Pure Mucinous ER- PR- HER2+

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specialinseattle
specialinseattle Member Posts: 3
edited June 2014 in HER2+ (Positive) Breast Cancer

My pathology results came back from my unilateral mastectomy today. From what I can find on the internet, the results are statistically not likely.  Has anyone else had an ER- PR- HER2+ mucinous tumor?  Am I nuts to think that I should ask for a 2nd pathology opinion?

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2011

    Lisacrogers1-

    I'm sorry to hear about your diagnosis.  I was diagnosed with pure mucinous breast cancer almost a year ago.  You have obviously done your homework because you are raising a very important question about mucinous breast cancer because your presentation of it is quite uncommon.

    Since there have been few studies about it, I will share with you what I have learned. 

    First, by all means, get a second pathology opinion!  When I was diagnosed, I read up on rare breast cancers and came across a researcher, Britta Weigelt, Ph.D.  I emailed her and she said the most important factor in getting the proper treatment is getting the PROPER PATHOLOGY.  She said that with the rare breast cancers, there's alot of different opinions about the characteristics of the tumor.  So getting a second pathology opinion, especially with your presentation is important.

    Again, because it is so rare, and there are different ways of catorgoritzing it, you may have "mixed" mucinous breast cancer or perhaps, IDC with "mucinous" cells.  What does that mean?  If you recall from your reading, with "pure" mucinous breast cancer, at least 90% of the cells are mucinous.  You would expect with that type of tumor, the presentation would be strongly ER/PR+ and HER/neu -.  There are however, some exceptions, but in those cases, with further review, they may in fact be "mixed" mucinous.

    With mixed mucinous as well as IDC with mucinous features, the characterisitics of the tumor will probably be less ER/PR+ and perhaps HER/neu +.

    The good news is that even if your characteristics are ER/PR- and HER/neu + there are excellent treatments.

    Hope this information helps.  Takeaway message is by all means, get a second pathology opinion.  And if it comes back ER/PR+ -- ask for the Oncotype DX test.

    BTW - how were your lymph nodes?  With pure mucinous breast cancers, if the tumor is less than 3 cms, the lymph nodes are usually negative.

    Good luck.

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2011

    Published in November of 2010, this is the latest information on Mucinous Breast Cancer:

    Mucinous carcinoma of the breast is genomically distinct from invasive ductal carcinomas of no special type.

    Lacroix-Triki M, Suarez PH, MacKay A, Lambros MB, Natrajan R, Savage K, Geyer FC, Weigelt B, Ashworth A, Reis-Filho JS.

    The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.

    Abstract

    Mucinous carcinomas are a rare entity accounting for up to 2% of all breast cancers, which have been shown to display a gene expression profile distinct from that of invasive ductal carcinomas of no special type (IDC-NSTs). Here, we have defined the genomic aberrations that are characteristic of this special type of breast cancer and have investigated whether mucinous carcinomas might constitute a genomic entity distinct from IDC-NSTs. Thirty-five pure and 11 mixed mucinous breast carcinomas were assessed by immunohistochemistry using antibodies against oestrogen receptor (ER), progesterone receptor, HER2, Ki67, cyclin D1, cortactin, Bcl-2, p53, E-cadherin, basal markers, neuroendocrine markers, and WT1. Fifteen pure mucinous carcinomas and 30 grade- and ER-matched IDC-NSTs were microdissected and subjected to high-resolution microarray-based comparative genomic hybridization (aCGH). In addition, the distinct components of seven mixed mucinous carcinomas were microdissected separately and subjected to aCGH. Pure mucinous carcinomas consistently expressed ER (100%), lacked HER2 expression (97.1%), and showed a relatively low level of genetic instability. Unsupervised hierarchical cluster analysis revealed that pure mucinous carcinomas were homogeneous and preferentially clustered together, separately from IDC-NSTs. They less frequently harboured gains of 1q and 16p and losses of 16q and 22q than grade- and ER-matched IDC-NSTs, and no pure mucinous carcinoma displayed concurrent 1q gain and 16q loss, a hallmark genetic feature of low-grade IDC-NSTs. Finally, both components of all but one mixed mucinous carcinoma displayed similar patterns of genetic aberrations and preferentially clustered together with pure mucinous carcinomas on unsupervised clustering analysis. Our results demonstrate that mucinous carcinomas are more homogeneous between themselves at the genetic level than IDC-NSTs. Both components of mixed mucinous tumours are remarkably similar at the molecular level to pure mucinous cancers, suggesting that mixed mucinous carcinomas may be best classified as variants of mucinous cancers rather than of IDC-NSTs.

    Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons
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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2011

    Abstract

    Background Pure mucinous breast carcinoma (PMBC) is uncommon and associated with better prognosis than mixed mucinous breast carcinoma                                    (MMBC). A micropapillary pattern in PMBC has been identified although its prognostic significance is questionable.                                

    Methods A retrospective review of 100 cases of mucinous carcinoma diagnosed between 2000 and 2009 was conducted. Two broad categories                                    were studied: PMBC (more than 90% mucinous component; n=45) and MMBC (less than 90% mucinous component; n=55). PMBC was further                                    subclassified as hypocellular/type A (n=37) and cellular/type B (n=8). Receptor status, clinicomorphological and prognostic                                    features were compared without patient follow-up.                                

