Ductal carcinoma of male breast with prominent lipid-rich component

Cytomorphological features of sebaceous carcinoma of the breast

Sebaceous carcinoma of the breast is an extremely rare histological subtype of breast cancer, with fewer than 30 cases reported to date. Because of its extremely rare histological presentation, there are few case reports that highlight its cytological findings. In this case report, the cytomorphological features of a sebaceous carcinoma of the breast are described in detail. Cytomorphological analysis revealed atypical cells presenting predominantly as loose clusters. No tubular or papillary structures were evident in the clusters and no mucin production was observed. The diagnosis of sebaceous carcinoma of the breast requires prominent sebaceous differentiation of cells. In Papanicolaou-stained smears, the differentiated tumor cells were found within the yellowish clusters. When these yellowish clusters were observed at high magnification and shifted out of focus, the sebaceous differentiation of tumor cells could be recognized. This finding is an advantage of observing Papanicolaou-stained specimens. Like previous reports, some individual cells showing sebaceous differentiation were also observed. In cases where many yellowish clusters appear, close observation of the interior of the clusters can confirm the presence of sebaceous differentiation of tumor cells and serve as a diagnostic clue for the cytological diagnosis of sebaceous carcinoma of the breast.

Special type breast carcinoma: Sebaceous carcinoma of the breast; A case report and review of literature

Sebaceous carcinoma of the breast is an extremely rare tumor. To the best of our knowledge only 15 cases have been reported in literature. Herein, we report a case of sebaceous carcinoma of the breast and describe the histopathologic features of sebaceous carcinoma of the breast in an elderly female.

Sebaceous Carcinoma of the Breast: Fact or Fiction? A Case Report and a Review of the Literature

Introduction. Previously considered an exceedingly rare entity, sebaceous carcinoma of the breast is now regarded in the World Health Organization 2019 classification as a "special histopathological pattern" of invasive breast carcinoma of no special type. Case Description. In this article, we report the case of a fine needle aspiration cytology and the histopathological features of a breast carcinoma with clear-cut morphological features suggesting sebaceous differentiation, but showing no positive staining with the anti-adipophilin antibody. Conclusions. A morphologically clear-cut sebaceous differentiation is not invariably associated with adipophilin positivity; moreover, in breast carcinoma, adipophilin positivity does not automatically imply sebaceous differentiation. At present, immunomorphological evidence for the recognition of sebaceous carcinoma as a "special type" breast carcinoma subtype is too weak.

Sebaceous carcinoma of the breast predominantly characterized by intraductal growth: a case report

Background

Sebaceous carcinoma (SC) is frequently classified as periocular or extraocular. Extraocular SC is rare and mainly occurs in the head and neck, the major salivary glands, or oral mucosa. SC of the breast, lung, and ovary is particularly rare, and the few cases of SC of the breast predominantly exhibit intraductal growth.

Case presentation

A 47-year-old Japanese woman was referred to our hospital with accumulated polymorphic calcification in the left breast which was detected using mammography. Ultrasonography revealed an irregular 13-mm mass in the left breast, and analysis of a core needle biopsy revealed noninvasive ductal carcinoma. Total mastectomy and sentinel lymph node biopsy were performed. Histopathology demonstrated that carcinoma in situ (CIS) represented a significant lesion, and the cytoplasm of tumor cells was clear with numerous minute vacuoles. Immunohistochemical analysis demonstrated that most tumor cells expressed adipophilin. Together, these findings led to a diagnosis of SC, mainly comprising CIS.

Conclusions

We encountered a rare case of SC of the breast with predominant CIS.

Sebaceous carcinoma of the breast in a patient with a pathogenic BRCA2 (886delGT) mutation - focus on histopathologic and immunohistochemical features

Sebaceous carcinoma of the breast (SCB) is a rare variant of ductal carcinoma arising within the mammary gland and containing at least 50% of malignant cells with sebaceous differentiation. Only 11 cases that adjust to the criteria delineated in the WHO classification have been published in the English literature, to the best of our knowledge. Here, we present the first SCB arising in the context of a deleterious BRCA2 mutation, focusing on the histopathologic and immunohistochemical features of this exceedingly rare tumor.

Lipid-Rich Carcinoma of the Breast. A Clinicopathological Study of 49 Cases

Aims and Background

Lipid-rich carcinoma is a very rare variant of breast cancer with an aggressive clinical course and poor prognosis. The present study aimed to explore its clinicopathologic characters.

