A rare case of extensive ductal carcinoma in situ of the breast with secretory features

Abstract

We report a very rare case of extensive ductal carcinoma in situ (DCIS) of the breast with secretory features in a 30-year old Japanese woman. The patient presented with a nodule in the lower inner quadrant of the left breast measuring approximately 2–3 cm, accompanied by an irregular tumor shadow with segmental microcalcification on mammography. These findings suggested malignancy, and excisional biopsy was performed following core needle biopsy. Pathological diagnosis was that of DCIS with secretory features. A treatment plan of simple mastectomy and sentinel lymph node biopsy was chosen. Most previous reports have only described invasive secretory carcinoma of the breast. We have only been able to find 2 case reports of non-invasive secretory lesion in the English literature to date. Because the characteristics of this lesion are not widely known, we thought it important to share our findings.

Secretory carcinoma of the breast: clinicopathologic profile of 14 cases emphasising distant metastatic potential

“…Presentation of non‐invasive secretory carcinoma is an extraordinarily rare circumstance. Such secretory carcinoma in situ has been reported twice in the English literature – in a 30‐year‐old woman and a 51‐year‐old man . In these two cases, both patients underwent unilateral mastectomies without adjuvant therapy and had no evidence of recurrence or metastasis.…”

“…There was no evidence of recurrence or metastasis in 212 months of clinical follow‐up. Both reported cases of in‐situ SCB demonstrated predominantly papillary growth . While slides of our case of in‐situ secretory carcinoma were not available for review, the original pathology report described the tumour arising in a complex papilloma.…”

“…Such secretory carcinoma in situ has been reported twice in the English literaturein a 30-year-old woman and a 51year-old man. 44,45 In these two cases, both patients underwent unilateral mastectomies without adjuvant therapy and had no evidence of recurrence or metastasis. Within our study cohort, a 59-year-old woman was found to have in-situ secretory carcinoma and treated with breast-conserving surgery alone.…”

“…Both reported cases of in-situ SCB demonstrated predominantly papillary growth. 44,45 While slides of our case of in-situ secretory carcinoma were not available for review, the original pathology report described the tumour arising in a complex papilloma. While papillary features may be seen in invasive secretory carcinoma of the breast among other morphological patterns, particularly microcystic, our findings suggest that in-situ disease may prefer proliferating in a papillary phenotype.…”

Clinicopathologic and molecular characteristics of 44 patients with pure secretory breast carcinoma

“…SBC can show several histological patterns including solid, microcystic, and tubular. Many tumors contain all three patterns with different proportions, and neoplastic cells show minimal atypia and rare mitotic activity 15,16 . Normally, SBC has been found to be negative for ER and PR, with absence or presence of HER-2 amplification, resembling TNBC.…”