1. Clinico-Pathological Conference (CPC) Meet Karpagam Medical College Hospital 30-01-2015

2. History 70 yrs old female presented with history of lump in left breast - 6 months FNAC was done

4. Treatment History FNAC gave a diagnosis of infiltrating ductal carcinoma -? Mucinous Variant Modified radical mastectomy was done and the specimen was sent for histopathological examination

5. Pathological Findings Histopathological examination revealed a diagnosis of Mucinous Carcinoma - Breast StageT4bN0M0

6. 4.5x5x7.5 cm 0.8 cm from DRM 1 cm from sup.margin 0.5 cm from inferior margin 7.5 cm from lateral margin 1.5 cm from medial margin Almost reaching the skin

7. Mucinous carcinoma breast GROSS: Circumscribed The cut surface is typically moist and glistening

8. Mucinous Carcinoma breast Rare tumour accounting for <2% of breast malignancies Characterised by presence of carcinoma cells surrounded by lakes/pools of extracellular mucin Mean age - 67 years Postmenopausal

13. Variants of breast carcinoma Microinvasive Tubular Mucinous Papillary Secretory Cribriform Adenoid cystic

14. Mucinous carcinoma Mucinous carcinomas – Pure(>90% mucinous component ) – Mixed(infiltrating duct carcinoma with mucinous component or mucinous differentiation )

15. Mucinous carcinomas Mucinous -pureMixed Small sizeLarge size Lobulated/circumscribedIrregular Slow growth rateHighly infiltrative lymph node mets rare lymph node mets frequent Good prognosisBad prognosis

16. Differential Diagnosis Mucocele-like tumor – Cystic lesion – Granular calcifications++

17. IHC Mucinous: – Increased MUC2 And MUC5 protein Expression – Decreased MUC1 Expression Non mucinous: – Increased MUC1 But normal MUC2 & MUC5 Nuclear reactivity for estrogen and progesterone receptors is found in 92% and 68%

18. Accessory tests ER-PR +ve =good prognosis Her2-Negative

22. Aromatase Inhibitors Anastrazole 1mg – MRP –Rs.600/10 tabs Letrozole 2.5mg – MRP – Rs.150/10 tabs Tamoxifen 20mg – MRP– Rs.21/10 tabs

24. Thank you