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

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Case 2: 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 PAPILLARY CARCINOMA OF THE BREAST Background: Among papillary breast carcinomas truly invasive tumors are rare (i.e.,
invasive micropapillary carcinoma may be highly aggressive (8). In any event, it is important that, whether cystic and/or solid, papillary carcinoma without invasion can be considered a form of “intraductal” carcinoma (1,9,10), and patients with noninvasive papillary carcinoma are essentially cured by mastectomy (1). But, recurrences can occur with pre-invasive examples, and they can be either in situ and/or invasive diseases. Clinicopathologic features: Papillary carcinomas occur in an older age group (mean ages from 63 to 67 years) than InvDC,NST (11). They tend to occur centrally, and nipple discharge and/or bleeding develops in ~33% of patients (1,4). Invasive papillary carcinomas can be large tumors, due to the bulky, cystic component frequently present. The average size is 2 to 3 cm, and, as their often low histologic grade would predict, papillary carcinomas are hormone receptor-positive in the majority of cases (12,13). Papillary carcinomas are usually circumscribed, as are fibroadenomas, benign cystic lesions, and medullary or mucinous carcinomas (14,15). Invasion is suggested by an irregular contour (14). Cut surfaces are brown or hemorrhagic, but usually they are tan or grey. Although variable, the arborescent fronds of papillary carcinoma are usually composed of very delicate fibrovascular cores; indeed, the fibrous component may be inconspicuous. The lining epithelial cells are of a single type, showing high nuclear to cytoplasmic ratios, increased mitotic activity, and usually uniform, hyperchromatic nuclei. Furthermore, the tumor cells may show stratification and resemble adenomatous polyps of the colon. Mitotic figures are variably present and more numerous in lesions that exhibit the most severe cytologic atypia. Myoepithelial cells, distributed relatively uniformly and proportionately within the epithelium in benign papillary lesions, are largely overgrown in papillary carcinomas; but, they may not be entirely absent from a papillary carcinoma. The finding of myoepithelial cells in some parts of a papillary lesion is not inconsistent with a diagnosis of carcinoma (16-18). “Intracystic papillary carcinomas” (IPC) is an uncommon breast tumor usually developing in elderly patients (median age ~70, range 27 to 99); and, they present as discrete, circumscribed solitary masses (usually subareolar), which are present within ducts of at least 1 cm in diameter by definition (1,9). 3.5% occur in men (19). They often contain dark brown, partly clotted blood and detached degenerated papillary fragments of the tumor. Mural nodules of residual tumor can usually be found on the inner or luminal surface or in the cyst wall. Presenting as a discrete cystic mass, “intracystic papillary carcinoma” has been considered a special form of preinvasive or 32
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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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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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10/8/2011 91
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10/8/2011 93
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Illustrative Case 10/8/2011 95
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SMA Calponin 10/8/2011 97
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Dx: Mixed Spindle-cell & Cl Classic
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Dx: Adenomyoepithelioma, Epithelioi
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10/8/2011 103
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10/8/2011 105
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Case 1 • 40 year old female • B
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What is your diagnosis? 1. Invasive
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Case 4 • Irregular large breast m
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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
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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
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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 165 and 166: 25. Richter GO, Dockerty MB, Claget
Page 167: Breast Cancer Cooperative Group). L
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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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Page 189 and 190: 9. Bondeson L, Lindholm K. Aspirati
Page 191 and 192: 43. Green I, McCormick B, Cranor M,
Page 193 and 194: mucinous carcinoma (7,11,12,14). In
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Page 203 and 204: 4. Tavassoli FA, Norris HJ. Secreto
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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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