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.
Highlights
Cystic hypersecretory carcinoma (CHC) and cystic hypersecretory hyperplasia (CHH) was first described in 1984 [1]
CHC is an uncommon distinctive variant of ductal breast carcinoma in situ that arises in the background of CHH and is characterised grossly by the presence of dilated ducts and cysts containing glistening, gelatinous material, and microscopically areas of micropapillary carcinoma in the epithelium lining the cyst [2]
We describe an additional new case of invasive CHC in a 57-year-old female, and the relevant literature is reviewed [Table 1]
Summary
Cystic hypersecretory carcinoma (CHC) and cystic hypersecretory hyperplasia (CHH) was first described in 1984 [1]. An invasive component has been reported approximately in 20% of CHC cases, and it tends to be poorly differentiated ductal carcinoma with solid growth pattern and no secretory activity [2]. The cut surface revealed a 7 x 7 cm tumour which showed multiple cystic spaces filled with thick gelatinous material and grey-white solid areas (Figue 1b). The tumour showed varied histological pattern with predominantly multiple variable- sized cystic spaces filled with PAS positive dense eosinophilic material resembling thyroid colloid (Figure 2a). These homogenous secretions were retracted from the surrounding epithelium producing a scalloped margin. None of the axillary lymph nodes were positive for tumour metastasis
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