 year), 72% (10 year), 66% (15 year) and 62% (20 year) for IDC. There were no significant differences in overall survival. Multivariate analysis by Cox regression revealed the nodal status (N) to be the most significant prognostic factor followed by age, tumor size (T), progesterone receptors and nuclear grade. Disease specific survival curves stratified for nodal status revealed a highly significant difference between node negative and node positive patients. The addition of radiation therapy after surgery did not significantly improve overall survival.

CONCLUSIONS: This large retrospective comparative analysis confirms the less aggressive behavior of PMBC compared to IDC. This favorable outcome is maintained after 20 years. This tumor presents typically in older patients and is rarely associated with nodal disease. Positive nodal status appears to be the most significant predictor of worse prognosis.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 17, 2011 09:39AM - edited Feb 17, 2011 12:34PM by voraciousreader

Note in the previous study that I just posted that the average age of women who got mucinous breast cancers were older. I am posting this recent Korean study that suggests that  these Asian women get mucinous breast cancers at a MUCH younger age.  I also think that from what I've been reading...because of more screening, women, in general,  the trend is that they are being diagnosed at younger ages.  However, this Korean study is quite surprising because of the average overall ages of the women are so much younger.

J Korean Med Sci. 2010 Mar;25(3):361-8. Epub  2010 Feb 19.

Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified.

Park S, Koo J, Kim JH, Yang WI, Park BW, Lee KS.

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Clinicopathological characteristics and prognostic factors of mucinous carcinoma (MC) were compared with invasive ductal carcinoma-not otherwise specified (IDC-NOS). Clinicopathological characteristics and survivals of 104 MC patients were retrospectively reviewed and compared with those of 3,936 IDC-NOS. The median age at diagnosis was 45 yr in MC and 47 yr in IDC-NOS, respectively. The sensitivity of mammography and sonography for pure MC were 76.5% and 94.7%, respectively. MC showed favorable characteristics including less involvement of lymph node, lower stage, more expression of estrogen receptors, less HER-2 overexpression and differentiated grade, and better 10-yr disease-free survival (DFS) and overall survival (OS) (86.1% and 86.3%, respectively) than IDC-NOS (74.7% and 74.9%, respectively). Ten-year DFS of pure and mixed type was 90.2% and 68.8%, respectively. Nodal status and stage were statistically significant factors for survival. MC in Koreans showed similar features to Western populations except for a younger age of onset than in IDC-NOS. Since only pure MC showed better prognosis than IDC-NOS, it is important to differentiate mixed MC from pure MC. Middle-aged Korean women presenting breast symptoms should be examined carefully and evaluated with an appropriate diagnostic work-up because some patients present radiologically benign-like lesions.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Feb 18, 2011 05:35AM JEA wrote:

Hymil - thannk you for the response.  I thought for a while that this was a sleeping thread.  I appreciate the information.  Thank you.

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Feb 18, 2011 03:23PM hymil wrote:

I think it's like a bear in winter - it doesn't wake up very often! Mostly when someone new has been given a diagnosis, and comes here for more information. People worry they might have Inflammatory BC and there are lots of "I might have" threads, but we are the opposite, until you are told you have it, mostly nobody has heard of it!, Then after finally getting (and maybe querying) the diagnosis, and going through the treatment planning stage, lots of the issues are then the same as other types of BC eg skin troubles with radiation, body image after surgery, SE of hormone treatments, complications such as LE, employment stuff, familty and fertility, and the general need to netwowrk. VoraciousReader is very good at keeping us up with the latest research findings, as sadly the low incidence means that data is often either very old (eg from when treatments not as advanced as they are now) or on a very small sample population.

Welcome to "the best of the worst" (that's the cancer, not the people!)

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Feb 19, 2011 06:06PM voraciousreader wrote:

From the Japanese Journal of Medical Oncology dated 2001, this exceptional case of mucinous breast cancer was described.  I've only included the abstract and brief discussion.   The treatment plan was also included in the full article. If anyone is interested in more information, just do a google search of the title of the article below: 

 Locally Advanced Mucinous Carcinoma of the Breast with Sudden Growth Acceleration: a Case Report

Abstract

We report a 35-year-old woman with locally advanced mucinous carcinoma of the breast with sudden growth acceleration. A pea-sized                     mass developed into an ulcerated large tumor within 1 month. After the combination of chemotherapy, radiation and hyperthermia,                     a radical mastectomy was performed, followed by repair of the skin defect by latissimus dorsi and rectus abdominis musculocutaneous                     flaps. Histological examination revealed a pure mucinous carcinoma with axillary lymph node involvement. Estrogen and progesterone                     receptors were not detected in the tumor. Twenty-five months after treatment, there is no sign of recurrent disease. Pure                     mucinous carcinoma generally has a less aggressive growth pattern as defined by tumor size, adherence to the overlying skin/bottom                     fasciae, estrogen and progesterone receptor positive and primary lymph axillary lymph node metastases. This case showed completely                     opposite features to all of these typical biological features of pure mucinous carcinomas.   

              

The reported frequency of mucinous carcinoma of the breast is as high as 3.6% (8). This type of the tumor is subclassified into two groups: ‘pure' mucinous carcinoma that consists solely of tumor tissue                     with extracellular mucin production and ‘mixed' mucinous carcinoma that also contains infiltrating carcinoma without mucin.                     Although the reported tumor clearly falls into the ‘pure' mucinous type (Fig. 2), this case is unusual not only in the sudden growth acceleration, but also in biological aspects of mucinous carcinoma.                     The mean age of women with pure mucinous carcinoma is greater than those with non-mucinous carcinoma, with those younger than                     35 years constituting only 1% of the patients (3,4). Pure mucinous carcinoma has a less aggressive growth pattern, i.e. smaller tumor size, a lower frequency of adherence to                     the overlying skin/bottom fasciae and primary axillary lymph node metastases and a higher percentage of positive estrogen                     receptor, compared with non-mucinous carcinoma (2-8). This case showed completely opposite features to all of these typical biological aspects of pure mucinous carcinomas.   

Discussion:              

There must be some explanation for the sudden growth acceleration of this tumor that led to the extremely locally advanced                     stage. Biological aspects of nuclear grading and status of c-erbB 2 and p53 are not correlated with the malignant potential                     of this tumor. The accumulation of abundant extracellular mucin around invasive tumor cells is characteristic of mucinous                     carcinoma. In this tumor specimen, mucin formed nests where tumor cells were degraded or had already disappeared, i.e. a ‘muconodular                     pattern'. This is a phenomenon that is seen when cells produce a large amount of mucin rapidly. Although it is unknown what                     triggered the sudden growth of this tumor, rapid enlargement of the tumor by mucin production developed the extremely locally                     advanced breast tumor with deep ulcer formation.                 

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)

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