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Clinicopathological evaluation of 100 cases of mucinous carcinoma of breast with emphasis on axillary staging and special reference to a micropapillary pattern
  1. Aditi Ranade1,
  2. Rashmi Batra1,
  3. Gagangeet Sandhu2,
  4. Rohit A Chitale3,
  5. Jasminka Balderacchi1
  1. 1Department of Pathology, St Luke's–Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, New York, USA
  2. 2Department of Medicine, St Luke's–Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, New York, USA
  3. 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Aditi C Ranade MD Department of Pathology, St. Luke's Roosevelt Hospital Center, Roosevelt Division 1000, Tenth Avenue, New York, NY 10019; aranade{at}chpnet.org, aditiranade{at}hotmail.com

Abstract

Background Pure mucinous breast carcinoma (PMBC) is uncommon and associated with better prognosis than mixed mucinous breast carcinoma (MMBC). A micropapillary pattern in PMBC has been identified although its prognostic significance is questionable.

Methods A retrospective review of 100 cases of mucinous carcinoma diagnosed between 2000 and 2009 was conducted. Two broad categories were studied: PMBC (more than 90% mucinous component; n=45) and MMBC (less than 90% mucinous component; n=55). PMBC was further subclassified as hypocellular/type A (n=37) and cellular/type B (n=8). Receptor status, clinicomorphological and prognostic features were compared without patient follow-up.

Results Mean age at diagnosis in PMBC and MMBC was 60 and 63 years, while mean tumour size was 1.65 and 2.5 cm, respectively. Mean age in type A and type B PMBC patients was 75 and 55 years, respectively. The majority of PMBCs were well differentiated, with two poorly differentiated cases as well. The majority of MMBCs were moderately differentiated. A micropapillary pattern was seen in 20% of PMBCs. Sentinel lymph nodes were positive in 18.5% of PMBCs and 16% of MMBCs. Non-sentinel lymph nodes were positive in 14% of PMBCs and 39% of MMBCs. A micropapillary pattern was seen in 60% of LN positive PMBCs and 14% of LN negative PMBCs. Furthermore, 95% of PMBCs were ER(+), 84% were PR(+) and 9% were Her-2(+); 91% of MMBCs were ER(+), 87% were PR(+) and 33% were Her-2(+).

Conclusions PMBCs with a micropapillary pattern were more frequently associated with nodal disease. PMBCs with axillary disease had one or more of the following: micropapillary pattern, high nuclear grade, Her-2 positivity, smaller tumour size or younger age. Hence, axillary staging by sentinel lymph node biopsy is recommended in PMBCs.

  • Pure mucinous breast carcinoma (PMBC)
  • micropapillary pattern
  • mixed mucinous breast carcinoma (MMBC)
  • poorly differentiated pure mucinous breast carcinoma
  • breast cancer

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics committee approval was obtained from St Luke's Roosevelt Hospital Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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