Surgical Pathology Criteria–

Secretory Carcinoma of the Breast

Differential Diagnosis

Histiocytoid Carcinoma Secretory Carcinoma
All reported cases >40 years Most cases <30 years
Scant or granular mucin Abundant cytoplasmic mucin
GCDFP15 strong positive GCDFP15 variable
Aggressive behavior Excellent prognosis

Mucinous Carcinoma Secretory Carcinoma
1/3 of volume is extracellular mucin Largely intracellular mucin
Carcinoma cells float in mucin Cells grow in sheets or tubules
No predilection for younger patients Most cases <30 years

Signet Ring Carcinoma Secretory Carcinoma
One or few vacuoles that indent nucleus Abundant granular to clear cytoplasm
May be nuclear grade I or II Low nuclear grade
Often associated with classic lobular carcinoma pattern No association with lobular carcinoma
No predilection for young patients Most cases <30 years
May show aggressive behavior Excellent prognosis
Signet ring carcinoma is usually a variant pattern of lobular carcinoma

Lipid Rich Carcinoma Secretory Carcinoma
Scant PASd positivity in cells Abundant PASd positive mucin
Fat stains positive Fat stains negative
May have any grade cytology Low grade cytology
No predilection for young patients Most cases <30 years
Many show aggressive behavior Excellent prognosis

Apocrine Carcinoma Secretory Carcinoma
Large vesicular nuclei with prominent nucleoli Low grade nuclei with inconspicuous nucleoli
Cytoplasm granular, eosinophilic Cytoplasm granular or clear and vacuolated
PASd may show granular cytoplasmic staining PASd shows abundant cytoplasmic mucin
No predilection for young patients Most cases <30 years
Many show aggressive behavior Excellent prognosis

Glycogen Rich Clear Cell Carcinoma Secretory Carcinoma
PAS positive, diastase sensitive glycogen PASd positive mucin
Cytology may be of any grade Low grade cytology
No predilection for younger patients Most cases <30 years
Behavior is that of usual invasive carcinoma Excellent prognosis

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