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

Recommendations

Info

cancerous change (43-47). To some extent, this reflects a tendency in some studies to include orderly papillary carcinomas in the group of papillomas. Yet in some cases, carcinoma and a papilloma are in such close proximity that they must be regarded as parts of a single lesion. Usually, the carcinomatous component is in situ. It is important that in a detailed 3-D reconstruction study of intraductal papillomas, Ohuchi et al. (44) "accidentally" discovered that 6 of 16 patients (37%) with peripheral duct papillomas had carcinomas in "close anatomic continuity" to the benign papillomas, whereas none of the 9 patients with central duct papillomas had cancers. Thus, these observations suggest that multiple peripheral duct papillomas may be a form of "benign" breast disease deserving of complete, yet conservative, local excision, especially, when palpable and/or cytoarchitectural atypia is present. Haagensen (45) advised that "when local excision of the lesion is carried out, the surgeon must take great care to try to remove all of the grossly evident disease." Standard histologic criteria for atypia and/or malignancy should be used in evaluating areas of duct hyperplasia that occur in conjunction with intraductal papilloma. Finally, it is important to add that in and around the bases of papillomas there may be considerable fibrosis and epithelial entrapment, resulting in a pseudoinvasive pattern. When the glands in these pseudoinvasive areas have a double cell layer cytologically identical to those found in the papilloma, their benign nature is secure. Over diagnosing the pseudoinvasive areas as invasive carcinoma (especially on frozen sections) must be avoided. But please remember that true invasive papillary carcinoma (48) and invasive micropapillary carcinoma (49) should not be underdiagnosed as benign. If there is any doubt, defer the final diagnosis until permanent sections are available, when special studies can be performed, and/or when consultation can be obtained from a trusted colleague and/or an expert in breast pathology. Although the above criteria may seem straightforward, controversial and/or borderline cases do arise. In some cases, the double cell layer may be inconspicuous. To delineate the double-cell layer, Papottie et al (50) were among the first to propose using immunohistochemical staining with carcinoembryonic antigen (CEA) to highlight carcinoma cells and actin to highlight myoepithelial cells. Benign papillomas have a basal layer of actin-rich, myoepithelial cells, and the cytoplasm of the benign luminal epithelial cells are CEA-negative. Papillary carcinomas, including intracystic papillary carcinoma, lack the myoepithelial layer. CEA was detected in 85% of the papillary carcinomas in Papottie's study. Two of their cases of "suspected" carcinoma lacked myoepithelial cells and were interpreted as carcinomas. Other immunohistochemical studies of papillomas and papillary carcinomas have found that antibodies to muscle actin (HHF-35) were reliable markers for myoepithelial cells 39
(i.e., much better than an antibody to high molecular weight keratin [34BE12] and antiserum to S-100 protein). Subsequently, many reports have documented that smooth-muscle myosin, calponin, p63, and CD10 are also reliable markers for myoepithelial cells. I often employ multiple myoepithelial markers in difficult cases. Furthermore, these studies show that the presence of a few myoepithelial cells alone does not exclude a malignant diagnosis in papillary lesions such as micropapillary duct carcinoma in situ and peripheral papillomas with cancerization from adjacent DCIS. The distinction between a papilloma and noninvasive intraductal papillary carcinoma is determined by the cytology and microscopic structure of the lesion. There are no simple rules and in many cases the diagnosis is a judgment reached after assessing all the important features. When in doubt, obtain consultation. Finally, CK5/6 can be useful in highlighting benign luminal cells, CK5/6 in negative in atypical duct hyperplasia and DCIS involving an otherwise benign papillary duct lesion. But, keep in mind that CK5/6 is negative in apocrine metaplasia and columnarcell change. Reference: (papillary carcinoma): 1. Carter D, Orr SL, Merino MJ. Intracystic papillary carcinoma of the breast after mastectomy, radiotherapy or excisional biopsy alone. Cancer 1983.52:14- 9. 2. Devitt JE, Barr JR. The clinical recognition of cystic carcinoma of the breast. Surg Gynecol Obstet 1984:159:130-2. 3. Fisher ER, Palekar AS, Redmond C, Barton B, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4). VI. Invasive papillary cancer. Am J Clin Pathol 1980;73:313-22. 4. Haagensen CD. Diseases of the breast. 2nd ed. Philadelphia: WB Saunders Co, 1971:528-44. 5. World Health Organization. Histological typing of breast tumours. 2nd ed. International Histological Classification of' Tumours No. 2. Geneva: World Health Organization, 1981:19. 6. Jonasson JG, Agnarsson BA, Thorlacius S, Eyfjord JE, Tulinius H. Male breast cancer in Iceland. Int J Cancer 1996;65:446-449. 7. Siriaunkgul S, Tavassoli FA. Invasive micropapillary carcinoma of the breast. Mod Pathol 1993;6:660-662. 8. Luna-More S, Gonalez B, Acedo C, Rodrigo I, Luna C. Invasive micropapillary carcinoma of the breast. A new special type of invasive mammary carcinoma. Pathol Res Pract 1994;190:668-674. 40
