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

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Grabowski et al. Cancer 2008 • 917 IPC cases (California Tumor Registry), 47% only “CIS”. • 53% had invasion. • 90% of invasive cases localized. • At 10 yrs, pts with “CIS” & invasive disease had same survival (96.8% ( and 94.4%; ; P = 0.18). ) • No significant difference in long-term survival of pts in the 2 subgroups of IPC. • Thus, excellent prognosis for IPC whether diagnosed as in situ or invasive. • The usual absence of axillary involvement and low recurrence rate after local excision suggests that wide local excision without axillary dissection is currently the treatment of choice for pure IPC. IPC in Males • Up to 7.5% of all breast cancers in males. • Presentation & pathology same as females. • Japanese men, mean age in males is 68 yrs. • Regardless g of in situ or invasive status, , excellent prognosis with adequate local therapy alone. • Thus, manage pts with IPCs as currently managed (i.e., like pts with DCIS) and avoid categorization of such lesions as frankly invasive papillary carcinomas. Collins et al. AJSP 2006 • Studied 22 IPCs. • 15 benign intraductal papillomas. • IHC for 5 MEC markers. • Smooth muscle myosin heavy chain, calponin, p63, CD10, & cytokeratin 5/6. • All IPCs showed complete absence of MEC • MEC layer detected around DCIS adjacent to IPC. • Intraductal papillomas showed a MEC layer. • Possibly, MEC layer attenuated by compression or encapsulated nodules of invasive papillary carcinoma. • Authors favored "encapsulated papillary carcinoma (EPC)" over "intracystic papillary carcinoma" 10/8/2011 36
Differential Diagnosis: 1. Invasive papillary carcinoma, grade 1 of 3. 2. Infiltrating duct carcinoma, micropapillary type 3. Solid papillary carcinoma. 4. Intraductal papilloma. 5. Sclerosing papillary lesions: - scleroelastotic lesion simulating malignancy. - nonencapsulated sclerosing lesion. - indurative mastopathy. - complex sclerosing lesion. - invasive epitheliosis. - radial scar. - duct adenoma (within sclerosing papillary lesion spectrum). Papillary Carcinoma: General Comments -Truly invasive papillary tumors are rare (
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 and 22: LCIS vs DCIS • Patients with lobu
Page 23 and 24: Examples of E-cadherin staining in
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: Carter et al. Cancer 1977 & 1983
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
Page 75 and 76: 10/8/2011 73
Page 77 and 78: 10/8/2011 75
Page 79 and 80: SMA Dx: Spindle-cell Breast Carcino
Page 81 and 82: Dx: Pure Squamous Carcinoma 10/8/20
Page 83 and 84: Osseous Differentiation (Osteosarco
Page 85 and 86: Spindle-cell Carcinoma of the Breas
Page 87 and 88: Phyllodes y Tumors Phyllodes Tumor
Page 89 and 90:
Diagnosis: Benign g (Low-grade) Phy
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Diagnosis: Malignant (High-grade) P
Page 93 and 94:
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
Page 105 and 106:
10/8/2011 103
Page 107 and 108:
10/8/2011 105
Page 109 and 110:
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.
Page 119 and 120:
349 Case 9 What is your diagnosis?
Page 121 and 122:
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
Page 179 and 180:
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
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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
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Adenoid cystic carcinoma (AdCC) is
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Because more than half of adenoid c
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Another family of salivary gland-ty
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Collagenous spherulosis is a recent
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cases: review of the literature and
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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
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Definitive diagnosis of medullary c
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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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