lnvasive cystic hypersecretory carcinoma of the breast associated with papillary pattern: a rare and poorly recognised variant of ductal carcinoma of the breast

Abstract

Cystic hypersecretory pattern is a rare and poorly recognised variant of invasive ductal carcinoma of the breast. Cystic hypersecretory lesions of the breast have a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia, cystic hypersecretory carcinoma (CHC) to invasive CHC. Until now, no case of invasive CHC has been reported in India, to the best of our knowledge. We report a case of a 57-year-old female with a history of a lump in the inferomedial quadrant of the right breast for three years, gradually increasing in size. A mammography showed a well-defined, lobulated radio-opacity. A modified radical mastectomy was done. Gross examination showed multiple cystic spaces filled with thick gelatinous material and solid areas. On histopathology, cystic hypersecretory variant of invasive ductal breast carcinoma with focal papillary pattern was diagnosed. Cystic hypersecretory ductal carcinoma behaves in a low-grade fashion for many years but has a potential for invasiveness and metastasis, so regular follow-up of such cases is crucial.

Keywords: breast; carcinoma; mastectomy.

Figure 1.. (a). Mammography, mediolateral oblique view showing well defined, lobulated radio-opacity in the right inferomedial quadrant. (b). The cut surface of the mass showing cysts filled with gelatinous secretions.

Figure 2.. Microscopic findings (H & E). The lesion is composed of multiple cyst and ducts containing eosinophilic secretions (a; 40x). Some of the cysts are lined by flattened epithelium (a; 40x) while others show epithelial proliferations in form of pseudostratification, knobby tufts (b; 100x), Roman arch (c; 100x), to micro-papillary carcinoma in situ (d; 630X), and invasive pattern in form of solid sheets (e; 100x), and papillary pattern of ductal carcinoma (f; 100x).