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Mucocele-Like Lesions
Laurie Margolies, MD; Selin Carkaci, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Mucocele-like lesions (MLL)
            • Synonyms

              • Mucocele-like tumors
            • Definitions

              • Uncommon lesion composed of mucin-producing ducts that rupture, discharging acellular mucin into periductal stroma
                • Associated with atypical ductal hyperplasia (ADH) in 11-57% of cases and DCIS in 2-30%, or invasive breast cancer
                • Thought that mechanical duct obstruction causes ducts to rupture
                • MLL comprise < 1% of benign breast biopsies
              • Mucocele = cystically dilated duct containing mucin
                • Mucins are high molecular weight, heavily glycosylated proteins
                  • Can be membrane-bound mucin (MUC1, MUC3, and MUC4) and involved in signal transduction
                    • MUC1 is on apical surface of most normal breast epithelium; loses polarity and expression increased in neoplastic epithelium
                  • Can be gel-forming, secreted mucin released into extracellular space (MUC2, MUC5AC, MUC5B, and MUC6)
                    • Seen in benign and malignant disease
              • Extravasated mucin: Stromal mucin collections adjacent to mucin-containing ducts

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Harrison BT et al: An update of mucinous lesions of the breast. Surg Pathol Clin. 11(1):61-90, 2018
                                        2. Dash I et al: Mucocoele-like lesions: is surgical excision still necessary? Clin Radiol. 72(11):992.e1-992.e6, 2017
                                        3. Zhang G et al: Mucocele-like lesions diagnosed on breast core biopsy: Low risk of upgrade and subsequent carcinoma. Breast J. ePub, 2017
                                        4. Gibreel WO et al: Mucocele-like lesions of the breast: Rate of upstaging and cancer development. Ann Surg Oncol. 23(12):3838-3842, 2016
                                        5. Meares AL et al: Mucocele-like lesions of the breast: a clinical outcome and histologic analysis of 102 cases. Hum Pathol. 49:33-8, 2016
                                        6. Toll A et al: Pathologic Spectrum of Secretory and Mucinous Breast Lesions. Arch Pathol Lab Med. 140(7):644-50, 2016
                                        7. Ha D et al: Mucocele-like lesions in the breast diagnosed with percutaneous biopsy: is surgical excision necessary? AJR Am J Roentgenol. 204(1):204-10, 2015
                                        8. Rakha EA et al: Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 62(6): 894-8, 2013
                                        9. Carkaci S et al: Do all mucocele-like lesions of the breast require surgery? Clin Imaging. 35(2):94-101, 2011
                                        10. Jaffer S et al: Benign mucocele-like lesions of the breast: revisited. Mod Pathol. 24(5):683-7, 2011
                                        11. Kim SM et al: Mucocele-like tumors of the breast as cystic lesions: sonographic-pathologic correlation. AJR Am J Roentgenol. 196(6):1424-30, 2011
                                        12. Ohi Y et al: Mucocele-like lesions of the breast: a long-term follow-up study. Diagn Pathol. 6:29, 2011
                                        13. Begum SM et al: Mucin extravasation in breast core biopsies--clinical significance and outcome correlation. Histopathology. 55(5):609-17, 2009
                                        14. Leibman AJ et al: Mucocelelike lesions of the breast: mammographic findings with pathologic correlation. AJR Am J Roentgenol. 186(5):1356-60, 2006
                                        15. Farshid G et al: Mucocele-like lesions of the breast: a benign cause for indeterminate or suspicious mammographic microcalcifications. Breast J. 11(1):15-22, 2005
                                        16. Kim JY et al: Benign and malignant mucocele-like tumors of the breast: mammographic and sonographic appearances. AJR Am J Roentgenol. 185(5):1310-6, 2005
                                        17. Ramsaroop R et al: Mucocele-like lesions of the breast: an audit of 2 years at BreastScreen Auckland (New Zealand). Breast J. 11(5):321-5, 2005
                                        18. Glazebrook K et al: Original report. Mucocele-like tumors of the breast: mammographic and sonographic appearances. AJR Am J Roentgenol. 180(4):949-54, 2003
                                        19. Jacobs TW et al: Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 26(9):1095-110, 2002
                                        20. Hamele-Bena D et al: Mammary mucocele-like lesions. Benign and malignant. Am J Surg Pathol. 20(9):1081-5, 1996
                                        21. Rosen PP: Mucocele-like tumors of the breast. Am J Surg Pathol. 10(7):464-9, 1986
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Mucocele-like lesions (MLL)
                                                  • Synonyms

