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

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These atypical vascular lesions have, thus far, proven to follow a benign course. Finally, I would like to point out that unusual cases of ductal carcinoma in situ have a large population of spindle cells that is 10% to 80% of the in-situ tumour cell population in one report (162). Although this would not cause a diagnostic problem in an excision biopsy, it could cause trouble in a limited needle biopsy or fine needle aspiration biopsy, where the spindle cells could be confused with other spindle-cell lesions. Almost all DCIS lesions with spindle cells disclose neuroendocrine differentiation. Although the distinction from benign florid usual hyperplasia may pose a diagnostic histological problem in an excision biopsy specimen, the presence of diffuse neuroendocrine expression, in conjunction with the pattern of high molecular weight keratin profile (CK5/6 negative) on immunohistochemistry, supports an in-situ neoplastic process. The absence of smooth-muscle acitin immunostaining, in conjunction with negative reactivity for cytokeratins 5/6 and 14, makes the possibility of a myoepithelial proliferation unlikely. Reference (Metaplastic carcinoma) 1. Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast. I. Matrix producing carcinoma. Hum Pathol 20:628–635, 1989. 2. Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol 20:732–740, 1989. 3. Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast. III. Carcinosarcoma. Cancer 64:1490–1499, 1989. 4. Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of duct origin. Cancer 65:272–276, 1990. 5. Wargotz ES, Norris HJ: Metaplastic carcinomas of the breast. V. Metaplastic carcinoma with osteoclastic giant cells. Hum Pathol 21:1142–1150, 1990. 6. Gersell DJ, Katzenstein ALA: Spindle cell carcinoma of the breast. A clinicopathologic and ultrastructural study. Hum Pathol 12:550–560, 1981. 7. Foschini MP, Dina RE, Eusebi V: Sarcomatoid neoplasms of the breast: proposed definitions for biphasic and monophasic sarcomatoid mammary carcinomas. Semin Diagn Pathol 10:128–136, 1993. 8. Kaufman MW, Marti JR, Gallager HS, Hoehn JL: Carcinoma of the breast with pseudosarcomatous metaplasia. Cancer 53:1908–1917, 1984. 9. Ridolfi RL, Rosen PP, Port A, et al: Medullary carcinoma of the breast. A clinicopathologic study with 10 year follow-up. Cancer 40:1365–1385, 1977. 10. Huvos AG, Lucas JC Jr, Foote FW Jr: Metaplastic breast carcinoma. N Y State 97
J Med 73:1078–1082, 1973. 11. Barnes PJ, Boutilier R, Chiasson D, Rayson D. Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression. Breast Ca Res Treat 2005;91:173-178. 12. Gallager HS. Pathologic types of breast cancer: their prognoses. Cancer 1984;53:623-629. 13. Beatty JD, Atwood M, Tickman R, Reiner M. Metaplastic breast cancer: clinical significance. Amer J Surg 191:657-664, 2006. 14. Cheung C, Milicent C, Margin L, Rosen PP. Metaplastic carcinoma of the breast with osteocartilaginous heterologous elements. Amer J Surg Pathol 22:188-194, 1998. 15. Zhuang Z, Lininger RA, Man YG, et al: Identical clonality of both components of mammary carcinosarcoma with differential loss of heterozygosity. Mod Pathol 10:354–362, 1997. 16. Lien H-C, Lin C-W, Mao T-L, Kuo S-H, Hsiao C-H, Huang C-S. p53 overexpression and mutation in metaplastic carcinoma of the breast: genetic evidence for a monoclonal origin of both the carcinomatous and the heterologous sarcomatous components. J Pathol 2004;204:131-139. 17. Leibl S, Gogg-Kammerer M, Sommersacher A, Denk H, Moinfar F. Metaplastic breast carcinomas: are they of myoepithelial differentiation?: immunohistochemical profile of the sarcomatoid subtype using novel myoepithelial markers. Am J Surg Pathol. 2005 Mar;29(3):347-53. 18. Sarrió D, Rodriguez-Pinilla SM, Hardisson D, Cano A, Moreno-Bueno G, Palacios J. Epithelial-mesenchymal transition in breast cancer relates to the basal-like phenotype. Cancer Res. 2008; 68:989-97. 19. Oberman HA: Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients. Am J Surg Pathol 11:918–929, 1987. 20. Al-Bozom IA, Abrams J: Spindle-cell carcinoma of the breast, a mimicker of benign lesions. Case report and review of the literature. Arch Pathol Lab Med 120:1066–1068, 1996. 21. Chen KT: Fine needle aspiration cytology of squamous cell carcinoma of the breast. Acta Cytol 34:664–668, 1990. 22. Eggers JW, Chesney TM: Squamous cell carcinoma of the breast: a clinicopathologic analysis of eight cases and review of the literature. Hum Pathol 15:526–531, 1984. 23. Kahn LB, Uys CJ, Dale J, Rutherford S: Carcinoma of the breast with metaplasia to chondrosarcoma: a light and electron microscopic study. Histopathology 2:93–106, 1978. 24. Rostock RA, Bauer TW, Eggleston JC: Primary squamous carcinoma of the 98
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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 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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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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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
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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
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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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Page 233: As noted above, any soft-tissue sar
Page 237 and 238: 40. Thorner PS, Kahn HJ, Baumal R,
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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
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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
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