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Difference between revisions of "Mucinous breast carcinoma"
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Mucinous breast carcinoma (view source)
Revision as of 11:37, 8 September 2016
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Mucinous Breast Carcinoma (4685032847).jpg | | Image = Mucinous Breast Carcinoma (4685032847).jpg | ||
| Width = | | Width = | ||
| Caption = Mucinous breast carcinoma. [[H&E stain]]. | | Caption = Mucinous breast carcinoma. [[H&E stain]]. | ||
| Line 14: | Line 14: | ||
| IF = | | IF = | ||
| Gross = pale, glistening, jelly-like appearance | | Gross = pale, glistening, jelly-like appearance | ||
| Grossing = | | Grossing = [[breast grossing]] | ||
| Staging = [[breast cancer staging]] | |||
| Site = [[breast]] - see ''[[invasive breast cancer]]'' | | Site = [[breast]] - see ''[[invasive breast cancer]]'' | ||
| Assdx = | | Assdx = | ||
| Line 25: | Line 26: | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = good compared to | | Prognosis = good compared to the usual ductal carcinoma | ||
| Other = | | Other = | ||
| ClinDDx = other breast tumours | | ClinDDx = other breast tumours | ||
| Line 36: | Line 37: | ||
==General== | ==General== | ||
*Rare. | *Rare. | ||
*2% of invasive breast carcinomas. | |||
*Good prognosis.<ref name=pmid18809061>{{Cite journal | last1 = Barkley | first1 = CR. | last2 = Ligibel | first2 = JA. | last3 = Wong | first3 = JS. | last4 = Lipsitz | first4 = S. | last5 = Smith | first5 = BL. | last6 = Golshan | first6 = M. | title = Mucinous breast carcinoma: a large contemporary series. | journal = Am J Surg | volume = 196 | issue = 4 | pages = 549-51 | month = Oct | year = 2008 | doi = 10.1016/j.amjsurg.2008.06.013 | PMID = 18809061 }}</ref> | *Good prognosis.<ref name=pmid18809061>{{Cite journal | last1 = Barkley | first1 = CR. | last2 = Ligibel | first2 = JA. | last3 = Wong | first3 = JS. | last4 = Lipsitz | first4 = S. | last5 = Smith | first5 = BL. | last6 = Golshan | first6 = M. | title = Mucinous breast carcinoma: a large contemporary series. | journal = Am J Surg | volume = 196 | issue = 4 | pages = 549-51 | month = Oct | year = 2008 | doi = 10.1016/j.amjsurg.2008.06.013 | PMID = 18809061 }}</ref> | ||
*Usually older women. | *Usually older women. | ||
| Line 50: | Line 52: | ||
*Malignant mucin producing glands. | *Malignant mucin producing glands. | ||
**Mucinous component must comprise >90% of the tumour - '''required for diagnosis'''.<ref name=pmid22006768>{{Cite journal | last1 = Dogan | first1 = E. | last2 = Aksoy | first2 = S. | last3 = Dizdar | first3 = O. | last4 = Arslan | first4 = C. | last5 = Dede | first5 = DS. | last6 = Ozisik | first6 = Y. | last7 = Altundag | first7 = K. | title = Pure mucinous carcinoma of the breast: a single center experience. | journal = J BUON | volume = 16 | issue = 3 | pages = 565-7 | month = | year = | doi = | PMID = 22006768 }}</ref> | **Mucinous component must comprise >90% of the tumour - '''required for diagnosis'''.<ref name=pmid22006768>{{Cite journal | last1 = Dogan | first1 = E. | last2 = Aksoy | first2 = S. | last3 = Dizdar | first3 = O. | last4 = Arslan | first4 = C. | last5 = Dede | first5 = DS. | last6 = Ozisik | first6 = Y. | last7 = Altundag | first7 = K. | title = Pure mucinous carcinoma of the breast: a single center experience. | journal = J BUON | volume = 16 | issue = 3 | pages = 565-7 | month = | year = | doi = | PMID = 22006768 }}</ref> | ||
** | **Small clusters of cells should float in the mucin - '''key feature'''. | ||
**Glands typically have irregular edges. | **Glands