Cystic Hypersecretory Carcinoma of the Breast: A Rare Case Report with Review of Literature and Emphasis on Differential Diagnosis

Abstract

Karthik Dhandapan

Cystic hypersecretory carcinoma (CHC) is a rare subset of in-situ breast carcinoma with or without associated invasive carcinoma. It is part of a spectrum of cystic hypersecretory lesions that includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situ, and CHC with invasion. Only 20 cases of CHC with invasion have been reported so far. A 60-year-old female presented with a palpable right breast mass. A core needle biopsy was carried out, which was reported as invasive breast carcinoma with areas of ductal carcinoma in situ (DCIS). Modified radical mastectomy was done post-neo-adjuvant chemotherapy; On microscopy, dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells with variable degrees of proliferation and atypia were seen. There were multiple foci of invasion; both skin invasion and axillary lymph node metastasis were present. Immunohistochemistry (IHC) was done with relevant markers; correlating all these findings, a diagnosis of CHC with invasion was made. CHC is a distinct form of DCIS with or without associated invasion. Awareness of this entity is required to rule out other differential diagnoses and to avoid misinterpretation. Little is known about the IHC profile, biological behavior, prognosis, and molecular profile of CHC due to its rarity.

Publikationsverlauf

Artikel online veröffentlicht:
12. August 2023

• References

• 1 Rosen PP, Scott M. Cystic hypersecretory duct carcinoma of the breast. Am J Surg Pathol 1984; 8 (01) 31-41
• 2 Sun J, Wang X, Wang C. Invasive cystic hypersecretory carcinoma of the breast: a rare variant of breast cancer: a case report and review of the literature. BMC Cancer 2019; 19 (01) 31
• 3 Yami H, Thambi R, Priya PV, Sundaram S. Cystic hypersecretory carcinoma with invasion: case series on a rare variant of carcinoma breast. Indian J Pathol Microbiol 2022; 65 (01) 149-151
• 4 D'Alfonso TM, Ginter PS, Liu YF, Shin SJ. Cystic hypersecretory (in situ) carcinoma of the breast: a clinicopathologic and immunohistochemical characterization of 10 cases with clinical follow-up. Am J Surg Pathol 2014; 38 (01) 45-53
• 5 Guerry P, Erlandson RA, Rosen PP. Cystic hypersecretory hyperplasia and cystic hypersecretory duct carcinoma of the breast. Pathology, therapy, and follow-up of 39 patients. Cancer 1988; 61 (08) 1611-1620
• 6 Hoda Syed, Brogi Edi, Koerner Frederick, Rosen Paul. Rosen's Breast Pathology 5th edition. Wolters Kluwer; 2020
• 7 Tramm T, Kim JY, Tavassoli FA. Diminished number or complete loss of myoepithelial cells associated with metaplastic and neoplastic apocrine lesions of the breast. Am J Surg Pathol 2011; 35 (02) 202-211
• 8 Park JM, Seo MR. Cystic hypersecretory duct carcinoma of the breast: report of two cases. Clin Radiol 2002; 57 (04) 312-315
• 9 Skalova A, Ryska A, Kajo K, Di Palma S, Kinkor Z, Michal M. Cystic hypersecretory carcinoma: rare and poorly recognized variant of intraductal carcinoma of the breast. Report of five cases. Histopathology 2005; 46 (01) 43-49
• 10 Song SW, Whang IY, Chang ED. Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass. Jpn J Radiol 2011; 29 (09) 660-662
• 11 Tamaki K, Sasano H, Ishida T. et al. Comparison of core needle biopsy (CNB) and surgical specimens for accurate preoperative evaluation of ER, PgR and HER2 status of breast cancer patients. Cancer Sci 2010; 101 (09) 2074-2079