Secretory carcinoma of the breast is a rare entity, most commonly seen in females and its occurrence in male is even rarer with only 15 cases reported in the world literature [3
]. Secretory carcinoma though known previously as juvenile breast carcinoma [19
] has been reported in all age groups. In the mix series of Tavassoli and Norris the median age at diagnosis was 25 years [4
]. In the recent review of data of 15 male patients by de Bree et al, the median age was 17 years [18
]. Secretory carcinoma seems to occur at a younger age in males than females [18
Characteristically the tumour presents as a circumscribed and mobile mass in the subareolar location. Most characteristic histological feature is the presence of abundant intra and extra cellular secretory material and tumour cells with vacuolated or granular eosinophilic cytoplasm [4
]. Intracytoplasmic lumen is seen frequently (figure ). The secretory material is PAS positive and diastase resistant.
Fine needle aspiration cytology (FNAC) shows presence of prominent intracytoplasmic vacuolisation [9
]. Vesoulis and Kashkari reported that cytological features of secretory breast carcinoma resemble that of benign epithelial proliferative lesions; particularly lactational changes or lactating adenoma [11
] and this could be the reason for missing the diagnosis on FNAC in the present case.
The prognosis for secretory carcinoma is favourable when compared with ductal carcinoma. Tavassoli and Norris suggested three features of secretory carcinoma that indicate a favourable prognosis: (1) tumour size less than 2 cm, (2) age of less than 20 years at diagnosis and (3) tumour with circumscribed margins [4
Case reports of local recurrence following local excision suggest that local excision alone may not be adequate and many have advocated mastectomy [4
]. Lymph node metastasis is observed in approximately 20–30% of the recorded cases [4
]. It is rare in females with tumour <2 cm [4
]. It has been suggested by de Bree et al
, that in males nodal metastasis might occur more frequently in smaller tumours [18
]. Therefore mastectomy with axillary lymph node dissection or sentinel lymph node biopsy is recommended in males [18
Distant metastases from secretory carcinoma are extremely rare with only four cases reported [7
]. Metastasis has been reported even after 20 years of surgery. In males, recurrence has been reported in only one case [18
]. Herz et al
, has reported non-responsiveness of the tumour to chemotherapy [21
]. Even though adjuvant therapy has been administered in many cases there is no evidence to support any form of therapy [18
]. In our case, tumour size of 6 cm and presence of metastasis in 10 axillary nodes suggests a relatively poor prognosis. However secretory carcinoma being an indolent tumour, a long-term follow-up is required to derive definite conclusions.