Abstract
Background Pure mucinous breast carcinoma (PMBC) is a rare histologic type of mammary neoplasm. It has been associated with a better short-term prognosis than infiltrating ductal carcinoma (IDC) but identical long-term survival curves have been reported. The value of tumor size for TNM staging has been challenged because of the mucin content of the lesions. This study presents a large PMBC series with 20 years follow up as compared to IDC. The relative significance of a variety of common prognostic factors is calculated for this uncommon histology. Materials and methods A retrospective analysis of all PMBC cases reported in the SEER database between 1973 and 2002 was conducted. Overall survival (OS) and disease specific survival (DSS) were calculated at 5, 10, 15 and 20 years of follow up. Those curves were compared with all the IDC cases reported into the database during the same period. The prognostic significance of gender, race, laterality, age at diagnosis, T and N status, estrogen and progesterone receptors and administration of radiation therapy was calculated by univariate and multivariate analysis. Results There were 11,422 PMBC patients reported. The median age at diagnosis was 71 years (Range 25–85). Fifty three percent of the tumors were well differentiated, 38% were moderately differentiated and the remaining 9% were poorly differentiated or anaplastic. The majority of the tumors were located in the upper outer quadrant (44%) the other 56% were roughly evenly divided between the upper inner, lower inner, lower outer and central quadrants. Eighty six percent of the patients had only localized disease at the time of surgery without nodal or distant disease while 12% had regional nodal involvement and 2% had distant metastases. The PMBC cases showed a better differentiation with lesions of lesser grade and more frequent ER/PR expression, smaller size and lesser nodal involvement when compared to the IDC cases of the same period. Kaplan Meier survival curves revealed a 5 years. breast cancer specific survival rate of 94%. Although slowly decreasing with time, 10, 15 and 20 years survival were 89%, 85% and 81% respectively compared to 82% (5 year), 72% (10 year), 66% (15 year) and 62% (20 year) for IDC. There were no significant differences in overall survival. Multivariate analysis by Cox regression revealed the nodal status (N) to be the most significant prognostic factor followed by age, tumor size (T), progesterone receptors and nuclear grade. Disease specific survival curves stratified for nodal status revealed a highly significant difference between node negative and node positive patients. The addition of radiation therapy after surgery did not significantly improve overall survival. Conclusions This large retrospective comparative analysis confirms the less aggressive behavior of PMBC compared to IDC. This favorable outcome is maintained after 20 years. This tumor presents typically in older patients and is rarely associated with nodal disease. Positive Nodal status appears to be the most significant predictor of worse prognosis.
Similar content being viewed by others
References
Andre S, Cunha F, Bernardo M et al (1995) Mucinous carcinoma of the breast: a pathologic study of 82 cases. J Surg Oncol 58(3):162–167
Azzopardi JG (1979) Problems in breast pathology. In: Bennington JL, London WB Saunders 294–296
Komaki K, Sakamoto G, Sugano H, Morimoto T, Monden Y et al (1988) Mucinous carcinoma of the breast in Japan. A prognostic analysis based on morphologic features. Cancer 61:989–996
Rosen PP et al (1985) Breast carcinoma at extremes of age: comparison of patients younger than 35 years and older than 75 years. J Surg Oncol 28:90–96
Rasmussen BB et al (1987) Prognostic factors in primary mucinous breast carcinoma. Am J Clin Pathol 87:155–160
Silverberg SG, Kay S, Chitale AR et al (1971) Colloid carcinoma of the breast. Am J Clin Pathol 55:355–363
World Health Organization (1982) Histological typing of breast tumors. Tumori 68:181–198
Capella C, Eusebi V, Mann B et al (1980) Endocrine differentiation in mucoid carcinoma of the breast. Histopathology 4(6):613–630
Clayton F (1986) Pure mucinous carcinomas of the breast: morphologic features and prognostic correlates. Hum Pathol 17(1):34–38
Norris HJ, Taylor HB (1965) Prognosis of mucinous (gelatinous) carcinoma of the breast. Cancer 18:879–885
Lee BJ, Hauser H, Pac GT (1934) Gelatinous carcinoma of the breast. Surg Gynecol Obstet 59:841–857
Toikkanen S, Kujari H (1989) Pure and mixed mucinous carcinoma of the breast: a clinicopathologic analysis of 61 cases with long term follow up. Hum Pathol 20:758–764
Saudade A et al (1995) Mucinous carcinoma of the breast: a pathologic study of 82 cases. J Surg Oncol 58:162–167
