Lipid-rich versus lipid-secreting carcinoma of the mammary gland

Assessment of breast cytoarchitecture and its associated axillary lymph node status under normal and pathological conditions in Egyptian women

OBJECTIVE

Herein, we compare the features of neoplastic cancer cells in invasive ductal carcinoma (IDC) grade II and III patients to their corresponding normal cells both in breast and axillary lymph node (ALN) tissues.

METHODS

A retrospective cohort of 70 female breast cancer patients enrolled between 2018 and 2020 at Medical Research Institute, Alexandria University, Egypt, was analyzed for clinicopathological features presentation. Fresh tiny pieces of breast tissue and its associated ALN tissues were then processed to investigate the morphological appearance by scanning electron microscopy. Moreover, the histological architecture of tissue sections stained with hematoxylin and eosin was studied by light microscope, while the characterization of the ultrastructure features of breast and ALN tissues was analyzed by transmission electron microscopy.

RESULTS

Clinicopathological presentation of patients revealed that the Egyptian female breast cancer population adhered to the global trends of breast cancer disease with elevated incidence rate among postmenopausal women (61.3%), high frequency of IDC (95.7%), and increased ALN metastasis (65.7%). The percentage of estrogen receptor alpha (ERα) and human epidermal growth factor receptor 2 (HER2) expression, as key indicators for carcinogenesis and disease progression was 87.1% and 55.8%, respectively. The present study points to the observed discrepancies among the investigated variables in the diagnostic separation between IDC grade II and grade III. Ductal epithelial cells organization, nuclei size and irregularity, chromatin amount and uniformity, mitochondrial abundance and dysfunction were differentially manifested in IDC grades. Moreover, aberrations in the cellular organelles like lysosomes, endoplasmic reticulum, and lipid droplets vary according to the grade of IDC and the aggressiveness of the invasive breast cancer.

CONCLUSIONS

To sum up, this study emphasizes the importance of accurate specimen evaluation for treatment choice and decision.

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: A report of two cases and a literature review

Lipid-rich carcinoma of the breast is extremely rare with no standard guidelines for treatment with poor patient prognosis. In the present study, the clinical features, imaging results, pathology, immunohistochemistry, treatment and prognoses of two patients with lipid-rich carcinoma of the breast were analyzed. Two patients were admitted to the Yantai Yuhuangding Hospital Affiliated to the Medical College of Qingdao University (Yantai, Shandong, China) for examination of a palpable mass in the breast. Enlarged lymph nodes were found in the axilla of each patient. The results of mammography and echography imaging suggested the presence of malignancy. A modified radical mastectomy was performed in each patient, and pathological examination revealed atypical large vacuolated cells arranged in clusters and confirmed lipid-rich carcinoma and lymph node metastases. The tumor tissue of patient one was immunohistochemically positive for estrogen receptor (ER), p53, p120 and E-cadherin, and negative for progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2), with a Ki-67 labeling index of 50%. The tumor tissue of patient two was immunohistochemically positive for p53, and negative for ER, PR, HER-2 and cytokeratin 5/6, with a Ki-67 labeling index of 30%. Post-surgery, patient one was administered chemotherapy for six cycles, radiotherapy and endocrine therapy in the form of anastrozole. Patient two was administered three cycles of chemotherapy without radiotherapy. Subsequent to being followed up for 25 months and 13 months, respectively, there was no evidence of recurrence or distant metastasis in patient one or two, respectively.

