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

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Mixed mucinous and ductal carcinoma Prognosis Mucinous carcinoma • Pure form has favorable prognosis • Pure forms are smaller than the mixed ones • Negative axillary node metastasis in patients with pure form range from 71 to 97% • Positive lymph nodes have been reported in pure mucinous carcinoma especially in cases with micropapillary pattern and in younger age Prognosis Mucinous carcinoma • Komaki et al. – 10 year survival for pure tumor: 90% – Versus 60% for mixed ductal and mucinous • Periera et al al. – 10 year survival for all pure tumor: 81% • 86% for mBR grade I • 75% for mBR grade II • 5 year survival after mastectomy from 84-100% 10/8/2011 68
Treatment • Breast conservation and radiation therapy • Late metastasis and recurrence of 25-30 years hhave bbeen reported t d Differential Diagnosis • DCIS with extravasated mucin – No epithelial component is present in mucin – Prior FNA and biopsy! • Benign mucocele-like mucocele like tumor – Extravasated mucin with multiple dilated cysts lined by flat bland epithelium – No tumor floater or rare cells (+ myoepithelial cells) – Large, granular calcification • Cystic hypersecretory hyperplasia – Ectatic ducts filled by eosinophilic, colloid like secretion Benign mucocele like lesion of breast 10/8/2011 69
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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
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
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: Case 4 Mucinous carcinoma Mixed muc
Page 73 and 74: Incipient mucocele-like lesion Cyst
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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
Page 91 and 92: 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
Page 99 and 100: SMA Calponin 10/8/2011 97
Page 101 and 102: Dx: Mixed Spindle-cell & Cl Classic
Page 103 and 104: Dx: Adenomyoepithelioma, Epithelioi
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Page 109 and 110: Case 1 • 40 year old female • B
Page 111 and 112: What is your diagnosis? 1. Invasive
Page 113 and 114: Case 4 • Irregular large breast m
Page 115 and 116: Case 6 • Needle core biopsy of a
Page 117 and 118: 343 What is your best diagnosis? 1.
Page 119 and 120: 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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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
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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
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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.
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Am J Clin Pathol 1979;72:383-389. 1
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