Mucinous breast carcinoma with tall columnar cells

Abstract

Mucinous carcinoma of the breast represents 1%-4% of all breast cancers. The World Health Organization classification divides this type of tumour into three different subtypes: mucinous carcinoma, mucinous carcinoma with tall columnar cells (mucinous cystadenocarcinoma and columnar cell mucinous carcinoma) and signet ring cell carcinoma. A 74-year-old woman presented a tumour with inflammatory features in the upper outer quadrant of her left breast, 7 cm in diameter. The core biopsy showed infiltrating ductal carcinoma of no specific type. The tumour-node-metastasis clinical staging was T4cN3M0 (Stage IIIC). She received neoadjuvant chemotherapy, underwent left mastectomy with radical axillary resection and subsequently received radiotherapy and chemotherapy. The histological examination of the surgical specimen revealed two solid tumors in the tail of Spence, which corresponded to adenocarcinoma with high columnar cells. The patient died 16 months after the diagnosis, suffering from pulmonary metastases and anterior chest wall infiltration. A review of the literature revealed only 21 reports of mucinous carcinoma of the breast with tall columnar cells, including our case. This is only the third time that the specific histological type of columnar cell mucinous carcinoma has been reported in the literature.

Primary Breast Mucinous Cystadenocarcinoma and Review of Literature

“…The exact pathogenesis of this tumor is unclear. The coexistence of ordinary DCIS and MCA in some cases indicates that tumor cells of MCA might have been transformed through metaplasia of epithelial cells of DCIS, accompanied by loss of expression of estrogen and progesterone receptors [7][8][9]. According to Lee and Chaung [10], the neoplasm is the result of an accumulation of mucin within intraductal papillary carcinoma with mucinous metaplasia and extracellular mucin production.…”

Primary breast mucinous cystadenocarcinoma—histopathological analysis

“…Nuclear grade in MCA is usually low to intermediate. However, the positive rate of Ki-67 in most tumour cells is high, reaching the value up to 90% (7). This proves that the vast majority of the MCA cells show high proliferative index, regardless their degree of atypia.…”

“…In some of these cases cystic dilatation catheters covered by a monolayer or stratified high columnar mucous cells in diverse degrees of cell dysplasia have been observed. The co-existence of DCIS and MCA in some cases indicates that cancer cells of MCA may transform through metaplasia of epithelial cells of DCIS, accompanied by estrogen and progesterone receptors expression loss (7). According to the theory presented by Chen et al [2004] it is believed that these DCIS components originates from the mucinous metaplasia of epithelial cells of widespread DCIS (5), and it was named as the in situ carcinoma form of MCA.…”

Mammary mucinous cystadenocarcinoma with long-term follow-up: molecular information and literature review

“…The presence of mucinous cells, invasive growth behavior, and loss of myoepithelial expression are the first characteristics used to rule out mucinous cyst lesions [ 31 ]. The presence of intracellular and extracellular mucus and a triple-negative phenotype exclude the diagnosis of invasive papillary carcinoma [ 30 , 33 ]. Additionally, the triple-negative phenotype and a relatively high Ki-67 index help to exclude mucinous carcinoma and EPC [ 10 , 13 , 30 – 32 ].…”