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

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commonly found in nonapocrine intraductal carcinomas, including comedo, micropapillary, solid, and cribriform patterns. Apocrine carcinomas have nuclei that are enlarged and pleomorphic when compared to the nuclei of benign apocrine cells. Typically, nucleoli are large, prominent, and usually eosinophilic, although they occasionally exhibit basophilia. Some examples have pleomorphic, deeply basophilic nuclei in which little or no internal structure can be discerned. In these cells, nucleoli are usually not evident. In most cases the cytoplasm exhibits eosinophilia that may be homogeneous or granular, but cytoplasmic vacuolization or clearing occur and are features associated with atypical apocrine proliferations and are most prominent in apocrine carcinomas. The tumor cells contain diastase-resistant, PAS-positive granules, which also stain with toluidine blue and are red with the trichrome stain. Cytoplasmic iron granules, a feature of benign apocrine cells, are variably present. Occasional cells may contain mucicarmine-positive secretions, but most tumors are negative for mucin and alphalactalbumin (26,27). Benign and malignant apocrine cells are strongly immunoreactive for GCDFP-15. This marker was positive in 55% of carcinomas, including 75% of those with apocrine histologic features, 70% of intraductal carcinomas, and 90% of infiltrating lobular carcinomas that had signet ring cell features (19,24,25). Positive staining was found in only 23% of carcinomas that did not have apocrine features and in 5% of medullary carcinomas. Staining for GCDFP-15 has not been a useful predictor of prognosis (25). Apocrine carcinoma cells contain abundant organelles, including many variably sized mitochondria (20) that often have incomplete cristae, and varying numbers of osmiophilic secretory granules (19,24,28,29). Many tumor cells also contain empty vesicles of about the same size as the osmiophilic granules. The prognosis of apocrine carcinoma, whether intraductal or invasive, is determined mainly by conventional prognostic factors such as grade, tumor size, and nodal status (22,30-32). Apocrine differentiation should be mentioned as a descriptive feature of the lesion, but it does not have prognostic or therapeutic implications. Reference (Secretroy Carcinoma): 1. McDivitt RW, Stewart FW. Breast carcinoma in children. J Am Med Assoc 1966;195:388-390. 2. Krauz T, Jenkins D, Grontoft O, Pollock DJ, Azzopardi JG. Secretory carcinoma of the breast in adults: emphasis on late recurrence and metastasis. Histopathol 1989;14:25-36. 3. Rosen PP, Cranor ML. Secretory carcinoma of the breast. Arch Pathol Lab Med 1991;115:141-144. 65
4. Tavassoli FA, Norris HJ. Secretory carcinoma of the breast. Cancer 1980;45:2404-2413. 5. Oberman HA. Secretory carcinoma of the breast in adults. Am J Surg Pathol 1980;4:465-470. 6. Akhtar M, Robinson c, Ashraf M, Godwin JT. Secretory carcinoma of the breast in adults. Cancer 1983;51:2245-2254. 7. Botta G, Fessia L, Ghiringhello B. Juvenile milk protein secreting carcinoma. Virchows Arch [A] 1982;395: 145-52. 8. Byrne MP, Fahey MM, Gooselaw JG. Breast cancer with axillary metastasis in an eight and one-half-year-old girl. Cancer 1973;31:726-8. 9. Hartman AW, Magrish R Carcinoma of breast in children. Case report: sixyear-old boy with adenocarcinoma. Ann Surg 1955;141:792-7. 10. Krausz T, Jenkins D, Grontoft 0, Pollock DJ, Azzopardi JG. Secretory carcinoma of the breast in adults: emphasis on late recurrence and metastasis. Histopathology 1989:14:25-36. 11. Tournemaine N, Audouin A-F, Anguill C, Gordeeff S. Le carcinome secretoire juvenile. Cinq nouveaux cas chez des femmes d’age adulte. Arch Anat Cytol Pathol 1986;34:146-51. 12. Lamovec J, Bracko M. Secretory carcinoma of the breast: light microscopical, immunohisto-chemical, and flow cytometric study. Mod Pathol 1994; 7:475- 479 13. Ferguson TB Jr, McCarty KS Jr, Filston HC. Juvenile secretary carcinoma and juvenile papillomatosis: diagnosis and treatment. J Pediatr Surg 1987;22:637- 9. 14. Rosen PP, Holmes G, Lesser ML, Kinne DW, Beattie EJ. Juvenile papillomatosis and breast carcinoma. Cancer 1985;55:1345-52. 15. Carter DJ, Rosen PP. Atypical apocrine metaplasia. Mod Pathol 1991:4:1-5. 16. Ahmed A. Apocrine metaplasia in cystic hyperplastic mastopathy. Histochemical and ultrastructural observations. J Pathol 1975;115:211-4. 17. Archer F, Omar M. Pink cell (oncocytic) metaplasia in a fibroadenoma of the human breast: electron-microscopic observations. J Pathol 1969;99:119-24. 18. Charles A. An electron microscopic study of the human axillary apocrine gland. J Anat 1959;93:226-32. 19. Mossler JA, Barton TK, Brinkhous AD, McCarty KS, Moylan JA, McCarty KS Jr. Apocrine differentiation in human mammary carcinoma. Cancer 1980;46:2463-71. 20. Pier WJ Jr, Garancis JC, Kuzma JF. The ultrastructure of apocrine cells in intracystic papilloma and fibrocystic disease of the breast. Arch Pathol 1970;89:446-52. 66
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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 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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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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What is your diagnosis? 1. Secretor
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American Soiety of Clinical Patholo
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SPECIAL TYPES OF INVASIVE BREAST CA
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INVASIVE BREAST CARCINOMAS THAT ARE
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of lymphoid cells between sheets of
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studied, this taxonomy identifies s
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molecular subtypes. Indeed, the pea
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Page 181 and 182: Case 3: History: A 73 year old fema
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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,
Page 239 and 240: 75. Fekete P, Petrek J, Majmudar B,
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Page 243 and 244: 2006 Apr;30(4):450-6 143. Liberman
Page 245 and 246: Case 8 Case history: A 50 year old
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Page 251 and 252: 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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