33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...

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American Soiety of Clinical Pathology 2011 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria with Prognostic and Therapeutic Significance Disclosure Statement Speakers (Noel Weidner, MD and Farnaz Hasteh, MD) do not have any financial or other relationships that create a conflict related to this educational course. Learning Objectives • Clarify and discuss diagnostic criteria for classification of special type of breast carcinoma • Identify potential diagnostic pitfalls in diagnosis from the benign entity • Describe the clinical implications associated with these diagnoses • Discuss the importance of clear pathology reporting on cases with mixed component of invasive breast carcinoma of no special type • Discuss the possibilities of immunohistochemical, molecular, and other ancillary studies in proper diagnosis -1-
American Soiety of Clinical Pathology 2011 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria with Prognostic and Therapeutic Significance Noel Weidner, MD, Farnaz Hasteh, MD Oct 21, 2011 10:00 AM - 11:50 AM Introduction and basal-like and triple-negative breast cancers Noel Weidner, MD Case 1: Noel Weidner, MD Hisory: A 65 y/o female with 2.5 cm ill-defined left breast mass with firm, tan cut surfaces. Submitted diagnosis: Invasive lobular carcinoma Case 2: Noel Weidner, MD History: 60 y/o male with 3.1 cm partially cystic right breast mass with soft, tan cut surfaces. Submitted Case Diagnosis: Intracystic papillary carcinoma Case 3: Farnaz Hasteh, MD History: A 73 y/o female with history of breast mass found by mammogram underwent percutaneous ultrasound-guided core biopsy of the left breast mass. Submitted diagnosis: Invasive tubular carcinoma (well-differentiated invasive breast carcinoma, overall mBR grade 1; nuclear grade 1, tubular grade 1, mitotic grade) Case 4: Farnaz Hasteh, MD History: 57 y/o female with palpable breast mass. Patient was participating in the breast cancer awareness month function when she examined her own breasts and noticed the left breast mass. Mammogram found 2 cm suspicious mass at 5 o'clock position of the left breast. Submitted diagnosis: Invasive mucinous carcinoma,“pure” (well-differentiated invasive breast carcinoma, overall mBR grade 1; nuclear grade 1, tubular grade “1", -2-
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33 Special Types of Invasive Breast
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Special Types of Invasive Breast Ca
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INVASIVE BREAST CARCINOMAS CONSIDER
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ER Neg. PR Neg. HER2 Neg. CK 5/6 Po
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Triple-negative Breast Carcinomas
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E-cadherin E-cadherin EGFR ++ ER ne
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ER/PR Positive HER2 Negative INVASI
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Tubulolobular Signet-ring Histiocyt
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Illustrative Example: 61 y/o female
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E-Cadherin ER PR 10/8/2011 17
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LCIS vs DCIS • Patients with lobu
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Examples of E-cadherin staining in
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Classic Low-grade DCIS - E-cadherin
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E-cadherin IHC CASE D 10/8/2011 25
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E-cadherin IHC CASE E 10/8/2011 27
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Literature Summary: Correlation of
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10/8/2011 31
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CD10 SMA MIB-1 10/8/2011 33
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Carter et al. Cancer 1977 & 1983
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Differential Diagnosis: 1. Invasive
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10/8/2011 39
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SYNAPTOPHYSIN SMA 10/8/2011 41
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Nassar et al. (AJSP 2006;30:501-7.)
