Secretory carcinoma of breast with predominant microcystic morphology： report of two cases and literature review

doi:10.16150/j.1671-2870.2025.03.015

Abstract

Abstract:

Secretory carcinoma of breast (SCB) is a rare salivary gland-type malignant tumor of the breast. This study reports two female patients with SCB admitted between 2019 and 2023, both presenting with breast masses. Breast ultrasonography indicated a BI-RADS category Ⅲ heterogeneous hyperechoic nodule in one case and a BI-RADS category Ⅳa hypoechoic nodule in the other. Histopathological examination showed that the maximum tumor diameters were 13 mm and 14 mm, respectively, with grayish-white cut surfaces, moderate consistency, and well-defined margins. Tumor cells exhibited mild to moderate atypia, with round or oval nuclei and a single small nucleolus. The cytoplasm was eosinophilic or vacuolated, and cells were arranged in microcystic, solid, or papillary patterns, with some showing cystic, hypersecretory lesion morphology. Eosinophilic secretions were observed within the lumens, and stromal fibrous tissue hyperplasia with hyaline degeneration was noted. Immunohistochemistry showed tumor cell expression of S100, pan-TRK, CD117, CK5/6, and GATA3, with low expression of ER and AR, and no expression of GCDFP-15, PR, or HER2. The Ki-67 proliferation index was approximately 5%. Alcian blue staining and periodic acid-Schiff staining showed positively stained secretions both within the cytoplasm and extracellularly. Molecular testing showed ETV6-NTRK3 gene fusion in both patients. A literature review of Chinese and English publications from 2020 to 2024 revealed 438 reported SCB cases, among which 80 had relatively complete clinicopathological and immunophenotypic data. This study summarized the clinicopathological characteristics, immunophenotypes, and molecular alterations of the 80 cases together with the two cases from our hospital, totaling 82 cases. The results showed expression rates of S100, pan-TRK, and GATA3 at 97%, 95%, and 100%, respectively. Approximately 50% of the cases showed low to moderate ER expression, about 20% showed low PR expression, and HER2 was generally negative. Molecular testing indicated that 98% of the cases had the characteristic ETV6-NTRK3 gene fusion, and two cases also had TERT promoter or PDGFR mutations.

Key words: Secretory carcinoma of breast, Clinical pathology, Immunophenotype, Molecular testing

CLC Number:

WEI Jingjing, YIN Haoqiang, WANG Yanwen, ZHANG Xiaoyun. Secretory carcinoma of breast with predominant microcystic morphology： report of two cases and literature review[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 349-354.

Figures/Tables 8

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Table 1

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临床病理、免疫表型及分子特征	数据/例数
中位年龄（范围）	43岁（3~85岁）
男性/女性(n)	1∶20
病理特征[n（%）]
微囊/蜂窝状	76（95%）
腺样/腺管状	61（76%）
实性	50（64%）
乳头状	46（58%）
免疫指标[n（%）]
ER	43（52%）
PR	15（18%）
HER2	2（2%）
Ki-67≤15%	41（70%）
S100	71（97%）
CK5/6	24（80%）
Pan-TRK	35（95%）
EGFR	6（60%）
CD117	11（65%）
GCDFP15	5（20%）
GATA3	16（100%）
基因改变[n（%）]
ETV6-NTRK3改变	58（98%）
伴PDGFR突变	1（1%）
伴TERT启动子突变	1（1%）