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

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Course Outline: - Noel Weidner, MD » Introduction » Case 1: » Case 2: - Farnaz Hasteh, MD » CCase 3 » Case 4: - Noel Weidner, MD » Case 5: - Farnaz Hasteh, MD » Unknown cases INTRODUCTION: SPECIAL TYPES OF INVASIVE BREAST CARCINOMA • ~35% invasive breast carcinomas special type (IC,ST). • Most IC,ST have favorable prognosis p g – IMPORTANT! • ST tumors must be ~ 90% or more special pattern. • Those not meeting criteria of a special type called: Invasive duct carcinoma - IDC,NOS or IDC,NST. • But, mixed patterns common, ~33% of invasive breast carcinomas. Ductal Carcinoma Mixed Ductal and Lobular Carcinoma Lobular Carcinoma 10/8/2011 2
INVASIVE BREAST CARCINOMAS CONSIDERED TO HAVE A RELATIVELY GOOD PROGNOSIS 1. Tubular Carcinoma 2. Cribriform Carcinoma 3. Pure Mucinous (Colloid) Carcinoma 4. Adenoid Cystic Carcinoma 5. Secretory Carcinoma 6. Low-Grade Adenosquamous Carcinoma 7. ? Classical Lobular Ca 8. ? Medullary Carcinoma. 9. ? Tubulolobular Carcinoma 10.? Invasive Papillary Ca • IDCs,NST having 10 to 90% of ST of carcinoma diagnosed as mixed DC & ST carcinomas. • IDCs,NST can have less than 10% of ST carcinoma and be “pure” type IDC,NST. • Grade all histologic types of invasive carcinoma. • Grade + tumor type yp together g more accurately y ppredict prognosis. • Grade transcends disagreements in subtype diagnosis. • Clinicians often more easily accept grade designation than subtype. 10/8/2011 3
Page 1 and 2: 33 Special Types of Invasive Breast
Page 3: Special Types of Invasive Breast Ca
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 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
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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 •
Page 65 and 66:
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
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
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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.
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
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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
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
Page 195 and 196:
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
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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
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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
Page 237 and 238:
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
Page 243 and 244:
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
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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