Mucinous breast carcinoma - young patient

Case contributed by Dr Giorgio M Baratelli

Presentation

Nulliparous woman with a negative family history has a palpable, round, firm and smooth breast lump of 1 cm near the areola. The lump is movable and painless and there is no nipple discharge and axillary adenopathy.

Patient Data

Age: 25 years
Gender: Female

Ultrasounds shows a heterogeneous round hypoechoic and well circumscribed mass, that measures 13 mm, with micro lobulated borders and distal enhancement.

The presence of vascularity within the lesion on Doppler ultrasounds is suspicious for malignancy.

Case Discussion

Mammography shows normal fibroglandular tissue and was therefore classified as false negative according to standard definitions in the BI-RADS Atlas. As many as 21% of mucinous carcinomas might at any age and tumor size might not be detected mammographically.

The patient underwent breast-conserving surgery and sentinel node dissection. 

Pathological examination confirms the diagnosis of a hypercellular type B or mixed mucinous breast cancer of 13 mm, grade 2. The positivity of estrogen receptor (ER) and progesterone receptor (PR) is 100% and 90%, respectively. Ki67 was 25%. HER2 (human epidermal growth factor receptor 2) is equivocal on IHC (immunohistochemistry) and negative on FISH test (fluorescence in situ hybridization). The sentinel node is negative.

Mucinous carcinoma of the breast is a rare tumor with a favorable prognosis due to the low incidence of lymph node metastases. The prevalence is only 1% in women younger than 35 years. 

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