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

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40. Sloane JP, Mayers MM. Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age. Histopathol 1993;23:225-231. 41. Lammie GA, Millis RR. Ductal adenoma of the breast - a review of fifteen cases. Hum Pathol 1989;20:903-908. 42. Haagensen CD, Stout AP, Phillips JS: The papillary neoplasms of the breast. I. Benign intraductal papilloma. Ann Surg 1951;133:18-36. 43. Kraus FT, Neubecker RD: The differential diagnosis of papillary tumors of the breast. Cancer 1962;15:444-455. 44. Murad TM, Contesso G, Mouriesse H: Papillary tumors of the large lactiferous ducts. Cancer 1981;48:122-133. 45. Ohuchi N, Rikiya A, Kasai M. Possible cancerous change of intraductal papillomas of the breast. A 3-D reconstruction study of 25 cases. Cancer 1984;54:605-611. 46. Haagensen CD. "Intraductal papilloma," In: Diseases of the breast. 2nd edition, 1971, pp. 250-291, W.B. Saunders, Philadelphia, PA. 47. Haagensen CD, Bodian C, Haagensen DE, Jr. Breast carcinoma. Risk and detection., 1st edition, W.B. Saunders, Philadelphia, PA, 1981. 48. Carter D. Intraductal papillary tumors of the breast. A study of 78 cases. Cancer 1977;39:1689-1692. 49. Fischer ER, Palekar AS, Redmond C, Barton B, Fischer B. Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol No. 4): VI. invasive Papillary Cancer. ASCP 1980;73:313-321. 50. Siriaunkagul S, Tavassoli FA. Invasive Micropapillary carcinoma of the breast. Mod Path 1993; 6:660-662. 51. Papotti M, Eusebi V, Gugliotta P, et al: Immunohistochemical analysis of benign and malignant papillary lesions of the breast. Am J Surg Pathol 1983;7:451-461. 43
Case 3: History: A 73 year old 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 1). TUBULAR AND CRIBRIFORM CARCINOMA Background: Tubular carcinoma is a well-differentiated (mBR grade 1) invasive carcinoma with regular cells arranged in well-defined tubules typically one layer thick and surrounded by an abundant fibrous stroma. Tubular carcinoma should not be confused with invasive ductal carcinomas with gland-like structures whose cells are less well differentiated (1,2). Pure tubular carcinomas constitute at least 2% of all breast carcinomas (3-5) and they are being seen with increasing frequency as a result of screening mammography. Likewise, cribriform carcinoma is a well-differentiated (mBR grade 1) variant of invasive breast carcinoma, in which the majority of the invasive component grows in an irregular cribriform pattern, often admixed with features of well-differentiated tubular carcinoma. Approximately 6% of invasive mammary carcinomas have a cribriform element with nearly equal proportions of "pure" and "mixed" lesions (6,7). When the tubular component is less than 50%, some advocate use of the term “invasive cribriform carcinoma;” when over 50%, then “invasive tubular carcinoma” is suggested as more appropriate (6-8). But, because of 44
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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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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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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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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
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343 What is your best diagnosis? 1.
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349 Case 9 What is your diagnosis?
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Case 11 Case 11 Case 12 • A 68 ye
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Case 13 • Needle core biopsy of a
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What is your diagnosis? 1. Intracys
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What is your best interpretation? 1
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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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