    Results Mean age at diagnosis in PMBC and MMBC was 60 and 63 years, while mean tumour size was 1.65 and 2.5 cm, respectively. Mean age in type A and type B PMBC patients was 75 and 55 years, respectively. The majority of PMBCs were well differentiated, with two poorly differentiated cases as well. The majority of MMBCs were moderately differentiated. A micropapillary pattern was seen in 20% of PMBCs. Sentinel lymph nodes were positive in 18.5% of PMBCs and 16% of MMBCs. Non-sentinel lymph nodes were positive in 14% of PMBCs and 39% of MMBCs. A micropapillary pattern was seen in 60% of LN positive PMBCs and 14% of LN negative PMBCs. Furthermore, 95% of PMBCs were ER(+), 84% were PR(+) and 9% were Her-2(+); 91% of MMBCs were ER(+), 87% were PR(+) and 33% were Her-2(+).                                

    Conclusions PMBCs with a micropapillary pattern were more frequently associated with nodal disease. PMBCs with axillary disease had one                                    or more of the following: micropapillary pattern, high nuclear grade, Her-2 positivity, smaller tumour size or younger age.                                    Hence, axillary staging by sentinel lymph node biopsy is recommended in PMBCs.                                

    Footnotes

    • Competing interests None.                                   

    • Ethics approval Ethics committee approval was obtained from St Luke's Roosevelt Hospital Center.                                   

    • Provenance and peer review Not commissioned; externally peer reviewed.                                   

    What's this?

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  • specialinseattle
    specialinseattle Member Posts: 3
    edited January 2011

    Thank-you so much voraciousreader!  You have given me alot of information in a very short time.  I have my oncology consult tomorrow, but am convinced that I need a second pathology opinion.   

    I did ask for oncotype testing, but was told that since it was ER- it couldn't be done.  I will ask again tomorrow.

    Again, thanks for all the great information you have shared.

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  • NJvictoria
    NJvictoria Member Posts: 119
    edited January 2011

    Lisa, I sent you a private message.

    Vikki

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  • hymil
    hymil Member Posts: 826
    edited January 2011

    Lisa, Truly you must be the elite amongst the elite! Yes definitely you are not nuts and in your shoes I would also go for the second opinion. I think my slide got showed around all the doctors at my hospital anyway at their weekly show-and-tell group hug, I mean the BC multidisciplinary team meeting! If you turned out to actually be ER+ like most of us, there are more treatment options and that would be worth knowing. Also it means twice as many pathologists get to meet this rare disease so we increase their expertise! My BS was very complimentary about how pretty the slide of my histology was, with the purple dye and blue bits, says he has it for his screensaver. (Uh, thanks?? Pretty boobs would be better...)

    Voracious reader, Thank you for all the information too, I hadn't seen all the latest stuff.

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  • NJvictoria
    NJvictoria Member Posts: 119
    edited January 2011

    I too was diagnosed with mucinous breast cancer the 3rd week of Dec. I'm scheduled for a bi-lateral mast. on the 20th of this month. I've never been put to sleep, so I'm extremely nervous!

    Vikki

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  • specialinseattle
    specialinseattle Member Posts: 3
    edited January 2011

    hymil, you are too funny!  I may have to ask to see my slide to see if it's as pretty as yours, but  agree that pretty boobs would be better.  In a few months I hope to have picture ready boobs again :)

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  • clhouse
    clhouse Member Posts: 1
    edited January 2011

    Hi everyone...this is my first posting.  I was diagnosed with mucinous and DNIC breast cancer several weeks ago. On the 29th of December I had a lumpectomy. They removed 4 lymph nodes and they tested negative. I had clear borders around it. My cancer is Stage 1/ Grade 3. I am ER+PR+HER2+. I am seeing an oncologist and radiologist/oncologist next week to determine treatment. I know I am having radiation therapy and hormone therapy but unsure of the chemo. Any experiences with this?

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited January 2011

    clhouse- I'm sorry to hear about your diagnosis as well.

    Regarding your question of whether or not you need chemotherapy, I can't answer that question because you mention that you are HER2+.  Often, mucinous breast cancer is HER2-.  Traditionally, when a breast cancer is HER2+, the standard of care would include Herceptin.  You do have the option of having the Oncotype DX test done on your tumor since you are ER/PR+.  However, since you will probably need the Herceptin, doing the Oncotype DX test might be moot because they might want you to do chemo with the Herceptin.

    You also don't mention how old you are.  That might also be a consideration when deciding whether or not to do chemotherapy.

    The good news is that you are lymph node negative, which is an excellent prognostic for mucinous breast cancer.  The only other concern though, is that you mention you are Grade 3.  The majority of mucinous breast cancers are Grades 1 and 2. Considering the fact you are Grade 3 and are HER2+ I would recommend a second pathology review to be doubly sure before deciding a treatment.  As I said earlier, according to Dr. Weigelt, with rare breast cancers your pathology report is paramount to guide your treatment.

    Good luck.

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  • Hindsfeet
    Hindsfeet Member Posts: 2,456
    edited March 2012

    vo
    Diagnosis: 1/7/2011, Stage I

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  • izzy32
    izzy32 Member Posts: 1
    edited May 2011

    I am a 32 year old woman with two young boys , i was diagnosed with mucinous cancer last friday . In my right breast i have two tumours my consultant wants me to see another consultant next friday , he says i have to have chemo for 5 mts then my breast removed then more chemo and radium i am so worried , nicola

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited May 2011

    Nicola, I am so sorry to hear about your diagnosis.  Please join us on another more active mucinous breast cancer thread.  Just go to the search box on the upper right corner and type in mucinous breast cancer and you'll find us.  I posted many articles about mucinous breast cancer and we are there to support you.  The other sisters will be along to comfort you.

    Our thoughts and prayers are with you.  This time between diagnosis and treatment plan AND treatment are the most stressful.  I can only imagine how you feel as a young mother.  Come join us over at the other thread.  Read everything carefully --TWICE and let it roll.....  Perhaps you will find a map there for your journey.....

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