Ultrastructural and immunohistochemical characteristics of lipid-rich carcinoma of the breast

The clinical and pathological characteristics of lipid-rich carcinoma of the breast: an analysis of 98 published patients

BACKGROUND

Due to the small number of cases and few literature reports, the clinical treatment and prognosis of lipid-rich carcinoma of the breast are not summarized, which will lead to misdiagnosis and mistreatment and delay the patient's condition. This study collected published case reports and analyzed the clinical characteristics of lipid-rich carcinoma of the breast in order to provide reference for early diagnosis and treatment of the disease.

METHODS

We performed a search using the PubMed, ClinicalTrials.gov, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for publicly published case reports of lipid-rich carcinoma of the breast and obtained basic information of the patients such as country, age, sex, onset site, surgical method, pathology, postoperative treatment, follow-up time, and outcome (Table 9). The data were analyzed using Statistical Product Service Solutions (SPSS).

RESULTS

The mean age of the patients at diagnosis was 52.79 years and the median age was 53 years. Breast masses were the main clinical manifestations, with the upper outer quadrant (53.42%) being the most common. The treatment for lipid-rich carcinoma of the breast is mainly surgery plus postoperative adjuvant radiotherapy and chemotherapy. According to the results of this study, the surgical method recommended modified radical mastectomy (46.59%). Lymph node metastasis was found in 50.60% of the patients at the time of the first diagnosis. Patients who received postoperative adjuvant chemotherapy and radiotherapy had the highest disease-free survival and overall survival.

CONCLUSION

Lipid-rich carcinoma of the breast has a short course of disease and early lymphatic or blood metastasis, and its prognosis is poor. In this study, we summarize the clinical and pathological characteristics to provide ideas for the early diagnosis and treatment of lipid-rich carcinoma of the breast.

Lipid-Rich Carcinoma of the Breast With Unusual Clinical and Histopathological Features

Lipid-rich carcinoma of the breast is a rare form of invasive breast carcinoma of special type. Most cases are grade 3, hormone receptor negative, and associated with aggressive clinical behavior. We report an unusual case of lipid-rich carcinoma with morphological and immunophenotypical features different from those of cases reported so far in the literature. The index case underscores the fact that there is no consensus with regard to the exact nature of this tumor. Hence, larger studies are needed to draw meaningful conclusions.

Lipid-rich carcinoma of the breast that is strongly positive for estrogen receptor: a case report and literature review

Lipid-rich carcinoma (LRC) of the breast is a rare breast cancer variant that accounts for <1% of all breast malignancies. It has been reported that LRCs are negative for estrogen receptor. Here, we report a case of LRC of the breast that was strongly positive for estrogen receptor and treated with endocrine adjuvant therapy. A 52-year-old postmenopausal female noticed a lump in her right breast by self-examination and presented to our hospital. Physical examination revealed an elastic 30 mm ×20 mm hard mass in the upper medial part of her right breast. The findings obtained using ultrasonography, mammography, and contrast-enhanced magnetic resonance imaging suggested breast cancer. Core needle biopsy resulted in the diagnosis of invasive carcinoma. The patient underwent mastectomy and sentinel lymph node biopsy. Histopathologically, the tumor cells were abundant in foamy cytoplasm. Because the presence of marked cytoplasmic lipid droplets was confirmed by Sudan IV staining and electron microscopic examination of the tumor and the lipid droplets were negative for periodic acid-Schiff staining, the tumor was diagnosed as an LRC. Immunohistochemically, estrogen and progesterone receptors of the tumor were strongly positive, human epidermal growth factor receptor type 2 was negative, and the ratio of Ki-67-positive cells was ~30%. After surgery, the patient underwent combination chemotherapy with anthracycline, cyclophosphamide, and 5-fluorouracil, followed by docetaxel. Thereafter, the pateint was treated with letrozole and has remained well for 24 months with no signs of recurrence.