Lannigan AK et al (2002) Mucinous breast carcinoma. The Breast 11:359–361
Lesser ML et al (1981) Estrogen and progesterone receptors in breast carcinoma; correlation with epidemiology and pathology. Cancer 299–309
Rosen PP, Wang T (1980) Colloid carcinoma of the breast: analysis of 64 patients with long term follow up. Am J Clin Pathol 3:304
Avisar E, Akram Khan M, Axelrod D, Oza K (1998) Pure mucinous carcinoma of the breast: a clinicopathologic correlation study. Ann Surg Oncol 5(5):447–451
Rasmussen BB (1985) Human mucinous breast carcinoma and their lymph node metastases. A histological review of 247 cases. Path Res Pract 180:377–382
Rasmussen BB, Rose C, Christensen I (1987) Prognostic factors in primary mucinous breast carcinoma. Am J Clin Pathol 87:155–160
Fisher ER, Gregorio RM, Fisher B et al (1975) The pathology of invasive breast cancer. Cancer 36:1–85
Surveillance, Epidemiology and End Results (SEER) Program (http://www.seer.cancer.gov), Cancer Statistics Branch, Surveillance Program, Division of Cancer Prevention and Control, National Cancer Institute (NCI)––US Department of Health, National Institute of Health (NIH)
Scopsi L, Andreola S, Pilotti S, Bufalino R et al (1994) Mucinous Carcinoma of the breast. A clinicopathologic, histochemical and immunicytochemical study with special reference to neuroendocrine differentiation. Am J Surg Pathol 18:702–711
Fujii H et al (2002) Mucinous cancers have fewer genomic alterations than more common classes of breast cancer. Breast Cancer Res Treat 76:255–260
Kato N, Endo Y Tamura G et al (1999) Mucinous carcinoma of the breast: a multifaceted study with special reference to histogenesis and neuroendocrine differentiation. Pathol Int 49(11):947–955
Goodman DNF et al (1995) Mammographic features of pure mucinous carcinoma of the breast with pathological correlation. Can Assoc Radiol J 46:296–301
Wilson TE, Helvie MA, Oberman HA, Joynt LK (1995) Pure and mixed mucinous carcinoma of the breast: pathologic basis for differences in mammographic appearance. Am J Roentgen 165:285–289
Matsuda M et al (2000) Mammographic and clinicopathological features of mucinous carcinoma of the breast. Breast Cancer 7(1):65–70
Memis A, Ozdemir N, Parildar M et al (2000) Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation. Eur J Radiol 35:39–43
Dhillon R, Depree P, Metcalf C, Wylie E (2006) Screen-detected mucinous breast carcinoma: potential for delayed diagnosis. Clin Radiol 61(5):423–430
Kawashima M, Tamaki Y, Nonaka T et al (2002) MR imaging of mucinous carcinoma of the breast. AJR 179:179–183
Okafuji T, Yabuuchi H, Sakai S et al (2006) MR imaging features of pure mucinous carcinoma of the breast. Eur J Radiol Sep. 8
Gupta RK, McHutchinson AGR et al (1991) Value of the FNA cytology of the breast with an emphasis to the cytodiagnosis of colloid carcinoma. Acta Cytologica 35:703–709
Renshaw A (2002) Can mucinous lesions of the breast be reliably diagnosed by core needle biopsy?. Am J Clin Pathol 118(1):82–84
Wai-Man Lam, Winnie Chiu-wing C et al (2006) Role of fine needle aspiration and tru-cut biopsy in diagnosis of mucinous carcinoma of the breast from a radiologist’s perspective. J Clin Imag. 30:6–10
Komenaka IK, El-Tamer MB, Troxel A, Hamele-Bena D et al (2004) Pure mucinous carcinoma of the breast. Am J Surg 187:528–532
Cardenosa G, Doudna C, Eklund GW (1994) Mucinous (colloid) breast cancer: clinical and mammographic findings in 10 patients. Am J Roentgenol 162:1077–1079
Ishikawa T, Hamaguchi Y, Ichikawa Y et al (2002) Locally advanced mucinous carcinoma of the breast with sudden growth acceleration: a case report. Jpn J Clin Oncol 32(2):64–67
Lannigan AK, Going JJ et al (2002) Mucinous breast carcinoma. The breast 11:359–361
Yoneyama F et al (2003) Massive mucinous carcinoma of the breast untreated for 6 years. Int J Clin Oncol 8:121–123
Koenig C, Tavassoli FA (1998) Mucinous cystadenocarcinoma of the breast. Am J Surg Pathol 22(6):698–703
Diab S et al (1999) Tumor characteristics and clinical outcome of tubular and mucinous breast carcinoma. J Clin Oncol 17:1442–1448
Paramo JC, Wilson C, Velarde D et al (2002) Pure mucinous carcinoma of the breast: is axillary staging necessary? Ann Surg Oncol 9(2):161–164
Fentiman IS, Mills RR, Smith P et al (1997) Mucoid breast carcinomas: histology and prognosis. Br J Cancer 75:1061–1065
Thurman S, Schnitt S, Connolly J et al (2004) Outcome after breast conserving therapy for patients with stage I or II mucinous, medullary or tubular breast carcinoma. Int J Rad Oncol Biol Phys 59(1):152–159
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Di Saverio, S., Gutierrez, J. & Avisar, E. A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat 111, 541–547 (2008). https://doi.org/10.1007/s10549-007-9809-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-007-9809-z