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

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pleomorphic sarcoma might be confused with a medullary carcinoma, but this seems unlikely for an experienced pathologist. References: (Medullary Carcinoma): 1. World Health Organization. Histological typing of breast tumors. Tumor 2003:28-29. 2. Richardson WW, Fields JR. Host resistance and survival in carcinoma of breast: a study of 104 cases of medullary carcinoma in a series of 1411 cases of breast cancer followed for 20 years. Br Med J 1970:3:181-8. 3. Rapin V, Contesso G, Mouriesse H, et al. Medullary breast carcinoma. A reevaluation of 95 cases of breast cancer with inflammatory stroma. Cancer 1988;61:2503-10. 4. Richardson WW. Medullary carcinoma of the breast. A distinctive tumor type with a relatively good prognosis following radical mastectomy. Br J Cancer 1956;10:415-23. 5. Rosen PP. The pathological classification of human mammary carcinoma: past, present and future. Ann Clin Lab Sci 1979;9:144-56. 6. Jensen ML, Kiaer H, Andersen J, Jensen V, Melsen F. Prognostic comparison of three classifications for medullary carcinomas of the breast. Histopathol 1997;30:523-532. 7. Fisher ER, Remigio MG, Fisher B, et al. The pathology of invasive breast cancer. A syllabus derived from findings of the National Sugical Adjuvant Breast Project (protocol no. 4) Cancer 1975;36:1-84. 8. Kurtz JM, Jacquemier J, Torhorst J, et al. Conservation therapy for breast cancers other than infiltrating ductal carcinoma. Cancer 1989;63:1630-5. 9. Moore OS Jr, Foote FW Jr. The relatively favorable prognosis of medullary carcinoma of the breast. Cancer 1949;2:635-42. 10. Ridolfi RL, Rosen PP, Port A, Kinne D, Miké V. Medullary carcinoma of the breast: a clinicopathologic study with 10 year follow-up. Cancer 1977:40:1365-85. 11. Wargotz ES, Silverberg SG. Medullary carcinoma of the breast: a clinicopathologic study with appraisal of current diagnostic criteria. Hum 113
Pathol 1988;19:1340-6. 12. Rosen PP, Groshen S, Saigo PE, Kinne DW. Hellman S. A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma. J Clin Oncol 1989;7:355-66. 13. Ellis IO, Galea M, Broughton N, Locker A, Blamey RW, Elston CW. Pathological prognostic factors in breast cancer. II. Histologic type. Relationship with survival in a large study with long-term follow-up. Histopathology 1992;20:479-489. 14. Pereira H, Pinder SE, Sibberin DM, Galea MH, Elston CW, Blamey RW, Robertson JFR, Ellis IO. Pathological prognostic factors in breast carcinoma. IV: should you be a typer or a grader? A comparative study of two histologic prognostic features in operable breast carcinoma. Histopathol 1995;27:219-226. 15. Rosen PP, Lesser ML, Senie RT, Duthie K. Epidemiology of breast carcinoma IV: age and histologic tumor type. J Surg Oncol 1982;19:44-51. 16. Schwartz GF. Solid circumscribed carcinoma of the breast. Ann Surg 1969;169:165-73. 17. Lesser ML, Rosen PP, Kinne DW. Multicentricity and bilaterality in invasive breast carcinoma. Surgery 1982:91:234-40. 18. Pedersen LP, Holck S, Schiödt T, Zedeler K, Mouridsen HT. Inter- and intraobserver variability in the histopathological diagnosis of medullary carcinoma of the breast, and its prognostic implications. Breast Cancer Res Treat 1989;14:91-9. 19. Foote FW Jr, Stewart FW. A histologic classification of carcinoma of the breast. Surgery 1946:19:74-99. 20. Hsu SM, Raine L, Nayak RN. Medullary carcinoma of breast: an immunohistochemical study of its lymphoid stroma. Cancer 1981;48:1368-76. 21. Ito T, Saga S, Nagayoshi S, et al. Class distribution of immunoglobulincontaining plasma cells in the stroma of medullary carcinoma of breast. Breast Cancer Res Treat 1986;7:97-103. 22. Jacquemier J. Robert-Vague D, Torrente M, Lieutaud R. Mise en evidence des immunoglobulines lymphoplasmocytaires et epitheliales dans les carcinomes infiltrants a stroma lymphoid et les carcinomes medullaries du sein. Arch Anat Cytol Pathol 1983;31:296-300. 23. Ben-Ezra J, Sheibani K. Antigenic phenotype of the lvmphocytic component of medullary carcinoma of the breast. Cancer 1987;59:2037-41. 24. Winsten S, Tabachnick J, Young I. Immunoglobulin G (IgG) levels in breast tumour cytosols. Am J Clin Pathol 1985;83:364-6. 25. Pedersen LP, Schiödt T, Holck S, Zedeler K. The prognostic importance of syncytial growth pattern in medullary carcinoma of the beast. APMIS 114
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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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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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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
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with long-term follow-up [Abstract]
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Page 235 and 236: J Med 73:1078-1082, 1973. 11. Barne
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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 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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