Targeting the PyMT Oncogene to Diverse Mammary Cell Populations Enhances Tumor Heterogeneity and Generates Rare Breast Cancer Subtypes

Human breast cancer is a heterogeneous disease composed of different histologies and molecular subtypes, many of which are not replicated in animal models. Here, we report a mouse model of breast cancer that generates unique tumor histologies including tubular, adenosquamous, and lipid-rich carcinomas. Utilizing a nononcogenic variant of polyoma middle T oncogene (PyMT) that requires a spontaneous base-pair deletion to transform cells, in conjunction with lentiviral transduction and orthotopic transplantation of primary mammary epithelial cells, this model sporadically induces oncogene expression in both the luminal and myoepithelial cell lineages of the normal mouse mammary epithelium. Microarray and hierarchical analyses using an intrinsic subtype gene set revealed that lentiviral PyMT generates both luminal and basal-like tumors. Cumulatively, these results show that low-level expression of PyMT in a broad range of cell types significantly increases tumor heterogeneity and establishes a mouse model of several rare human breast cancer subtypes.

Intraductal lipid-rich carcinoma of the breast with a component of glycogen-rich carcinoma

We report a rare case of intraductal lipid-rich carcinoma of the breast with a component of glycogen-rich carcinoma. An impalpable tumor that was revealed by mammography and magnetic resonance imaging was excised. Histologic examination showed vacuolated neoplastic cells in the mammary ducts, and electron microscopy confirmed lipid droplets in the cytoplasm. The coexistence of glycogen-rich carcinoma was shown. Lipid-rich carcinoma that is coexistent with glycogen-rich carcinoma is rare, and most lipid-rich carcinomas are invasive. Intraductal lipid-rich carcinoma is difficult to detect without echography or mammography.

Mammary lipid-rich carcinoma with extensive amyloid deposition in a dog

A 6-year-old female Labrador retriever presented with a mass in the right mammary gland, and swollen right inguinal and axillary lymph nodes. Fine needle aspiration biopsy suggested a malignant lipid-producing tumor, such as liposarcoma. Histopathologically, the neoplasms were solid, lobulated nests of atypical epithelial cells with a large amount of extracellular deposits of amyloid in both mammary gland and lymph nodes. The proliferating cells contained large cytoplasmic vacuoles, positive for oil red-O. These cells were immunopositive for cytokeratin (AE1/AE3) and β-casein and negative for SMA. The amyloid deposits were immunopositive for β-casein. These findings suggested that the proliferating cells secreted β-casein forming amyloid deposits. This is the first report of mammary lipid-rich carcinoma with extensive amyloid deposition derived from β-casein.

Lipid-rich histology in a basal-type immuno-profile breast carcinoma: a clinicopathological histochemical and immunohistochemical analysis of a case

We describe the clinicopathological and morphological features of an unusual breast carcinoma classifiable as a lipid-rich variant of ductal invasive carcinoma, with a basal-type immunohistochemical profile. Basal-type breast cancers show no hormonal receptor expression, rarely over-express HER-2 but exhibit molecular high weight cytokeratins, EGFR and c-kit positivity. Special stains and histochemistry tests were used to elucidate the nature of vescicles in the neoplastic cells. Sudan IV was performed on formalin-fixed tissue. Commercially available antibodies tested were: ER, PgR, EGFR, HER2, c-kit, high molecular weight cytokeratins. Cytoplasmic lipids were highlighted as red-orange droplets on Sudan IV staining. As for immunohistochemistry, the tumor showed no reactivity to ER, PgR and HER2 (triple negative), and diffuse and strong positivity to high weight cytokeratins, EGFR and c-kit, such as a basal-type breast carcinoma. A basaloid phenotype in a lipid-rich carcinoma has not been previously reported.

Cytomorphology of Rare Malignant Tumors of the Breast

This article reviews cytomorphology of rare malignant tumors of the breast: squamous carcinoma, metaplastic carcinoma, adenoid cystic carcinoma, apocrine carcinoma, secretory carcinoma, lipid-rich carcinoma, and carcinoma with choriocarcinomatous features. It is important to bear in mind the cytomorphology and diagnosis of rare malignant tumors of the breast in analysis of breast fine needle aspiration smears. Although rare, these malignant tumors can be diagnosed by the cytomorphological characteristics, and should be included in the differential diagnoses of breast neoplasms.

