Intraductal carcinoma of the breast associated with high levels of circulating tumor‐associated antigens (CA 15‐3 and NCC‐ST‐439)

Abstract

Background. A remarkable elevation of serum tumor‐associated antigen levels usually occurs in advanced or metastatic cancer and has not been reported previously in the setting of noninvasive carcinoma of the breast. Methods. An immunohistochemical and histopathologic study is presented on a specimen taken from a 43‐year‐old Japanese woman with micropapillary intraductal carcinoma of the breast with significantly high levels of preoperative circulating tumor‐associated antigens, CA 15‐3 (198.5 U/ml) and NCC‐ST‐439 (1400 U/ml). Results. A histologic specimen consisted of numerous cysts lined by slightly stratified, monotonous columnar cells producing foci of micropapillary intraductal carcinoma. Extensive sampling of the specimen demonstrated no invasive foci although faintly eosinophilic secretory material occasionally leaked from disrupted cysts into the surrounding stroma. The cancerous and normal epithelium showed intense apical reactivity with monoclonal antibodies 115D8, DF3, and NCC‐ST‐439; intraluminal and spilled secretion also showed positive reaction with these antibodies. Serum levels of CA 15‐3 and NCC‐ST‐439 were within normal limits after subcutaneous mastectomy. No carcinoembryonic antigen was demonstrated either in the sera, the neoplastic epithelium, or the secretory material. Conclusions. These histopathologic and immunohistochemical studies showed that the leaked secretion from the disrupted cysts into the surrounding connective tissue stroma may be responsible for the marked elevation of circulating tumor‐associated antigen levels in this micropapillary intraductal carcinoma. Copyright © 1994 American Cancer Society