[Clinicopathologic features of cystic hypersecretory lesion of the breast].
OBJECTIVE
To study the clinicopathologic features, immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast.


METHODS
Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed.


RESULTS
All six patients were female, age ranged from 37 to 71 years (average 49.3 years). Three cases were cystic hypersecretory hyperplasia (CHH), the other three cases were cystic hypersecretory carcinoma (CHC). Clinically the lesions presented as either breast mass or mammographic calcification.Grossly, the cystic hypersecretory lesions were poorly circumscribed, with multiple colloid containing cysts on the cut surface. Microscopically, the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles, and calcification was seen in the cyst in one case. The secretion was D-PAS and mucicarmine positive. The lining epithelium of the cysts was uniformly flat, cuboid or columnar, and arranged in a monolayer. The cells may be arranged in turfs, solid or micropapillary patterns in CHH.In cases with dysplasia, the epithelium showed cytological and structural atypia, but the usual morphology of atypical dutal hyperplasia such as arcades, rigid bridges or cribriform pattern was less common. The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL, there was immunoreactivity to S-100 protein, CK5/6 and CK14.Of the three CHCs, ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up, and the rest were uneventful at 18 months.


CONCLUSIONS
CHL of the breast is a rare pathological entity. Multiple colloid-filled cysts is a unique histological feature. The epithelium of CHL may show usual hyperplasia, dysplasia or carcinoma.
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Rui
R
Bi
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Yufan
Y
Cheng
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Baohua
B
Yu
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Ruohong
R
Shui
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Wentao
W
Yang
Department of Pathology, Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China. E-mail: lilysh21@hotmail.com.
Xiaoli
X
Xu
D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D004848:Epithelium / Q000473:pathology; D005260:Female; D005348:Fibrocystic Breast Disease / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D053547:Keratin-14 / Q000378:metabolism; D053555:Keratin-5 / Q000378:metabolism; D053553:Keratin-6 / Q000378:metabolism; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009418:S100 Proteins / Q000378:metabolism
D053547:Keratin-14; D053555:Keratin-5; D053553:Keratin-6; D009418:S100 Proteins