Invasive breast carcinoma - IARC

colour measuring from 0.5 to 12 cm.
Larger tumours occur in older patients.
A
Fig. 1.51 Lipid rich carcinoma. A The cells have abundant eosinopohilic or microvacuolated cytoplasm with
round nuclei displaying prominent nucleoli. B Oil red O stain shows abundant intracytoplasmic lipids within
every cell.
Immunoprofile
There is limited data in hormone receptor
e x p ression but all tumours from one
series were negative {3158}.
Ultrastructure
Well developed Golgi apparatus and
lipid droplets of different sizes are recognized
in the cytoplasm {1546}.
Prognosis and predictive factors
Despite the positive correlation of lipid
content with high histological grade
{873} and extensive lymph node metastases
in 11 of 12 patients {2330}, at the
present it is not possible to establish with
certainty that lipid rich carcinomas are
aggressive tumours. The reported series
include very heterogeneous lesions and
have very short follow up.
Secretory carcinoma
B
(37%) were aged less than 20 years, 21
(31%) older than 30 years and the
remaining 21 in between. Therefore, the
term secretory carcinoma is preferred
{2080}. Mucoid carcinoma, invasive lobular
carcinoma and signet ring cell carcinoma
are "secre t o ry" carcinomas "in
sensu strictu", but are all well defined distinct
entities and therefore it is preferred
to restrict the use of the term secretory
c a rcinoma to this rare tumour type
{2080}.
Clinical features
The tumours manifest as indolent, mobile
lumps, located near the areola in about
half of the cases, this being especially so
in men and children.
Macroscopy
SC usually presents as circumscribed
nodules, greyish-white or yellow to tan in
Histopathology
Microscopically SC is generally circumscribed,
but areas of invasion of the adipose
tissue are frequent. Sclerotic tissue
in the centre of the lesion may be
observed. The lesions are structurally
composed of 3 patterns present in varying
combinations:
1. A microcystic (honeycombed) pattern
composed of small cysts often merge
into larger spaces closely simulate thyroid
follicles {2722},
2. A compact more solid, and
3. A tubular pattern consisting of numerous
tubular spaces containing secretions
{1519}.
The neoplastic cells have been subdivided
into two types {2881} with all possible
combinations. One has a large
amount of pale staining granular cytoplasm,
which on occasions can appear
f o a m y. The nuclei are ovoid and have a
small nucleolus. Intracytoplasmic lumina
(ICL) are numerous and vary fro m
small to "enormous" {1579}. Fusion of
ICL generates the microcystic struct
u res. The secretion located within the
ICL or in the extracytoplasmic compartment
is intensely eosinophilic and PA S
positive after diastase digestion in most
of the cases; Alcian blue positive material
is also seen. The two types of mucosubstances
are usually independently
p roduced and a combination of the two
Definition
A rare, low grade carcinoma with a solid,
m i c rocystic (honeycomb) and tubular
architecture, composed of cells that produce
abundant intracellular and extracellular
secretory (milk-like) material.
ICD-O code 8502/3
Synonym
Juvenile carcinoma.
Epidemiology
This is a rare tumour, with a frequency
below 0.15% of all breast cancers
{323,1579}. The tumour usually occurs in
females, but has also been seen in males
including a 3-year-old boy {1401}.
It occurs in children {1831} as well as
adults {1519,2080}. A recent re p o rt
{2430} disclosed 67 patients. Twenty-five
Fig. 1.52 Secretory carcinoma. The tumour cells have abundant pink eosinophilic cytoplasm.
42 Tumours of the breast