J Pathol Transl Med.  2017 Mar;51(2):176-179. 10.4132/jptm.2016.08.17.

Mucinous Carcinoma with Extensive Signet Ring Cell Differentiation: A Case Report

• Kim HM
• Kim EK
• Koo JS

• KMID: 2372968
• DOI: http://doi.org/10.4132/jptm.2016.08.17

Abstract

Breast cancers that present with mucin include mucinous carcinoma and carcinoma with signet ring cell differentiation. The former shows extracellular mucin and the latter shows abundant intracellular mucin. Here, we report a case of breast cancer showing both extracellular mucin and extensive signet ring cell differentiation due to abundant intracellular mucin. Unlike mucinous carcinoma, this case had the features of high-grade nuclear pleomorphism, high mitotic index, estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor-2 positivity, and ductal type with positivity for E-cadherin. In a case with signet ring cell differentiation, differential diagnosis with metastatic signet ring cell carcinoma of the stomach and colon is essential. In this case, the presence of accompanied ductal carcinoma in situ component and mammaglobin and gross cystic disease fluid protein-15 positivity were findings that suggested the breast as the origin.

Keyword

Breast; Mucinous carcinoma; Signet ring cell

Figure

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  Fig. 1. Histologic features and biomarker status in mucinous carcinoma with extensive signet ring cell differentiation. (A) In the low-power view, a tumor with an expanding margin is observed. Tumor cell clusters floating in the mucin pool are shown and the cell density is higher in the periphery than in the center. (B) In the high-power view, tumor cell cluster floating in the mucin pool shows dysplasia suitable for the nuclear grade 3. Many tumor cells are seen as signet ring cell with the nucleus pushed into the corner by abundant intracellular mucin. (C) Ductal carcinoma in situ (DCIS) is observed in the periphery of the expanding invasive nodule. (D) The DCIS component shows significantly high nuclear grade and signet ring cell differentiation. Mucinous carcinoma cells are negative for estrogen receptor (E) and progesterone receptor (F) and positive for human epidermal growth factor receptor-2 (3+) (G). Mucinous carcinoma cells are positive for mammaglobin (H) and gross cystic disease fluid protein-15 (I).

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