Histopathological and Immunohistochemical Characteristics of Two Canine Lipid-Rich Mammary Carcinomas

Clinicopathological and immunohistochemical findings of two uncommon canine lipid-rich mammary carcinomas are described. The predominant histological feature in both tumours was the presence of at least 80% of cells with intracytoplasmic vacuoles which stained positively with Sudan IV but not with alcian-blue periodic acid-schiff method. In both tumours, small groups of non-vacuolated cells were identified among the vacuolated cells. However, histological and immunohistochemical differences were also found between these tumours. Thus, one of them was composed of tumour cells with a large and single vacuole, which were arranged in lobular pattern, while the other neoplasm showed an intraductal growth of tumour cells with a fine vacuolated cytoplasm. Immunohistochemically, in the first tumour most vacuolated cells were positive for CK (cytokeratin)8-7, indicating a secretory epithelial immunophenotype while CK5 and CK8-7-expressing non-vacuolated cells were associated with luminal duct immunophenotype. However, in the second tumour the expression of CK14 in most of vacuolated cells and alpha-smooth muscle actin (alpha-SMA) in non-vacuolated cells, alone or in combination with CK5 suggested a myoepithelial immunophenotype for both cell types. These results suggest heterogeneity of the cell type and growth pattern for this type of canine tumour as has been described in women but not in dogs.

Lipid-rich carcinomas of the mammary gland in seven dogs: clinicopathologic and immunohistochemical features

Lipid-rich carcinomas occurred in seven female dogs. Affected dogs were purebred (all but one), intact (all but one), and between 4 and 13 years of age. Five of them had a history of parity, one had pseudopregnancy, and none had received contraceptive steroids. The tumors were single (five cases) or multiple (two cases) well-circumscribed masses of different sizes (varying from 1 to 6 cm in diameter), composed of solid nests and cords of tumor cells separated by a moderate amount of stroma. The tumor cells contained either multiple and small or large and solitary vacuoles that pushed the nucleus to the periphery of the cell (signet-ring cell). A glandular epithelial immunophenotype (cytokeratins 5 and 8 and 8 and 18) was observed in the majority of tumor cells. All tumors lacked both estrogen and progesterone receptors, and five out of seven tumors gave rise to local recurrence and proximal or distant metastases or both.

Pleomorphic lobular carcinoma: morphology, immunohistochemistry, and molecular analysis

