Mucinous carcinoma of the breast with neuroendocrine
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Transcript Mucinous carcinoma of the breast with neuroendocrine
Congresso
Nazionale
SIAPEC
7 – 9 Settembre
2009
Firenze
Pure type mucinous carcinoma of the
breast with neuroendocrine
differentiation: a case report and
short review of literature
A. D’Amuri, F. Floccari, L. Aiello, A. T. Pede, S. A. Senatore
U.O.C. Anatomia Patologica Ospedale “S. Cuore di Gesù” P.O. Gallipoli
ASL/LECCE
INTRODUCTION
Mucinous carcinoma (MC) is a special type of invasive
breast neoplasm grouped into pure and mixed types: the
former contains only tumour with the typical mucinous
carcinoma morphology; the latter is mixed with
conventional infiltrating ductal carcinoma.
Some authors subdivided MC components on the basis
of mucin content, epithelial growth pattern and associated
figures in type A (tumors containing 60-90% of mucin) and
type B (tumors containing 33-75% of mucin).
A large proportion of MC show a neuroendocrine
differentiation and its significance is still unclear.
INTRODUCTION
MC with or without neuroendocrine differentiation occurs
in the elderly and the proportion of postmenopausal
patients is high.
The symptom and sign is palpable mass and bloody
nipple discharge.
The evaluation of MC outcome is difficult because of the
short follow-up period due to the old age of the patients
who may die of other unrelated causes.
The majority of patients do not show local recurrences or
distant metastasis. Lymph nodes metastasis are rare.
CASE REPORT
An 82 year old woman with no significant medical history
showed a palpable mass in her retro-areolar right breast.
The patient underwent radical mastectomy and right
axillary lymph nodes dissection.
SURGICAL FEATURES
Grossly the right breast showed nipple retraction,
discromic skin with a normal areolar gland. The remaining
breast parenchima had a lipomatous aspect.
In the retro-areolar region a 4x4x2cm nodular lesion was
observed.
The nodule had a hard-elastic consistency, a yellowish
white appearance with interspersed brownish and
gelatinous areas.
MATERIALS & METHODS
Once removed specimens were fixed in 10% buffered
formalin and paraffin embedded. 5mm serial sections were
obtained and routinely stained with haematoxylin-eosin
(H/E) and histochemically evaluated with Grimelius.
Immunohistochemical studies were performed for
Neuron Specific Enolase (NSE), Chromogranin (CGA),
Synaptophysin (SYN), Neurofilament (NF), estrogen (ER)
and progesteron (PgR) receptors, c-erbB-2 and Ki-67
(MIB-1).
MICROSCOPICAL FINDINGS
Microscopically we observed small clusters of tumor
cells with abundant extracellular mucin accumulation
(65%).
The cells were small to medium sized with a spindle
shape. The nuclei appeared uniform and the cytoplasm
eosinophilic and finely granular.
The 19 axillary lymph nodes were found all negative for
metastasis.
MICROSCOPICAL FINDINGS
Immunohistochemical stains for NSE, CGA, SYN and NF
were positive with a marked histochemical expression of
Grimelius (argyrophilic cells). The tumor was positive for
estrogen (90%) and progesteron (80%) receptors,
incompletely positive for c-erbB-2 (15%) with a low Ki-67
proliferative index (10%).
A diagnosis of pure type mucinous carcinoma
(hypercellular variant) of the breast with neuroendocrine
differentiation was performed.
H&E
H&E
Grimelius
NSE
SYN
CGA
Estrogen receptors
Progesteron receptors
DISCUSSION
MC of the breast is a good prognostic type malignancy
which may occur in elderly patients.
MC is most commonly associated with neuroendocrine
differentiation.
Neuroendocrine differentiation has long been described
but its significance is still unknown.
The criteria for diagnosing neuroendocrine differentiation
is based on immunohistochemistry, histochemistry with
Grimelius for argyrophil reaction and electron microscopy
evaluation.
DISCUSSION
As reported in literature some authors consider the
expression of the neuroendocrine markers namely CGA,
SYN and NSE definitive.
Other authors used two out of three positivity as
diagnostic criteria.
It is also associated with higher expression of estrogen
and progesteron receptors and lower c-erbB-2 oncoprotein
expression and with a low Ki-67 proliferative index.
Lymph nodes metastasis are uncommon.
DISCUSSION
In our case report the clinicopathological features were
similar to those reported in literature and included the
presence of clusters of tumor cells of moderate-grade with
abundant extracellular mucin accumulation.
Our histochemical study (positive for Grimelius) and
immunohistochemical findings (positive for CGA, SYN,
NSE, NF; higher expression of ER and PgR receptors and
lower expression of Ki-67 and c-erbB-2) strongly support
the diagnosis.
This type of tumour occurred in an old patient and the
axillary lymph nodes were found all negative for metastasis
as reported in previous studies.
REFERENCES
Kato N. et al. Mucinous carcinoma of the breast: A multifaceted study
with special reference to histogenesis and neuroendocrine
differentiation. Pathol Int 1999; 49: 947-955
Nakagawa H. et al. Mucinous carcinoma of the breast with
neuroendocrine differentiation. Pathol Int 2000; 50: 644-648
David O. et al. Diffuse neuroendocrine differentiation in a
morphologically composite mammary infiltrating ductal carcinoma. A
case report and review of the literature. Arch Pathol Lab Med 2003; 127:
e131-e134
Tse GMK. et al. Neuroendocrine differentiation in pure type mammary
mucinous carcinoma is associated with favorable histologic and
immunohistochemical parameters. Mod Pathol 2004; 17: 568-572