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

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10-YEAR SURVIVAL BY INVASIVE TUMOR TYPE AND MODIFIED BLOOM-RICHARDSON GRADE (mBR) (Periera et al. Histopathol 1995;27:219-226) Type (~100% total): Overall Grade 1 Grade 2 Grade 3 Ductal (NST) (50%) 46 76 55 39 Lobular (Classic) (6%) 53 71 55 38 Mixed Ductal + Lobular (5%) 41 88 52 31 Tubular (2.4%) 90 90 none none Tubulo-lobular (1%) 91 91 none none Mixed Tubular + Ductal (15%) 64 86 63 18 Mucinous (1%) 81 86 75 none Mixed Ductal+Special type (2.5%) 64 81 59 55 Medullary (3%) 51 none none 51 Atypical Medullary (5%) 63 none none 63 Invasive Papillary (0.3%) 60 to few to few to few Invasive Cribriform (0.8%) 90 90 none none Solid Lobular (1.4%) 33 none 63 18 Alveolar Lobular (0.6%) 77 none 77 none Mixed Lobular (6.4%) 48 71 52 43 NOTE: (Ellis et al. [8] and Periera et al. [6] criteria): Tubular = > 90% classic lowgrade tubular carcinoma. Mixed tubular = stellate mass with peripheral infiltrating border showing ductal (NST) carcinoma + some central areas showing classical tubular carcinoma. Cribriform = > 90% invasive cribriform pattern of small regular cells or > 50% classic cribriform, if remainder classic tubular carcinoma. Mucinous = small islands (10-20 cells) of uniform small cells in lakes of extracellular mucin; any amount of invasive ductal (NST) carcinoma places the lesion in the mixed ductal + mucinous type. Mixed ductal + special types or lobular = a special type or lobular tumor that also contains ductal (NST) carcinoma amounting to10-90% of the total invasive tumor. Medullary = must show all of the following features: 1) sheets of large bizarre carcinoma cells forming syncytial network, 2) moderate to large numbers -7-
of lymphoid cells between sheets of tumor cells, 3) sharply defined pushing margin, 4) usually little fibrous stroma, and 5) usually no DCIS or LVI. Atypical Medullary = any deviation from the criteria defined for medullary but with medullary features; usually this is either less inflammation, microscopic invasion beyond the sharply defined pushing margin, or dense areas of fibrosis. References (Introduction): 1. World Health Organization. Tumors of the breast. 2003: 20, 21 2. Rosen PP, Oberman HA. “Invasive carcinoma,” In: Atlas of Tumor Pathology, Tumors of the Mammary Gland; 3rd Series, Fascicle 7; ARP; AFIP, Washington, DC, pp. 157-243, 1993. 3. Fisher ER, Gregorio RM, Fisher B, et al. The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (No.4). Cancer 1975;36:1-85. 4. Elston CW. Grading of invasive carcinoma of the breast. In: Page DL, Anderson TJ. eds. Diagnostic Histopathology of the Breast. Edinburgh: Churchill Livingstone. 1987;300-311. 5. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 1991;19:403-410. 6. 6. Pereira H, Pinder SE, Sibberin DM, Galea MH, Elston CW, Blamey RW, Robertson JFR, Ellis IO. Pathological prognostic factors in breast carcinoma. IV: should you be a typer or a grader? A comparative study of two histologic prognostic features in operable breast carcinoma. Histopathol 1995;27:219-226. 7. Clayton F, Hopkins CL. Pathologic correlates of prognosis in lymph nodepositive breast carcinoma. Cancer 1993;71:1780-1790. 8. Ellis IO, Galea M, Broughton N, Locker A, Blamey RW, Elston CW. Pathological prognostic factors in breast cancer. II. Histologic type. Relationship with survival in a large study with long-term follow-up. Histopathol 1992;20:479-489. 9. Gaffey MJ, Mills SE, Frierson HF, Zarbo RJ, Boyd JC, Simpson JF, Weiss LM. Medullary carcinoma of the breast: interobserver variability in histopathologic diagnosis. Mod Pathol 1995;8:31-38. 10. Patey DH, Scarff RW. The position of histology in the prognosis of carcinoma -8-
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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 73
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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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Phyllodes y Tumors Phyllodes Tumor
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Diagnosis: Benign g (Low-grade) Phy
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Diagnosis: Malignant (High-grade) P
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Page 97 and 98: Illustrative Case 10/8/2011 95
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Page 101 and 102: Dx: Mixed Spindle-cell & Cl Classic
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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 and 138: What is your diagnosis? 1. Secretor
Page 139 and 140: American Soiety of Clinical Patholo
Page 141 and 142: SPECIAL TYPES OF INVASIVE BREAST CA
Page 143: INVASIVE BREAST CARCINOMAS THAT ARE
Page 147 and 148: studied, this taxonomy identifies s
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Page 151 and 152: In summary, basal-like breast cance
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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
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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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