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

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considered to have a prognosis essentially identical to pure tubular carcinoma, but this view is not held by all. Green et al. (13) noted that tubulolobular carcinomas were more frequently associated with positive axillary lymph nodes (i.e., ~43%) and multifocallity (i.e., ~29%), compared to pure tubular carcinoma. They concluded that the distribution of prognostic factors suggested that tubulolobular carcinoma was a higher-grade lesion than pure tubular carcinoma. References: (Tubular/Cribriform carcinoma): 1. Foote FW Jr. Surgical pathology of cancer of the breast. In: Parsons VM, ed. Cancer of the breast. Springfield III: Charles C. Thomas, 1959:37-8. 2. World Health Organization. Histological typing of breast tumours. International Histological Classification of Tumours Geneva: World Health Organization, 2003;26-27. 3. Carstens PH, Greenberg RA, Francis D, Lyon H. Tubular carcinoma of the breast. A long term follow-up. Histopathology 1985;9:271-80. 4. Cooper HS, Patchefsky AS, Krall RA. Tubular carcinoma of the breast. Cancer 1978:42:2334-42. 5. Peters GN, Wolff M, Haagensen CD. Tubular carcinoma of the breast. Clinical pathologic correlations based on 100 cases. Ann Surg 981;193:138- 49. 6. Page DL, Dixon JM, Anderson TJ, Lee D, Stewart HJ. Invasive cribriform carcinoma of the breast. Histopathology 1983;7:525-36. 7. Venable JG, Schwartz AM, Silverberg SG. Infiltrating cribriform carcinoma of the breast: a distinctive clinicopathologic entity. Hum Pathol 1990;21:333-8. 8. Fisher ER, Gregorio RM, Fisher B, Redmond C, Vellios F, Sommers SC. The pathology of invasive breast cancer. A syllabus derived from findings of the 51
9. Bondeson L, Lindholm K. Aspiration cytology of tubular breast carcinoma. Acta Cytol 1990;34:15-20. 10. 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. ). 11. McDivitt RW, Boyce W, Gersell D. Tubular carcinoma of the breast. Clinical and pathological observations concerning 135 cases. Am J Surg Pathol 1982;6:401-11. 12. Berger AC, Miller SM, Harris MN, Roses DF. Axillary dissection for tubular carcinoma of the breast The Breast J 1996;2:204-208. 13. Green I, McCormick B, Cranor M, Rosen PP. A comparative study of pure tubular and tubulolobular carcinoma of the breast. Am J Surg Pathol 1997;21:653-657. 14. Elson BC, Helvie MA, Frank TS, Wilson TE, Adler DD. Tubular carcinoma of the breast. Mode of presentation, mammographic appearance, and frequency of nodal metastases. AJR 1993;161:1173-1176. 15. Winchester DJ, Sahin AA, Tucker SL, Singletary SE. Ann Surg 1996;223:342- 347. 16. Andersen JA, Carter D, Linell F. A symposium on sclerosing duct lesions of the breast. Pathol Annu 1986;21(Pt 2):145-79. 17. Beahrs OH, Shapiro S, Smart C. Report of the working group to review the National Cancer Institute-American Cancer Society Breast Cancer Detection Demonstration Projects. JNCI 1979;62:640-709. 18. Oberman HA, Fidler WJ Jr. Tubular carcinoma of the breast. Am J Surg Pathol 1979;3:387-95. 19. Taylor HB, Norris HJ. Well-differentiated carcinoma of the breast. Cancer 1970;25:687-92. 20. Wells CA, Ferguson DJ. Ultrastructural and immunocytochemical study of a case of invasive cribriform breast carcinoma. J Clin Pathol 1988;41:17-20. 21. Masood S, Barwick KW. Estrogen receptor expression of the less common breast carcinomas [Abstract]. Am J Clin Pathol 1990;93:437. 22. Egger H, Dressler W. A contribution to the natural history of breast cancer. 1. Duct obliteration with periductal elastosis in the centre of breast cancers. Arch Gynecol 1982;231:191-8. 23. Weidner N. Benign breast lesions that mimic malignant tumors: analysis of five 52
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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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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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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
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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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Case 18 What is your best interpret
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Case 20 • 35 year old female with
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Negative ER stain NEG ER Case 22
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What is your best interpretation? 1
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Page 139 and 140: American Soiety of Clinical Patholo
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Page 181 and 182: Case 3: History: A 73 year old fema
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Page 187: Sclerosing papillary proliferations
Page 191 and 192: 43. Green I, McCormick B, Cranor M,
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Page 235 and 236: J Med 73:1078-1082, 1973. 11. Barne
Page 237 and 238: 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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