Unusual occurrence of rare lipid-rich carcinoma and conventional invasive ductal carcinoma in the one breast: case report

A 56-year-old woman noticed a palpable mass in her left breast during self-examination. Patient was admitted to our hospital and malignant bifocal tumour was diagnosed by ultrasonography, digital mammography, magnetic resonance, and core-cut biopsy. The patient underwent planned conservative surgery (biquadrantectomy) with a sentinel node examination, but after results of the frozen section with positive resection margins and positive sentinel lymph nodes subsequent mastectomy with axillary lymph node dissection were realized. Histology in the resection specimen revealed two isolated and distinct tumours. One of the lesions represented conventional invasive ductal carcinoma of histological grade 3, and the second tumour was evaluated as invasive lipid-rich carcinoma, containing tumour cells with clear and foamy cytoplasm. Lipids in neoplastic cells were detected by Oil Red O staining and ultrastructural examination. Immunohistochemical analysis of both carcinomas was almost identical with negative steroid receptors, positive staining of HER-2, and p53 and with high proliferation activity (Ki-67). Mastectomy specimen contained residual foci of invasive ductal carcinoma and dissected axillary lymph nodes were free of metastasis. Patient underwent first cycles of chemotherapy with paclitaxel and Herceptin together with local radiotherapy and two month after surgery is without any evidence of the disease.

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.

A non-invasive form of lipid-secreting carcinoma of the breast

Lipid-secreting carcinoma is a rare variant of breast carcinoma. The tumor cells possess abundant vacuolated cytoplasm containing neutral fat. A 68-year-old Japanese female patient presented with a left breast tumor, which was detected by mass screening, and she was admitted to our hospital. The physical examination revealed an elastic hard lump in the left lateral quadrant of the left breast. The tumor size was 1.2 × 1.0 cm in diameter and the borderline was unclear. There were no palpable axillary lymph nodes or supraclavicular nodes. Mammography showed a polygonal mass with microcalcification. Ultrasonography indicated a hypoechoic lesion measuring 9 × 4 mm in diameter, with an irregularly shaped, slightly indistinct surface. The internal echoic level of the mass was heterogenous. Enhanced magnetic resonance imaging revealed a mass of high intensity in the left breast, and the connection of the intraductal spread was not detected. The time-intensity curve showed a peak-and-plateau pattern. Fine-needle aspiration cytology suggested a malignant tumor. The patient underwent a partial resection of the left breast (breast-conserving therapy) and a left axillary lymphadenectomy. Macroscopically, the resected specimen revealed a white tumor measuring approximately 0.6 × 0.5 cm. Histopathologically, the tumor measured up to approximately 0.9 × 0.7 cm because of additional components of intraductal spread and therefore was diagnosed as an extensive ductal carcinoma in situ with focal mass formation; the tumor also had abundant foamy cytoplasm. Oil-red-O staining confirmed the presence of marked cytoplasmic lipid droplets. These droplets were periodic acid-Schiff (PAS) negative even after diastase digestion, and negative with PAS-Alcian blue staining. In immunohistochemistry, these carcinoma cells were positive for E-cadherin. Thus, the pathological diagnosis was a non-invasive form of lipid-secreting carcinoma. The tumors were negative for both estrogen receptors and progesterone receptors. There were no metastases in the left axillary lymph nodes. The patient has remained well for 8 years without any evidence of recurrence.

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.

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.

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

Five cases of lipid-rich carcinomas of the breast were investigated ultrastructurally and immunohistochemically for alpha-lactalbumin (ALA), lactoferrin (Lfr) and human milk fat globule membrane antigen (HMFG-2). Staining for ALA and Lfr showed intensive reaction on nearly all of the tumour cells whereas immunoreaction for HMFG-2 revealed positivity in single cells. All tumours were negative for steroid receptor content. Ultrastructurally the tumour cells showed numerous intracytoplasmic non-membrane bound lipid droplets which were often found within autophagocytic vacuoles. Neither rough endoplasmic reticulum nor Golgi complexes showed any sign of lipid synthesis. Extrusion of lipid droplets and extracellular lipid deposition was not observed. In conclusion, our findings do not justify the consideration of lipid-rich carcinoma of the breast as a clearly defined group of tumours with specific secretory activity. Therefore, the term lipid-rich carcinoma should be used in preference to lipid-secreting, unless there is evidence of active lipid secretion.