Mucinous (colloid) breast cancer: clinical and mammographic findings in 10 patients.

OBJECTIVE: The purpose of this study was to review the clinical and mammographic findings in patients with mucinous (colloid) breast cancer. MATERIALS AND METHODS: We retrospectively reviewed the pathology reports of 444 women with breast cancers diagnosed between May 1988 and October 1993 after mammographic evaluation. Of these, 10 women 31-88 years old (mean, 67 years) had pure mucinous adenocarcinoma of the breast. We reviewed the clinical and mammographic findings in these 10 patients. RESULTS: Three patients (30%) had palpable masses. Mammographic abnormalities were detected on screening studies in the seven patients (70%) who were asymptomatic. The mammographic findings included poorly defined, lobulated, solitary masses in seven patients, poorly defined, clustered masses in two patients, and a well-circumscribed mass in one patient. No tumors had calcifications as the primary finding, and only one tumor had a few scattered, round, calcifications associated with clustered masses. Two patients had areas of noncomedo ductal carcinoma in situ without calcifications adjacent to the invasive mucinous adenocarcinoma. The tumors were 7-35 mm in diameter. No metastases were found in the axillary lymph nodes in the eight patients in whom biopsies of these nodes were done. CONCLUSION: The most common and distinctive mammographic feature of mucinous breast carcinoma is a poorly defined, lobulated mass. The absence of axillary nodal metastases, even in patients with large palpable tumors, supports the notion that biologically, mucinous carcinomas are slower growing, less aggressive tumors than infiltrating ductal carcinomas not otherwise specified.

Ductography of the breast: technique and findings.

The evaluation of spontaneous nipple discharge is controversial. Many surgeons advocate major subareolar duct excision for postmenopausal patients or solitary duct excision for premenopausal women with this symptom, without preoperative diagnostic imaging. There is no dispute that as a symptom, nipple discharge can be eliminated by severing the major subareolar ducts. However, this decision requires generous assumptions on the part of the surgeons: first, that the abnormal duct can be identified correctly; second, that the segmental area or areas of the breast drained by the duct can be predicted accurately; and third, that the amount of tissue that needs to be excised to ensure inclusion of the lesion or lesions can be defined. Ductography can show the course of abnormal ducts, as well as the variability in location and extent of intraductal lesions. Preoperative mapping of the abnormal duct can expedite surgery, facilitate accurate minimal-volume breast biopsies, and alert the surgeon to the existence of an extensive ductal lesion or multiple lesions. In patients with fibrocystic changes or duct ectasia on ductography, surgery might be averted altogether. In an effort to demonstrate the usefulness of ductography and encourage its increased use, we review the technique and illustrate normal and abnormal findings.