Secretory Carcinoma of the Breast with a Cystically Dilated Intraductal Component: Report of a Case

Abstract

A case of secretory carcinoma of the breast in a 61-year-old woman is described. She came to our hospital complaining of a bloody nipple discharge. The physical examination revealed a 2.8 x 2.1-cm, firm, irregular lump with bloody nipple discharge in her left breast. Mammography demonstrated an irregular mass and ultrasonography showed an irregular hypoechoic mass accompanied with a cyst. Ductgraphy was done. It showed a dilated mammary duct leading to the cyst which was partially occupied with carcinoma. A cytologic smear of the nipple discharge and fine-needle aspiration cytology revealed similar findings, and both findings were malignant. A modified radical mastectomy was performed. A pathological examination revealed secretory carcinoma of the breast which had spread inward and outward from the cyst. In addition, the nipple discharge flowed from the cyst through the dilated mammary duct. The patient is presently alive and well 2 years after the operation. Secretory carcinoma is an extremely rare tumor of the breast and 48 cases have been reported in Japan. The present case is the first known case of secretory carcinoma demonstrating a bloody nipple discharge to come from a cyst which has been invaded by carcinoma.

Secretory Breast Carcinoma With Extensive Intraductal Component: Case Report

“…The intraductal carcinoma may extend beyond the confines of the grossly evident tumor. Multifocal gross lesions, and cystically dilated intraductal components have been described [13,14]. Most commonly, the intraductal carcinoma is papillary or cribriform.…”

Secretory Carcinoma of the Breast

“…6,10,11 The presenting symptom is usually a mobile and palpable mass, but in a few cases patients have a bloody nipple discharge. 2,3,8 In this study, 3 patients had a palpable and nontender mass, and 1 had a nipple discharge. This tumor is frequently located in the subareolar region but may occur in any part of the breast.…”

“…Secretory carcinoma of the breast is so named because the characteristic histologic features of the tumor are abundant periodic acid-Schiff-positive secretions in both cells and tubular acini and tumor cells that are typically vacuolated with abundant secretory materials ( Figure 1). [1][2][3][4] This tumor tends to have rare locoregional recurrence and is associated with prolonged survival. 1,[3][4][5] In a literature review from a report by Ozguroglu et al, 6 distant metastasis was found in only 6 of 121 cases.…”

Secretory Carcinoma of the Breast

“…This long natural course of the disease points out the importance of surgery in young patients despite locally advanced disease. None of the metastatic cases responded to chemotherapy and actually, none of the patients during childhood had adequate, standard surgery (table 1) [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52]. …”