LETTER TO EDITOR
Year : 2010 | Volume
: 53 | Issue : 1 | Page : 200--202
Mucinous cystadenocarcinoma: A rare primary malignant tumor of the breast
Hanni Gulwani, Sunita Bhalla
Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
C/O Mr V.T.Gulwani, 553/151/5, Adarsh Nagar, Alambagh, Lucknow-226 005
|How to cite this article:|
Gulwani H, Bhalla S. Mucinous cystadenocarcinoma: A rare primary malignant tumor of the breast.Indian J Pathol Microbiol 2010;53:200-202
|How to cite this URL:|
Gulwani H, Bhalla S. Mucinous cystadenocarcinoma: A rare primary malignant tumor of the breast. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Jan 18 ];53:200-202
Available from: https://www.ijpmonline.org/text.asp?2010/53/1/200/59242
Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare entity with only eight cases reported in literature to date. ,, This entity should be differentiated from mucinous carcinoma and cystic hypersecretory carcinoma because of the distinct biologic behavior.  We discuss one such case with review of the literature.
A 61-year-old woman presented with sub areolar cystic lump of one year duration in the left breast. The lesion was aspirated twice, elsewhere, but it refilled in a short interval. The cystic mass was resected and sent for histopathology examination.
Grossly, the cyst was unilocular and measured 3 cms in diameter. On opening the cyst, blood tinged mucoid fluid was drained out. The cyst wall was mostly smooth except in an area where a solid papillary mass was projecting out from the cyst wall. Microscopic examination revealed a fibrocollagenous cyst wall lined by cuboidal to tall columnar mucin secreting cells. Sections from the solid area showed numerous coalescing papillary fronds with delicate fibrovascular cores and lining by similar tall columnar cells with abundant intracytoplasmic mucin and basal nuclei [Figure 1] and [Figure 2]. The tumor cells were seen to infiltrate the cyst wall and also present in surrounding fibroadipose tissue [Figure 3]. In the latter, the tumor cells were present in sheets with mucin depletion and intense eosinophilic cytoplasm. These cells also exhibited a higher degree of nuclear atypia. On immunohistochemical stain, estrogen receptor (ER), progesterone receptor (PR), Her2neu and CK20 were negative.
In the absence of any other primary elsewhere, the patient subsequently underwent completion mastectomy and axillary lymph node resection. Multiple sections examined from the resected breast showed only one nodular area of intraductal papillary mucinous carcinoma. All the lymph nodes were free of tumor. No further treatment was given and after a follow-up of six months the patient is free of any recurrence or tumor metastases.
Most of the cases of primary MCA of breast have been reported in postmenopausal females.  It has been suggested that these tumors develop independent of estrogenic stimulation as evidenced by absence of hormonal markers (estrogen and progesterone) on immunohistochemical staining.  In an earlier case report, MCA was seen coexisting with infiltrating ductal carcinoma. A transition from ordinary DCIS (Ductal Carcinoma in situ) to MCA in situ was noted denoting that MCA might derive from a metaplastic process of ordinary DCIS. 
It is also important to rule out the possibility of a metastatic mucinous cystadenocarcinoma before the diagnosis of primary tumor in breast can be made. Although no patient has died of this disease so far, longer follow-up is required to determine the exact course of the disease.
|1||Honma N, Sakamoto G, Ikenaga M, Kuroiwa K, Younes M, Takubo K. Mucinous cystadenocarcinoma of the breast: A case report and review of the literature. Arch Pathol Lab Med 2003;127:1031-3.|
|2||Koenig C, Tavassoli FA. Mucinous cystadenocarcinoma of the breast. Am J Surg Pathol 1998;22:698-703.|
|3||Chen WY, Chen CS, Chen HC, Hung YJ, Chu JS. Mucinous cystadenocarcinoma of the breast coexisting with infiltrating ductal carcinoma. Pathol Int 2004;54:781-6.|
|4||Rosen PP, Scott M. Cystic hypersecretory duct carcinoma of the breast Am J Surg Pathol 1984;8:31-41.|