Page 1 and 2:
33 Special Types of Invasive Breast
Page 3 and 4:
Special Types of Invasive Breast Ca
Page 5 and 6:
INVASIVE BREAST CARCINOMAS CONSIDER
Page 7 and 8:
ER Neg. PR Neg. HER2 Neg. CK 5/6 Po
Page 9 and 10:
Triple-negative Breast Carcinomas
Page 11 and 12:
E-cadherin E-cadherin EGFR ++ ER ne
Page 13 and 14:
ER/PR Positive HER2 Negative INVASI
Page 15 and 16:
Tubulolobular Signet-ring Histiocyt
Page 17 and 18:
Illustrative Example: 61 y/o female
Page 19 and 20:
E-Cadherin ER PR 10/8/2011 17
Page 21 and 22:
LCIS vs DCIS • Patients with lobu
Page 23 and 24:
Examples of E-cadherin staining in
Page 25 and 26:
Classic Low-grade DCIS - E-cadherin
Page 27 and 28:
E-cadherin IHC CASE D 10/8/2011 25
Page 29 and 30:
E-cadherin IHC CASE E 10/8/2011 27
Page 31 and 32:
Literature Summary: Correlation of
Page 33 and 34:
10/8/2011 31
Page 35 and 36:
CD10 SMA MIB-1 10/8/2011 33
Page 37 and 38:
Carter et al. Cancer 1977 & 1983
Page 39 and 40:
Differential Diagnosis: 1. Invasive
Page 41 and 42:
10/8/2011 39
Page 43 and 44:
SYNAPTOPHYSIN SMA 10/8/2011 41
Page 45 and 46:
Nassar et al. (AJSP 2006;30:501-7.)
Page 47 and 48:
Special Types of Invasive Breast Ca
Page 49 and 50:
Tubular carcinoma • It has been d
Page 51 and 52:
Tubular carcinoma Histopathology
Page 53 and 54:
Flat Epithelial Atypia When should
Page 55 and 56:
Microglandular adenosis + reticulin
Page 57 and 58:
mitosis ductal ductal, NST tubular
Page 59 and 60:
Treatment • Breast conservation t
Page 61 and 62:
Cribriform carcinoma Histopathology
Page 63 and 64:
Cribriform carcinoma Prognosis •
Page 65 and 66:
Cribriform Carcinoma Pearls of Path
Page 67 and 68:
Clinicopathological features Mucino
Page 69 and 70:
Case 4 Mucinous carcinoma Mixed muc
Page 71 and 72:
Treatment • Breast conservation a
Page 73 and 74:
Incipient mucocele-like lesion Cyst
Page 75 and 76:
10/8/2011 73
Page 77 and 78:
10/8/2011 75
Page 79 and 80:
SMA Dx: Spindle-cell Breast Carcino
Page 81 and 82:
Dx: Pure Squamous Carcinoma 10/8/20
Page 83 and 84:
Osseous Differentiation (Osteosarco
Page 85 and 86:
Spindle-cell Carcinoma of the Breas
Page 87 and 88:
Phyllodes y Tumors Phyllodes Tumor
Page 89 and 90:
Diagnosis: Benign g (Low-grade) Phy
Page 91 and 92:
Diagnosis: Malignant (High-grade) P
Page 93 and 94:
10/8/2011 91
Page 95 and 96:
10/8/2011 93
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
Page 105 and 106:
10/8/2011 103
Page 107 and 108:
10/8/2011 105
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 and 144: INVASIVE BREAST CARCINOMAS THAT ARE
Page 145 and 146: of lymphoid cells between sheets of
Page 147 and 148: studied, this taxonomy identifies s
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
Page 155 and 156: The classical pattern of infiltrati
Page 157 and 158: pathologic findings indistinguishab
Page 159 and 160: east carcinomas with overlapping fe
Page 161 and 162: standard" LCIS (their figure 2), wh
Page 163 and 164: References (lobular carcinoma): 1.
Page 165 and 166: 25. Richter GO, Dockerty MB, Claget
Page 167 and 168: Breast Cancer Cooperative Group). L
Page 169 and 170: invasive micropapillary carcinoma m
Page 171 and 172: whether these lesions are in situ o
Page 173 and 174: irregular margin suggests the prese
Page 175: ich in elastic fibers. The connecti
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
Page 185 and 186: carcinoma in almost all tubular car
Page 187 and 188: Sclerosing papillary proliferations
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
Page 195 and 196: mucinous carcinoma. A fine-needle a
Page 197 and 198: with long-term follow-up [Abstract]
Page 199 and 200: cystic hypersecretory duct carcinom
Page 201 and 202: considerable secretion and/or morph
Page 203 and 204: 4. Tavassoli FA, Norris HJ. Secreto
Page 205 and 206: Case 6: History: 66 year old female
Page 207 and 208: Adenoid cystic carcinoma (AdCC) is
Page 209 and 210: Because more than half of adenoid c
Page 211 and 212: Another family of salivary gland-ty
Page 213 and 214: Collagenous spherulosis is a recent
Page 215 and 216: cases: review of the literature and
Page 217 and 218: Case 7 the breast associated with l
Page 219 and 220: size (14). Metaplastic breast carci
Page 221 and 222: adenoma by others who prefer to avo
Page 223 and 224: survival rate than is usually repor
Page 225 and 226: it arises in other soft tissue site
Page 227 and 228:
implies a relative risk for develop
Page 229 and 230:
sclerosing adenosis wherein the str
Page 231 and 232:
overgrowth (136). While acknowledgi
Page 233 and 234:
As noted above, any soft-tissue sar
Page 235 and 236:
J Med 73:1078-1082, 1973. 11. Barne
Page 237 and 238:
40. Thorner PS, Kahn HJ, Baumal R,
Page 239 and 240:
75. Fekete P, Petrek J, Majmudar B,
Page 241 and 242:
microscopic, ultrastructural, and i
Page 243 and 244:
2006 Apr;30(4):450-6 143. Liberman
Page 245 and 246:
Case 8 Case history: A 50 year old
Page 247 and 248:
secondary peripheral tumor nodules
Page 249 and 250:
Definitive diagnosis of medullary c
Page 251 and 252:
Pathol 1988;19:1340-6. 12. Rosen PP
Page 253 and 254:
40. Di Bonito; Royen PM, Ziter FMH.
Page 255:
Am J Clin Pathol 1979;72:383-389. 1
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?