Mucin Neovascularization as a Diagnostic Aid to Distinguish Mucinous Carcinomas From Mucocele-like Lesions in Breast Core Needle Biopsies

• Published in: The American journal of surgical pathology Vol. 46; no. 5; p. 637
• Main Authors: Onken, Allison M, Collins, Laura C, Schnitt, Stuart J
• Format: Journal Article
• Language: English
• Published: United States 01.05.2022
• Subjects: Adenocarcinoma, Mucinous - diagnosis; Adenocarcinoma, Mucinous - pathology; Biopsy, Large-Core Needle; Breast - pathology; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Carcinoma, Intraductal, Noninfiltrating - pathology; Female; Humans; Mucins; Mucocele - diagnosis; Mucocele - pathology; Neovascularization, Pathologic - pathology
• ISSN: 1532-0979
• DOI: 10.1097/PAS.0000000000001814

The distinction between mucinous carcinomas (MCs) and mucocele-like lesions (MLLs), particularly those containing detached epithelial fragments, can be problematic in the limited samples afforded by breast core needle biopsies (CNBs). Neovascularization of mucin has been proposed as a criterion to distinguish MC from MLL, but its value in helping to categorize mucin-producing breast lesions in CNB has not been previously investigated. To address this, we evaluated mucin neovascularization on hematoxylin and eosin (H&E)-stained sections of 140 CNB containing mucin-producing breast lesions including 52 MC, 17 mucin-producing ductal carcinoma in situ (mDCIS), and 71 MLL. In 116 cases with sufficient remaining material (42 MC, 16 mDCIS, and 58 MLL), we also assessed mucin neovascularization on CD31 immunostains. On H&E-stained sections, neovascularization of mucin, defined as delicate, thin-walled microvessels in mucin, and unassociated with fibrous septae, was identified significantly more frequently in MC than in MLL (69.2% vs. 14.1%; P=0.0001). The difference in the frequency of mucin neovascularization between MC and MLL was even greater on CD31 immunostains (97.6% vs. 13.8%, P<0.00001). The sensitivity, specificity, positive predictive value, and negative predictive value of mucin neovascularization for categorizing a lesion as MC were 69.2%, 85.8%, 78.3%, and 79.2%, respectively, for H&E-stained sections and 97.6%, 86.2%, 83.7%, and 98.0%, respectively, for CD31 immunostains. We conclude that mucin neovascularization is significantly more common in MC than in MLL in breast CNB on H&E-stained sections and particularly on CD31 immunostains and may be a valuable adjunct in distinguishing between MC and MLL in problematic cases.