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Special Types of Invasive Breast Ca
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Tubular carcinoma • It has been d
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Tubular carcinoma Histopathology
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Flat Epithelial Atypia When should
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Microglandular adenosis + reticulin
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mitosis ductal ductal, NST tubular
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Treatment • Breast conservation t
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Cribriform carcinoma Histopathology
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Cribriform carcinoma Prognosis •
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Cribriform Carcinoma Pearls of Path
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Clinicopathological features Mucino
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Case 4 Mucinous carcinoma Mixed muc
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Treatment • Breast conservation a
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Incipient mucocele-like lesion Cyst
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10/8/2011 75
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SMA Dx: Spindle-cell Breast Carcino
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Dx: Pure Squamous Carcinoma 10/8/20
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Osseous Differentiation (Osteosarco
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Spindle-cell Carcinoma of the Breas
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Page 89 and 90: Diagnosis: Benign g (Low-grade) Phy
Page 91 and 92: Diagnosis: Malignant (High-grade) P
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Page 97 and 98: Illustrative Case 10/8/2011 95
Page 99 and 100: SMA Calponin 10/8/2011 97
Page 101 and 102: Dx: Mixed Spindle-cell & Cl Classic
Page 103 and 104: Dx: Adenomyoepithelioma, Epithelioi
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Page 109 and 110: Case 1 • 40 year old female • B
Page 111 and 112: What is your diagnosis? 1. Invasive
Page 113 and 114: Case 4 • Irregular large breast m
Page 115 and 116: Case 6 • Needle core biopsy of a
Page 117 and 118: 343 What is your best diagnosis? 1.
Page 119 and 120: 349 Case 9 What is your diagnosis?
Page 121 and 122: Case 11 Case 11 Case 12 • A 68 ye
Page 123 and 124: Case 13 • Needle core biopsy of a
Page 125 and 126: What is your diagnosis? 1. Intracys
Page 127 and 128: What is your best interpretation? 1
Page 129 and 130: Case 18 What is your best interpret
Page 131 and 132: Case 20 • 35 year old female with
Page 133 and 134: Negative ER stain NEG ER Case 22
Page 135 and 136: What is your best interpretation? 1
Page 137: What is your diagnosis? 1. Secretor
Page 141 and 142: SPECIAL TYPES OF INVASIVE BREAST CA
Page 143 and 144: INVASIVE BREAST CARCINOMAS THAT ARE
Page 145 and 146: of lymphoid cells between sheets of
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Page 149 and 150: molecular subtypes. Indeed, the pea
Page 151 and 152: In summary, basal-like breast cance
Page 153 and 154: Page et al. (15) described a pleomo
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Page 163 and 164: References (lobular carcinoma): 1.
Page 165 and 166: 25. Richter GO, Dockerty MB, Claget
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Page 179 and 180: outcome of patients with intracysti
Page 181 and 182: Case 3: History: A 73 year old fema
Page 183 and 184: cases. In this small tubular carcin
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9. Bondeson L, Lindholm K. Aspirati
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43. Green I, McCormick B, Cranor M,
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mucinous carcinoma (7,11,12,14). In
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mucinous carcinoma. A fine-needle a
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with long-term follow-up [Abstract]
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cystic hypersecretory duct carcinom
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considerable secretion and/or morph
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4. Tavassoli FA, Norris HJ. Secreto
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Case 6: History: 66 year old female
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Adenoid cystic carcinoma (AdCC) is
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Because more than half of adenoid c
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Another family of salivary gland-ty
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Collagenous spherulosis is a recent
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cases: review of the literature and
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Case 7 the breast associated with l
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size (14). Metaplastic breast carci
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adenoma by others who prefer to avo
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survival rate than is usually repor
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it arises in other soft tissue site
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implies a relative risk for develop
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sclerosing adenosis wherein the str
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overgrowth (136). While acknowledgi
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As noted above, any soft-tissue sar
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J Med 73:1078-1082, 1973. 11. Barne
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40. Thorner PS, Kahn HJ, Baumal R,
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75. Fekete P, Petrek J, Majmudar B,
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microscopic, ultrastructural, and i
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2006 Apr;30(4):450-6 143. Liberman
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Case 8 Case history: A 50 year old
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secondary peripheral tumor nodules
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Definitive diagnosis of medullary c
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Pathol 1988;19:1340-6. 12. Rosen PP
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40. Di Bonito; Royen PM, Ziter FMH.
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Am J Clin Pathol 1979;72:383-389. 1
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