Invasive Cystic Hypersecretory Carcinoma of Breast: A Rare and Under Diagnosed Variant of Ductal Carcinoma

Abstract

Handful cases of invasive Cystic Hypersecretory Ductal Carcinoma (CHC) have been reported so far in literature. Cystic hypersecretory lesions of breast have a spectrum of morphological features ranging from Cystic Hypersecretory Hyperplasia (CHH), CHH with atypia, in situ to invasive CHC. We are reporting a case of a 32-year-old female who had nipple discharge and lump in her right breast for one month. A modified radical mastectomy was done and morphological diagnosis of invasive CHC with axillary node metastasis was made. The postoperative events were uneventful. Invasive CHC being a rare entity, our understanding of its biological behavior, prognostic factors and genetic basis is limited. The authors are aware of only 15 similar cases being reported in the English literature.

Keywords: Breast carcinoma; Discharge; Lump; Mastectomy.

[Table/Fig-1]:

a) Aspiration cytology showed tumour cells in papillary pattern and cell balls in a mucoid like background (H&E 40X); b) Mastectomy specimen showing multiple cysts with intervening greyish white areas; c) Cysts of various sizes filled with gelatinous mucoid material; d) Intraductal component with cystic dilatation and micropapillary pattern (H&E10X).

[Table/Fig-2]:

a) Scalloping of secretions and tumour cells showing high nuclear grade (H&E 40X); b) Patchy nuclear positivity of p53 in the tumour cells. (IHC 20X); c) Tumour invasion in nests with stromal inflammatory response (H&E 40X); d) Lymph node showing macro metastasis (H&E, 10X).