typically have irregular edges. | ||
**+/-Vessels within the mucin pools. | **+/-Vessels within the mucin pools. | ||
*Subtypes <ref>{{Cite journal | last1 = Weigelt | first1 = B. | last2 = Geyer | first2 = FC. | last3 = Horlings | first3 = HM. | last4 = Kreike | first4 = B. | last5 = Halfwerk | first5 = H. | last6 = Reis-Filho | first6 = JS. | title = Mucinous and neuroendocrine breast carcinomas are transcriptionally distinct from invasive ductal carcinomas of no special type. | journal = Mod Pathol | volume = 22 | issue = 11 | pages = 1401-14 | month = Nov | year = 2009 | doi = 10.1038/modpathol.2009.112 | PMID = 19633645 }}</ref> | |||
**Mucinous A (or paucicellular) - more mucin | |||
**Mucinous B (or hypercellular) - less mucin and neuroendocrine differentiation and argyrophilia | |||
DDx: | DDx: | ||
*[[DCIS]] with a mucinous component. | *[[DCIS]] with a mucinous component. | ||
**Mucin has a homogenous appearance, mucin lacks vascularization, mucin pools have a regular border. | **Mucin has a homogenous appearance, mucin lacks vascularization, mucin pools have a regular border. | ||
*[[Invasive ductal carcinoma of the breast]] with a mucinous component - more common than ''mucinous breast carcinoma''. | *[[Invasive ductal carcinoma of the breast]] with a mucinous component - more common than ''mucinous breast carcinoma''. Any 'no special type' component imparts a worse prognosis so the diagnosis 'mucinous carcinoma' is reserved for tumours with close to pure mucinous features. | ||
Note: | Note: | ||
*The amount of mucinous component to call ''[[mucinous carcinoma]]'' varies by anatomical site. | *The amount of mucinous component to call ''[[mucinous carcinoma]]'' varies by anatomical site. | ||
* | *A breast core biopsy that show any degree of mucinous change is an indication for excision to exclude mucinous carcinoma.<ref name=pmid12218567>{{Cite journal | last1 = Jacobs | first1 = TW. | last2 = Connolly | first2 = JL. | last3 = Schnitt | first3 = SJ. | title = Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? | journal = Am J Surg Pathol | volume = 26 | issue = 9 | pages = 1095-110 | month = Sep | year = 2002 | doi = | PMID = 12218567 }}</ref> | ||
*Size and margins are assessed from edge of mucin, even if it does not contain epithelial cells | |||
*These tumors can be very difficult to assess lymphovascular invasion. Look for tumour cells in areas where lymphatics are expected ie. tumour in arc-shape around vascular bundle | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image:Mucinous Breast Carcinoma (4685032847).jpg | MBC - high mag. (WC/Uthman) | Image:Mucinous Breast Carcinoma (4685032847).jpg | MBC - high mag. (WC/Uthman) | ||
Image:Mucinous Breast Carcinoma (4685664022).jpg | MBC - low mag. | Image:Mucinous Breast Carcinoma (4685664022).jpg | MBC - low mag. (WC/Uthman) | ||
Image:Breast MucinousCarcinoma LP SNP.jpg|Mucinous Carcinoma - low power (SKB) | |||
Image:Breast MucinousCarcinoma 2 MP SNP.jpg|Mucinous Carcinoma - medium power (SKB) | |||
Image:Breast MucinousCarcinoma MP SNP.jpg|Mucinous Carcinoma - medium power (SKB) | |||
Image:Breast MucinousCarcinoma MP SNP.jpg|Mucinous Carcinoma - high power (SKB) | |||
Image:Breast DCIS Mucinous Extravasation MP2 PA.JPG|Breast - Mucinous ductal carcinoma in situ with mucin extravasation - low power. Compare the profile of the involved gland to the examples above. (SKB) | |||
Image:Breast DCIS Mucinous Extravasation MP3 PA.JPG|Breast - Mucinous ductal carcinoma in situ with mucin extravasation - medium power. Notice the lack of floating tumour nests (SKB) | |||
</gallery> | </gallery> | ||