Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149741 (nipple discharge)
 551 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of neuroendocrine carcinomas of the breast displaying unusual histological features: numerous spindle cells and argyrophilic signet-ring cells. Both patients were older than 70 years, and both presented with a bloody nipple discharge. The tumor in both cases was predominantly intraductal. The tumor cells showed little pleomorphism or cytological atypia; because of the presence of spindle cells, benign diagnoses, such as ductal epithelial hyperplasia and intraductal papilloma, were considered for the in situ component. Recognition of the palisading arrangement of the peripheral cells, intracytoplasmic lumina, mitotic figures, and mucin permitted the diagnosis of intraductal carcinoma. Invasive nests composed of identical cells confirmed the diagnosis of malignancy in both cases. Our cases, along with those previously reported, suggest that neuroendocrine carcinoma with mucin production is a distinct breast tumor that usually occurs in older patients who experience bloody nipple discharge. The prognosis may be more favorable than that of the usual type of breast carcinoma. Common histological features include predominantly intraductal growth, an absence of desmoplasia, and low-grade atypia. Awareness of morphological variants of this tumor, such as those reported here, is necessary to avoid erroneous diagnoses.
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PMID:Spindle-cell argyrophilic mucin-producing carcinoma of the breast. Histological, ultrastructural, and immunohistochemical studies of two cases. 171 95

Endocrine ductal carcinoma in situ (E-DCIS), first characterized by Cross et al. in 1985, is an uncommon entity, and there is little information on its pathobiologic features and natural history in the literature. This report describes the largest series of 34 cases: 14 cases were pure in situ (group A), and 20 were accompanied by an invasive component (group B). All except three patients were over the age of 60 years, with the mean being 69.5 years for group A and 72.6 years for group B. Except for six patients in group A who had nipple discharge, all had a breast mass. On follow-up, one of five group A patients developed local recurrence 5 years after mastectomy, and two of seven group B patients developed another invasive primary in the contralateral breast. Histologically, E-DCIS showed expansile intraductal growths forming solid sheets and festoons traversed by delicate fibrovascular septa. Accumulation of basophilic mucin might be found within the growth and the fibrovascular septa. There were variable degrees of stromal sclerosis. In some cases, the solid intraductal cellular proliferations were focally punctuated by microglandular spaces and rosettes. Comedo necrosis was absent. Intraductal papillomas were found in the immediate vicinity of the tumors in 18 cases and invariably showed pagetoid involvement by E-DCIS. Pagetoid spread into the adjacent ducts and ductules was also a common feature (17 cases). The tumor cells were polygonal, oval, or spindly, often with eccentrically placed, bland-looking, ovoid nuclei and abundant eosinophilic granular cytoplasm. Intracellular mucin was commonly demonstrable. Immunostaining for myoepithelium using muscle-specific actin antibody confirmed the in situ nature of the E-DCIS component. The majority of tumor cells showed strong staining with the neuroendocrine markers chromogranin, synaptophysin, and neuron-specific enolase (monoclonal). Immunostaining also dramatically highlighted the pagetoid spread into the papillomas and ductules by outlining the tumor cells between the negatively stained residual ductal epithelium and myoepithelium. All cases were immunoreactive for estrogen and progesterone receptor, but not p53 and c-erbB2. The Ki-67 index was < 5%. Ultrastructural studies on four cases showed many dense-core neurosecretory granules and larger mucigen granules. In group B cases, the invasive component, which comprised 5-95% of the tumor, included colloid carcinoma, 12; "carcinoid" tumor, 3; mixed "carcinoid"/colloid carcinoma, 4; and small cell neuroendocrine carcinoma, 1. Neuroendocrine markers were also consistently demonstrable in the invasive component. In conclusion, E-DCIS is predominantly a disease of older women that is frequently accompanied by papillomas in the vicinity and may present as nipple discharge (an uncommon presentation in the usual forms of DCIS). It can mimic epitheliosis histologically, but the pagetoid spread is a helpful clue to its neoplastic nature. The bland nuclear morphology, lack of necrosis, and biologic marker profile suggest that E-DCIS is a form of low-grade DCIS despite its solid growth pattern. The invasive carcinomas associated with E-DCIS are also neuroendocrine programmed rather than the usual types of ductal carcinomas, suggesting that E-DCIS represents a biologically distinctive category of DCIS.
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PMID:Endocrine ductal carcinoma in situ (E-DCIS) of the breast: a form of low-grade DCIS with distinctive clinicopathologic and biologic characteristics. 871 93

Solid papillary carcinoma is a rare breast lesion, but this entity remains poorly recognized. In this article, we report a case of solid papillary carcinoma of the breast with focus on cytological and histological findings. A 66-year-old Japanese woman presented with nipple discharge. Imprint cytology obtained from the surgically resected breast specimens showed a plasmacytoid appearance and spindle cell morphology with low-grade atypia. Histologically, the tumor revealed findings of solid papillary carcinoma and predominantly showed an intraductal lesion with focal minimal invasion into the breast parenchyma. Fibrovascular cores with hyalinization were seen. Proliferation of short spindle cells was also focally observed. Pseudorosette formation or nuclear palisading at the stromal-glandular interface was seen, and intracellular or extracellular mucin deposition was occasionally identified. Nuclear atypia generally showed low grade. Finally, clinicians, cytotechnologists, and pathologists should recognize this rare tumor entity because this tumor is a malignant neoplasm showing characteristic pathological findings.
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PMID:Solid papillary carcinoma of the breast: imprint cytological and histological findings. 2034 6

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra-ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra-ductal tumour suggested low-grade carcinoma. Additional findings of mucin production and rosette-formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low-grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.
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PMID:Fine-needle aspiration cytology of solid papillary carcinoma of the breast. 3151 48

Mucin-producing carcinomas are unusual primary malignancies of breast, and constitute about 1-4 percent of total breast cancer. The mammary mucin producing carcinomas are divided into 4 histologic subtypes according to WHO classification, including mucinous carcinoma, mucinous cystadenocarcinoma (MCA), columnar cell mucinous carcinoma (CCMC), and signet ring cell carcinoma. However, the synchronous primary MCA and CCMC of breast is a very rare case presentation. The case reported a 56-year-old female, who presented with right mammary lumps and nipple discharge about 1 year. Imaging examinations revealed multiple cystic and solid nodules in upper outer quadrant of right breast, associated with ectatic ducts. Serum levels of tumor markers were normal. Right mammary lumpectomy revealed mucinous carcinoma, modified radical mastectomy, and lymph node dissection were carried out. For neoplastic cells, ER and PR were positive, HER2 (1+) was negative, Ki67 was low expression (3-5%). There was no metastatic carcinoma in lymph nodes (0/8). Modified radical mastectomy and lymph node dissections were carried out. Tamoxifen was chosen for adjuvant therapy. After a 3 month follow up, the patient survived without recurrences and distant metastasis. We report the first synchronous primary MCA and CCMC of breast with molecular subtype of Luminal A.
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PMID:Mammary synchronous mucinous cystadenocarcinoma and columnar cell mucinous carcinoma: a case report. 3304 47