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

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MISCELLANEOUS TYPES OF SPECIAL BREAST CARCINOMA Lipid-cell carcinoma and variants in breast (1). Breast carcinoma with sebaceous differentiation (2). Small-cell carcinoma of the breast (3). Invasive carcinoma with granulomatous reaction (4,5). Neural invasion in intraductal carcinoma of breast (6). Carcinoma with "choriocarcinomatous" features (7) Glycogen-rich, clear-cell carcinoma of breast (8). Oncocytic carcinoma of breast (9). Giant-cell tumor of male breast with myoepithelial & myofibroblastic features(10). Mammary carcinoma with osteoclast-like giant cells (11,12). Neuroendocrine differentiation in breast carcinoma (13). Anaplastic variant of Paget's disease (14). REFERENCES (MISCELLANEOUS CARCINOMAS): 1. van Bogaert L-J, Maldague P. Histologic variants of lipid-secreting carcinoma of the breast. Virchows Arch A [Pathol Anat Histol] 1977;375:345-353. 2. Tavassoli FA, Norris HJ. Mammary adenoid cystic carcinoma with sebaceous differentiation. A morphologic study of the cell types. Arch Pathol Lab Med 1986;110:1045-1053. 3. Wade PM, Mills SE, Read M, Cloud W, Lambert MJ, Smith RE. Small cell neuroendocrine (oat cell) carcinoma of the breast. Cancer 1983;52:121-125. 4. Oberman HA. Invasive carcinoma of the breast with granulomatous response. Am J Clin Pathol 1987;88:718-721. 5. Coyne J, Haboubi NY. Micro-invasive breast carcinoma with granulomatous stromal response. Histopathol 1992;20:184-185. 6. Tsang WYW, Chan JKC. Neural invasion in intraductal carcinoma of the breast. Hum Pathol 1992;23:202-204. 7. 306. Saigo PE, Rosen PP. Mammary carcinoma with "choriocarcinomatous" features. Am J Surg Pathol 1981;5:773-778. 8. Toikkanen S, Joensuu H. Glycogen-rich clear-cell carcinoma of the breast. Hum Pathol 1991;22:81-83. 9. Costa MJ, Silverberg SG. Oncocytic carcinoma of the male breast. Arch Pathol Lab Med 1989;113:1396-1399. 10. Lucas JG, Sharma HM, O'Toole RV. Unusual giant cell tumor arising in a male breast. Hum Pathol 1981;12:840-844. 11. Agnantis NT, Rosen PP. Mammary carcinoma with osteoclast-like giant cells. 117
Am J Clin Pathol 1979;72:383-389. 12. Holland R, van Haelst UJGM. Mammary carcinoma with osteoclast-like giant cells. Cancer 1984;53:1963-1973. 13. Scopsi L, Andreola S, Pilotti S, Testori A, Baldini MT, Leoni F, Lombardi L, Hutton JC, Shimizu F, Rosa P, Huttner WB, Rilke F. Argyrophilia and granin (chromogranin/secretogranin) expression in female breast carcinomas: Their relationship to survival and other disease parameters. Am J Surg Pathol 992;16:561-576. 14. Rayne SC, Santa Cruz DJ. Anaplastic Paget's disease. Am J Surg Pathol 1992;16:1085-1091. 118
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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 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 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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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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cystic hypersecretory duct carcinom
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considerable secretion and/or morph
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