Methods and Study Design

We reviewed 3,206 cases treated in two centers in the last 10 years. They all met the criteria of positive oil red O staining, were PAS negative and had the typical histological features included in the study. Their clinical data were collected. The expression of estrogen and progesterone receptors, HER2 and Ki67 was evaluated by immunohistochemistry.

Results

Forty-nine patients were diagnosed with lipid-rich carcinomas. They were all female and ranged in age from 22 to 72 years (mean, 45). The presenting symptoms included a breast mass or lump and nipple discharge. Axillary lymph node metastases were found in 79.2% of the patients at the time of surgery. Respectively 100% and 89.8% were negative for estrogen and progesterone receptors, whereas 71.4% were positive for HER2. All patients received surgery plus chemotherapy with or without radiotherapy. In vitro MTT assay showed taxol- or platinum-based chemotherapy to be the most effective. The 2- and 5-year overall survival rates were 64.6% and 33.2%, respectively.

Conclusions

Lipid-rich carcinoma has a biopathological profile significantly different from other types of breast cancer, with a predominance of unfavorable prognostic parameters. Early diagnosis and active treatment may be helpful to increase its overall survival.

Sebaceous carcinoma of the breast: a case report

Background

Sebaceous carcinoma of the breast is a distinct variant of invasive ductal carcinoma. It is rare and only several cases have been reported.

Case presentation

An 80-year-old woman noted bloody discharge from her left nipple and palpated a lump in her left breast. Ultrasonography revealed a 19-mm mass in the left breast. Fine-needle aspiration suggested invasive ductal carcinoma. Partial mastectomy and sentinel lymph node biopsy were performed. On histological examination, the tumor revealed solid growth of small, round uniform cells with clear cytoplasm, partially intermingled with vacuolated cells indicative of sebaceous differentiation. The tumor cells contained abundant Sudan Black B-positive lipid droplets in the cytoplasm, and they were immunohistochemically positive for adipophilin. They were negative for estrogen receptor, progesterone receptor, and androgen receptor; positive for cytokeratin 7 and Ber-EP4; and partially positive for epithelial membrane antigen. Based on these findings, the patient was diagnosed with sebaceous carcinoma of the breast.

Conclusions

We diagnosed a rare case of sebaceous carcinoma of the breast.

Lipid-rich Carcinoma of the Mammary Gland in a Cat

A 1.5-year-old female, intact, clinically healthy cat presented for a subcutaneous mass of the ventral abdomen. surgical excision and microscopic examination of the mass were performed. Histologically, this was a discrete, unencapsulated, multilobular, expansile mass, which compressed the surrounding normal mammary tissue. Lobules were composed of tubuloacinar structures formed by atypical round to polygonal cells, which contained foamy to microvacuolated cytoplasm and variably sized, intracytoplasmic, distinct vacuoles causing nuclear peripheralization. Neoplastic cells demonstrated intense and diffuse immunoreactivity for cytokeratin and lacked immunoreactivity for vimentin. The vacuolar contents stained positively with oil RedO and negatively with periodic acid-Schiff and Alcian blue stains. Histomorphologic, histochemical, and immunohistochemial analysis support a diagnosis of lipid-rich mammary carcinoma. This is the first report of a cat with a lipid-rich variant of mammary carcinoma.

Sebaceous metaplasia in a canine mammary gland non-infiltrative carcinoma with myoepithelial component

Sebaceous metaplasia in canine mammary tumors is a rare condition with only 1 case documented. The current study describes a case of sebaceous metaplasia in a mammary gland carcinoma of an 8-year-old intact, nulliparous female Poodle dog with a subcutaneous tumor located in the left fifth mammary gland. The lesion measured 0.7 cm × 0.5 cm × 0.6 cm in diameter, was firm, circumscribed, painless, non-haired, and non-ulcerated, and did not adhere to deep tissues. The cut surface was non-lobulated, non-encapsulated, whitish to gray, and opaque. Histological evaluation revealed 3 different populations of cells: the first was composed of columnar to cuboidal malignant epithelial cells arranged in intraductal papillary projections, the second of myoepithelial cells associated with a myxoid stroma, and the third presenting sebaceous metaplasia similar to those previously described in both human and veterinary medicine.