Infiltrating pleomorphic lobular carcinoma (PLC) is an aggressive variant of infiltrating lobular carcinoma. Recently, in situ changes identical to PLC (PLCIS) have been described. The role of prognostic markers and their correlation with therapeutics, clinical outcome, and genetic changes is not well established in PLC. The authors examined 38 cases of this entity to understand better this tumor's biology. Immunohistochemical (IHC) analysis was performed in 21 specimens for estrogen and progesterone steroid receptors, p53, Her 2 (p185), and GCDFP-15. Genomic deoxyribonucleic acid was obtained from microdissected tumor as well as normal control cells, and loss of heterozygosity was investigated at the ESR (16q24), p53 (TP53 17p), Her 2 (17q 11-12), and BRCA 1 (17q12-25) loci. In this series, the average patient age was 57.5 years (age range, 24-92 years). Twenty-seven women were postmenopausal. Tumor size ranged from 1.2 to 25 cm. Six patients were a pathologic stage I; 19, stage II; 12, stage III; and one, stage IV. Histologically, multifocal nodular aggregates of discohesive pleomorphic tumor cells were seen interspersed in dense and fibrotic breast parenchyma. Twenty-nine percent of the specimens demonstrated associated signet ring cells. The remainder had dishesive, globoid, plasmacytoid cells with high-grade nuclear features. PLCIS was identified in 17 of 38 patients (45%), and lobular carcinoma in situ (LCIS) was noted in 8 patients (21%). IHC analysis showed estrogen immunoreactivity in 81%, progesterone in 67%, GCDFP-15 in 71%, and Her 2 in 81% (2+ to 3+ membranous staining) of specimens. Antibodies to p53 stained the tumor cell nuclei in 48% of the tumors. Loss of heterozygosity was identified in 52% of the specimens at the p53 locus, 18% at the ESR locus, 19% to 24% at the Her 2 loci, and 27% to 32% at the BRCA 1 locus. Follow-up was available in 19 patients and ranged from 12 months to 15 years (mean, 73 months). Seven patients had no evidence of disease at last examination (range, 1-15 years), three patients were alive with disease (range, 2-14 years), and nine patients were dead of disease (range, 2 months-9 years). Six patients had subsequent diagnoses of tumor in the contralateral breast. Analysis shows that PLC tends to appear in older postmenopausal women who present with locally advanced disease. PLCIS was found to be associated with PLC 45% of the time. The aggressive clinical course of patients with PLC is supported by tumor immunoreactivity with unfavorable markers Her 2 and p53. Overexpression of Her 2 in PLC may be therapeutically relevant, enabling the use of novel chemotherapeutic drugs like Herceptin. Interestingly, tumors that were Her 2 immunoreactive also maintained estrogen hormone immunoreactivity.

Metaplastic lipid-rich carcinoma of the breast

A case of lipid-rich mammary carcinoma identified in a lumpectomy specimen from a 56-year-old female is presented. The tumor showed features of poorly differentiated invasive ductal carcinoma of clear-cell phenotype. Cytoplasmic lucency was mainly accounted for by the accumulation of neutral fat and, to a lesser degree, glycogen. Tinctorial properties included positivity of tumor cells with Sudan III dye and diastase-sensitive periodic acid-Schiff staining. Ultrastructural examination confirmed the presence of abundant cytoplasmic lipid droplets and some glycogen rosettes. On immunohistochemistry, most tumor cells reacted for cytokeratin, vimentin and S-100 protein, and there was focal expression of carcinoembryogenic antigen. A minority of tumor cell nuclei expressed progesterone receptors. As an additional feature, part of the lesion exhibited chondroid metaplasia. Lipid-rich carcinoma of the breast is exceedingly rare and, to our knowledge, no such example harboring metaplastic elements has been described previously.

Lipid-Secreting Carcinoma of the Breast: A Case Report and Review of the Literature

A case of lipid-secreting carcinoma in the right breast of a 78-year-old Japanese woman is reported. Light microscopy revealed solid alveolar proliferation in the majority of tumor cells, which had abundant foamy cytoplasm. A variable amount of neutral lipid was identified in the cytoplasm of the tumor cells by Sudan III staining and electron microscopy. This case is reported along with a discussion of other cases of lipid-secreting or lipid-rich carcinoma that have been reported in the international literature.

Breast carcinoma in patients receiving neuroleptic therapy. Morphologic and clinicopathologic features of thirteen cases

We report 13 cases of breast carcinoma in patients treated with neuroleptics (prolactin-releasing drugs). Twelve of the patients were female and one was male. Nine patients had unicentric carcinoma, one had multicentric tumors arising synchronously, and three had bilateral tumors (synchronous in one case and metachronous in two cases). Thirteen tumors in ten patients were invasive ductal carcinomas, two tumors in one patient were mucinous carcinomas, and the two other patients had lipid-secreting carcinomas. Immunohistochemical staining showed alpha-lactalbumin (alpha-LA) in the lipid-secreting carcinomas at sites exhibiting active lipid secretion. A precise cause-effect relationship is difficult to elucidate, since the patients ranged in age from 40 to 64 years (mean: 51 years) when cancer was first diagnosed. However, the relatively high incidence of multiple tumors and the production of lipid and alpha-LA by the cancer cells were unusual features suggesting an association with neuroleptic therapy.