                                                    • Mucocele-like tumors
                                                  • Definitions

                                                    • Uncommon lesion composed of mucin-producing ducts that rupture, discharging acellular mucin into periductal stroma
                                                      • Associated with atypical ductal hyperplasia (ADH) in 11-57% of cases and DCIS in 2-30%, or invasive breast cancer
                                                      • Thought that mechanical duct obstruction causes ducts to rupture
                                                      • MLL comprise < 1% of benign breast biopsies
                                                    • Mucocele = cystically dilated duct containing mucin
                                                      • Mucins are high molecular weight, heavily glycosylated proteins
                                                        • Can be membrane-bound mucin (MUC1, MUC3, and MUC4) and involved in signal transduction
                                                          • MUC1 is on apical surface of most normal breast epithelium; loses polarity and expression increased in neoplastic epithelium
                                                        • Can be gel-forming, secreted mucin released into extracellular space (MUC2, MUC5AC, MUC5B, and MUC6)
                                                          • Seen in benign and malignant disease
                                                    • Extravasated mucin: Stromal mucin collections adjacent to mucin-containing ducts

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Image-Guided Biopsy

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Harrison BT et al: An update of mucinous lesions of the breast. Surg Pathol Clin. 11(1):61-90, 2018
                                                                              2. Dash I et al: Mucocoele-like lesions: is surgical excision still necessary? Clin Radiol. 72(11):992.e1-992.e6, 2017
                                                                              3. Zhang G et al: Mucocele-like lesions diagnosed on breast core biopsy: Low risk of upgrade and subsequent carcinoma. Breast J. ePub, 2017
                                                                              4. Gibreel WO et al: Mucocele-like lesions of the breast: Rate of upstaging and cancer development. Ann Surg Oncol. 23(12):3838-3842, 2016
                                                                              5. Meares AL et al: Mucocele-like lesions of the breast: a clinical outcome and histologic analysis of 102 cases. Hum Pathol. 49:33-8, 2016
                                                                              6. Toll A et al: Pathologic Spectrum of Secretory and Mucinous Breast Lesions. Arch Pathol Lab Med. 140(7):644-50, 2016
                                                                              7. Ha D et al: Mucocele-like lesions in the breast diagnosed with percutaneous biopsy: is surgical excision necessary? AJR Am J Roentgenol. 204(1):204-10, 2015
                                                                              8. Rakha EA et al: Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 62(6): 894-8, 2013
                                                                              9. Carkaci S et al: Do all mucocele-like lesions of the breast require surgery? Clin Imaging. 35(2):94-101, 2011
                                                                              10. Jaffer S et al: Benign mucocele-like lesions of the breast: revisited. Mod Pathol. 24(5):683-7, 2011
                                                                              11. Kim SM et al: Mucocele-like tumors of the breast as cystic lesions: sonographic-pathologic correlation. AJR Am J Roentgenol. 196(6):1424-30, 2011
                                                                              12. Ohi Y et al: Mucocele-like lesions of the breast: a long-term follow-up study. Diagn Pathol. 6:29, 2011
                                                                              13. Begum SM et al: Mucin extravasation in breast core biopsies--clinical significance and outcome correlation. Histopathology. 55(5):609-17, 2009
                                                                              14. Leibman AJ et al: Mucocelelike lesions of the breast: mammographic findings with pathologic correlation. AJR Am J Roentgenol. 186(5):1356-60, 2006
                                                                              15. Farshid G et al: Mucocele-like lesions of the breast: a benign cause for indeterminate or suspicious mammographic microcalcifications. Breast J. 11(1):15-22, 2005
                                                                              16. Kim JY et al: Benign and malignant mucocele-like tumors of the breast: mammographic and sonographic appearances. AJR Am J Roentgenol. 185(5):1310-6, 2005
                                                                              17. Ramsaroop R et al: Mucocele-like lesions of the breast: an audit of 2 years at BreastScreen Auckland (New Zealand). Breast J. 11(5):321-5, 2005
                                                                              18. Glazebrook K et al: Original report. Mucocele-like tumors of the breast: mammographic and sonographic appearances. AJR Am J Roentgenol. 180(4):949-54, 2003
                                                                              19. Jacobs TW et al: Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 26(9):1095-110, 2002
                                                                              20. Hamele-Bena D et al: Mammary mucocele-like lesions. Benign and malignant. Am J Surg Pathol. 20(9):1081-5, 1996
                                                                              21. Rosen PP: Mucocele-like tumors of the breast. Am J Surg Pathol. 10(7):464-9, 1986