Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Secretory Breast Carcinoma

Secretory breast carcinoma is a slow growing breast cancer which is actually more common in younger patients, and was in fact originally termed ‘juvenile‘ breast cancer. It is called secretory breast carcinoma because of the abundant secretion of mucin within the tumor. It is one of the rarest types of breast carcinomas, accounting for less than 1% of all breast cancers. It can occur over virtually all age ranges, but the average age of presentation is estimated at around 25 years.

I just want to let you know that I have created a newer version of this page with more up-to-date information on Secretory Breast Cancer. However, this page is still pretty useful and so because of that, I would still use it as well as the new one.

Secretory breast carcinoma is a fairly benign type of breast cancer. It may be considered a subtype of infiltrating ductal carcinoma of the breast, but is generally associated with a better prognosis than generic ductal carcinoma. However, secretory breast carcinoma is prone to metastasis and local recurrence so must be treated aggressively.

secretory breast carcinoma

Clinical presentation of secretory breast carcinoma

Most often a secretory breast carcinoma presents clinically as an asymptomatic mobile mass, which is usually subareolar. The tumor size might have an average diameter of 3 cm, but can range from 1 cm to 16 cm.

Histological features common to secretory breast carcinoma

Secretory breast carcinoma can demonstrate a number of different histological patterns. These include solid, microcystic, and ductal, and also tumors containing all three patterns. These neoplasms are all distinguished by gross and microscopic circumscription and by prominent intracellular and intra acinar mucin. Tumor cells tend to be polygonal, and with granular eosinophilic cytoplasm. Cellular atypia is either minimal or absent, and the rate of mitoses >is typically low.

The “classic” secretory carcinoma presents with microacini, abundant secretion and with papillary features, while at other times it can present with prominent solid and papillary apocrine features.

secretory breast carcinoma 2

Immunohistochemical features common to secretory breast carcinoma

Secretory breast cancer tumors tend to react positive for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, alpha-lactalbumin and vimentin. Secretory breast carcinomas also frequently express the S-100 protein, but are usually negative for estrogen, and often negative progesterone receptors and for HER2.

Secretory breast carcinomas and the ETV6-NTRK3 gene fusion

Recent studies have demonstrated that many secretory breast carcinomas tend to be characterized by a balanced genetic trans location, t(12;15). This creates a ETV6-NTRK3 gene fusion. The significance of this finding is unclear at present, but may lead to some innovative and targeted treatments in the future.

Treatment and prognosis for secretory carcinoma of the breast

It is worth noting that secretory breast carcinomas are known to be very slow growing. They are prone to recur, but usually only after rather long intervals. If there is recurrence, a local resection usually provides a cure. Axillary node metastasis is not uncommon with secretory breast carcinomas, with an estimated rate of about 15%-30%. For these reasons, most breast cancer experts tend to suggest that secretory breast carcinomas be treated with simple mastectomy and at least a low axillary resection.

In other words, it this type of breast cancer is usually curable, but it is better to treat it aggressively right away rather than waiting to see what might happen. Radiation therapy and chemical therapy are used in individual cases, but there is some indication that secretory breast carcinoma is a little bit resistant to conventional chemical treatments. Distant metastasis of secretory breast carcinoma is extremely rare.

Young women tend to have the highest survival rate with secretory breast cancer

The prognosis tends to be related to the age of the patient as well. A young patient with secretory breast carcinoma has virtually a 100% survival rate after five years. Secretory breast cancers in adults, however, tend to have about the same prognosis as for generic infiltrating ductal carcinoma.

For further reading, I suggest you visit this page that has information about adenocarcinoma of the breast, this page for breast abnormalities typically discovered by mammogram, and go to this page with mucinous cystadenocarcinoma of the breast.

References

  1. Diallo R, Schaefer KL, Bankfalvi A, Decker T, Ruhnke M, Wˆºlfing P, Jackisch C, Luttges J, Sorensen PH, Singh M, Poremba – Secretory carcinoma of the breast: a distinct variant of invasive ductal carcinoma assessed by comparative genomic hybridization and immunohistochemistry. Human pathology. 2003 ; 34 (12) : 1299-1305.
  2. Tognon C, Knezevich SR, Huntsman D, Roskelley CD, Melnyk N, Mathers JA, Becker L, Carneiro F, MacPherson N, Horsman D, Poremba C, Sorensen PH Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma. Cancer cell. 2002 ; 2 (5) : 367-376.
  3. Euhus DM, Timmons CF, Tomlinson GE ETV6-NTRK3–Trk-ing the primary event in human secretory breast cancer. Cancer cell. 2002 ; 2 (5) : 347-348.
  4. Paeng MH, Choi HY, Sung SH, Moon BI, Shim SS. Secretory carcinoma of the breast. Journal of clinical ultrasound : JCU. 2003 ; 31 (8) : 425-429.
  5. Makretsov N, He M, Hayes M, Chia S, Horsman DE, Sorensen PH, Huntsman DG. A fluorescence in situ hybridization study of ETV6-NTRK3 fusion gene in secretory breast carcinoma. Genes, chromosomes & cancer. 2004 ; 40 (2) : 152-157.
  6. Costa, NM., Rodrigues, H., Pereira, H. Pardal, F., Matos, E., Secretory breast carcinoma—case report and review of the medical literature. The Breast Volume 13, Issue 4, August 2004, Pages 353-355
  7. Arce C, Cortes-Padilla D, Huntsman DG, Miller MA, Dueñnas-Gonzalez A, Alvarado A, Pérez V, Gallardo-Rincón D, Lara-Medina F.Secretory carcinoma of the breast containing the ETV6-NTRK3 fusion gene in a male: case report and review of the literature.World J Surg Oncol. 2005 Jun 17;3:35.
  8. Pohar-Marinsek Z, Golouh R. Secretory breast carcinoma in a man diagnosed by fine needle aspiration biopsy. A case report. Acta Cytol. 1994 May-Jun;38(3):446-50.
  9. Krohn M, Trams G, Brandt G: Secretory breast cancer – a special morphological entity predominantly in children and young women – a case report. Geburtshilfe Frauenheilkunde 1989 , 49:299-301.
  10. Sullivan JJ, Magee HR, Donald KJ. Secretory (juvenile) carcinoma of the breast. Pathology. 1977 Oct;9(4):341-6.
  11. Rosen PP, Cranor ML. Secretory carcinoma of the breast. Arch Pathol Lab Med. 1991 Feb;115(2):141-4.
  12. Oberman HA. Secretory carcinoma of the breast in adults. Am J Surg Pathol. 1980 Oct;4(5):465-70.

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About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.