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

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• 17% recurred with recurrence rates equal in both pure LCIS and LCIS+DCIS cases. • All recurrences were IPSILATERAL. • 50% of recurrences invasive carcinomas. • Recurrence related to extent and cell type type. • Recurrence Rate Among LCIS Types: (10 lobules LCIS + large nuclei) = 41% • I believe, CIS having mixed ductal & lobular features, should be (at least in part) called DCIS - this encourages complete excision. • YET, I mention the concomitant LCIS pattern to emphasize somewhat greater risk of bilateral carcinoma (e (e.g., g “mixed mixed ductal & lobular CIS”) CIS ). • This encourages adequate follow-up studies of the contra-lateral breast. WHO 2003 “The current recommended management for lobular neoplasia is life long followup with or without tamoxifen rx. Re- excision i i should h ld bbe considered id d iin cases of massive acinar distention, and when pleomorphic, signet ring, or necrotic variants are identified at or close to the margin.” 10/8/2011 20
Examples of E-cadherin staining in Breast Carcinomas - Classic and Otherwise - CASE A Classic ILC & LCIS 10/8/2011 21
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: LCIS vs DCIS • Patients with lobu
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
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10/8/2011 73
Page 77 and 78:
10/8/2011 75
Page 79 and 80:
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
Page 95 and 96:
10/8/2011 93
Page 97 and 98:
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
Page 107 and 108:
10/8/2011 105
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Case 1 • 40 year old female • B
Page 111 and 112:
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.
Page 119 and 120:
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
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
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Case 20 • 35 year old female with
Page 133 and 134:
Negative ER stain NEG ER Case 22
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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
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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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In summary, basal-like breast cance
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Page et al. (15) described a pleomo
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The classical pattern of infiltrati
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pathologic findings indistinguishab
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east carcinomas with overlapping fe
Page 161 and 162:
standard" LCIS (their figure 2), wh
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References (lobular carcinoma): 1.
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25. Richter GO, Dockerty MB, Claget
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Breast Cancer Cooperative Group). L
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invasive micropapillary carcinoma m
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whether these lesions are in situ o
Page 173 and 174:
irregular margin suggests the prese
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ich in elastic fibers. The connecti
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(i.e., much better than an antibody
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outcome of patients with intracysti
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Case 3: History: A 73 year old fema
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cases. In this small tubular carcin
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carcinoma in almost all tubular car
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Sclerosing papillary proliferations
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9. Bondeson L, Lindholm K. Aspirati
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43. Green I, McCormick B, Cranor M,
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mucinous carcinoma (7,11,12,14). In
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mucinous carcinoma. A fine-needle a
Page 197 and 198:
with long-term follow-up [Abstract]
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cystic hypersecretory duct carcinom
Page 201 and 202:
considerable secretion and/or morph
Page 203 and 204:
4. Tavassoli FA, Norris HJ. Secreto
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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
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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
Page 231 and 232:
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
Page 249 and 250:
Definitive diagnosis of medullary c
Page 251 and 252:
Pathol 1988;19:1340-6. 12. Rosen PP
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40. Di Bonito; Royen PM, Ziter FMH.
Page 255:
Am J Clin Pathol 1979;72:383-389. 1
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