Palliative surgery for giant mucinous carcinoma of the breast in an elderly patient: A rare case report

Abstract

Abstract. Mucinous breast carcinoma (MBC) is relatively rare, accounting for <10% of all breast cancers in women. These tumors are usually slow-growing and exhibit less aggressive characteristics compared with other types of breast cancer. Between 1989 and 2016, 55 patients underwent surgery for MBC at the Shiga Medical Center for Adults (Moriyama, Japan). The 10-year disease-free survival (DFS) and overall survival rates were 94.5 and 100.0%, respectively. Specifically, the 10-year DFS rates of pure MBC (PMBC) and mixed MBC were 97.7 and 83.3%, respectively. We herein report the case of a sizeable mucinous carcinoma causing rupture of the skin and bleeding due to tumor pressure. Palliative surgery was performed in order to remove the bleeding source after a total of 5 months of preoperative endocrine-based therapy. In conclusion, palliative surgery improved the patient's quality of life and may be a viable option for PMBC patients. The aim of the present study was to review the characteristics and management of these tumors, particularly in elderly patients. IntroductionMucinous breast carcinoma (MBC) of the breast is a special type of breast cancer that is characterized by the presence of carcinoma cells surrounded by large amounts of extracellular mucin (1). MBC may be encountered in all age groups, and the median age at presentation is 50-57 years (2-4). MBC comprises approximately <10% of all invasive breast cancers. This type of tumor has an overall better prognosis and a higher incidence among peri-and post-menopausal patients. Pathologically, there are two main subtypes of MBC, namely pure type MBC (PMBC) and mixed type MBC (MMBC) (1). PMBC in particular is known to have a favorable prognosis compared with invasive ductal carcinoma (IDC) (4-9). We herein report a case of a giant MBC causing rupture of the skin and bleeding due to tumor pressure, and review the characteristics and palliative management of these tumors, particularly in elderly patients. Case reportA 81-year-old Japanese woman presented to the outpatient clinic of the Department of Breast Surgery of the Shiga Medical Center for Adults (Moriyama, Japan) in January 2016 with a history of rapid enlargement of a right breast mass. The patient had noticed a mass 10 years prior. There was no family history of breast cancer. On physical examination, a large nodular mass was identified, measuring 18x15 cm, involving the entire right breast (Fig. 1A). There were also palpable right axillary lymph nodes, with the largest measuring 4x3 cm. The left breast was normal. A computed tomography (CT) scan revealed a large heterogeneous solid mass with axillary lymph node metastases (Fig. 1B); however, there was no evidence of distant metastasis.PMBC with axillary lymph nodes metastases was diagnosed by core needle biopsy and fine-needle aspiration cytology. The patient received letrozole endocrine therapy as a primary systemic therapy, as she declined surgery. Soon after endocrine therapy initiation, the patient visited our emergency room due to continuous b...

Influence of CYP19A1 gene expression levels in women with breast cancer: a systematic review of the literature

“…Among EldCa, mucinous carcinomas exhibited significantly higher levels of CYP19A1 mRNA than in other carcinomas (33). Mucinous carcinoma is a rare histological type that usually occurs in the elderly (54,55) and these findings may suggest the importance of the aromatase enzyme and peripheral estrogens in the pathobiology of this carcinoma (33).…”

A case of bilateral invasive mucinous adenocarcinoma of the lung with severe productive cough and dyspnea successfully treated with palliative lung lobectomy

“…The efficacy of palliative surgery for improvement of symptoms have been demonstrated in patients with various organs of advanced mucinous carcinoma, such as mucinous ovarian cancer and mucinous carcinoma of the breast [ 18 , 19 ]. However, since the lung is a vital organ and has a low regenerative capacity, the determination of surgical indication in patients with bilateral pneumonic-type IMA must be rigorous.…”