Metaplastic Carcinoma of the Breast With Dominant Squamous and Sebaceous Differentiation in the Primary Tumor and Osteochondroid Metaplasia in a Distant Metastasis

Metaplastic breast carcinoma is an uncommon tumor that develops from conventional ductal mammary carcinoma, usually consisting of squamous and/or spindle cell components and/or mesenchymal elements. Although several morphological subtypes of metaplastic breast carcinoma are known, sebaceous metaplasia has not yet been described in this context. The authors report a case of an 84-year-old woman with a huge, ulcerated primary tumor in her left breast that had already been present for 10 years. Pulmonary and bone metastases and a tumor nodule in the contralateral breast were also detected at the time of admission. Left simple mastectomy was performed. Histological examination of the tumor revealed metaplastic carcinoma consisting of ductal carcinoma, which immunohistochemically exhibited a triple-negative immunoprofile, along with dominant areas of squamous and sebaceous differentiation. Adjuvant chemotherapy was subsequently given with partial regression of the systemic metastases. Seven months after surgery and diagnosis, a new, rapidly growing, large soft tissue metastatic tumor appeared in the intramuscular compartment of the patient’s right thigh, which was removed and histologically examined. Morphologically this metastatic tumor showed ductal adenocarcinoma along with areas of sebaceous differentiation and, in addition, osteochondroid metaplasia. Immunohistochemically, unlike the primary, this tumor expressed HER-2. The case is presented because of its rarity, and sebaceous differentiation is also proposed as a novel type of metaplasia in this context, expanding the spectrum of the histological patterns of metaplastic breast carcinoma. The literature concerning breast sebaceous lesions is reviewed, and the hypothetical biological mechanisms responsible for the tumor pathogenesis in this case are discussed.

A case report of lipid-rich carcinoma of the breast including histological characteristics and intrinsic subtype profile

A 57-year-old Japanese woman with schizophrenia, who had received long-term treatment with neuroleptics, noticed a painless, pea-sized lump in her right breast. She was admitted to our hospital and a malignant tumor was diagnosed. The patient underwent a conservative radical mastectomy (Patey's operation). The excised tumor measured 2.0 × 1.2 × 1.1 cm in diameter, and its cut surface was grayish-white. Histologically, tumor cells with clear to foamy cytoplasm were invariably Oil Red O-positive and periodic acid Schiff-negative with or without diastase digestion. The tumor was diagnosed as a lipid-rich carcinoma accompanied by an in situ component. Neuroleptics increase serum prolactin levels by interfering with dopaminergic inhibition of prolactin secretion. Immunohistochemical analysis revealed that, although prolactin was not detected, the tumor cells expressed prolactin receptor, indicating prolactin as the genesis of this neoplasm. In immunohistochemical intrinsic subtype analysis, the tumor was negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 1 and 2, and basal cytokeratins (CK5, CK6, and CK14), indicating an unclassified (all-marker negative) subtype. Axillary lymph nodes were free of metastasis (stage I), and the patient has been well for 20 years without any evidence of recurrence.

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.

Lipid-rich carcinoma in the mammary gland of a Djungarian hamster (Phodopus sungorus)

A lipid-rich carcinoma of the mammary gland was diagnosed in a female Djungarian hamster (Phodopus sungorus), which was kept as an indoor pet. The animal underwent surgery for a primary tumor arising in the mammary gland at the age of 16 months, and also for a recurrent tumor 6 months later. Histologically, the primary neoplasm was composed of 2 different cell populations: nonvacuolated glandular neoplastic cells with moderate atypia, and vacuolated neoplastic cells with marked atypia. Transition from the nonvacuolated glandular cells to the vacuolated cells was frequently seen. The recurrent neoplasm was composed predominantly of vacuolated neoplastic cells that often invaded the surrounding soft tissue. The cytoplasmic vacuoles contained neutral lipids, as confirmed by oil red O and Nile blue staining. The vacuolated neoplastic cells were immunopositive for cytokeratin and negative for vimentin, alpha-smooth muscle actin, p63, estrogen receptor alpha, and androgen receptor. Presumably, this high-grade, lipid-rich mammary carcinoma had developed from a low-grade mammary adenocarcinoma.

Mammary carcinoma with sebaceous differentiation in a dog

This report describes an invasive mammary carcinoma with a rare distinctive feature characterized by sebaceous differentiation of tumor cells. This tumor occurred in a 10-year-old female mixed breed dog. The patient had two masses in the left fifth mammary gland. Grossly, the masses were firm, whitish to light brown, and superficially ulcerated. On cut surface, they were multilobulated with foci of necrosis. Microscopically, the tumors were composed of two distinctive neoplastic components, intraductal papillary adenocarcinoma and sebaceous carcinoma. The regions of sebaceous tumor were clumped separately, contained well-developed sebaceous cells and keratinized epithelial cells, and were surrounded by few to several layers of basaloid cells. The cells with abundant foamy cytoplasm that resembled sebaceous cells were also found within the intraductal papillary-like nests of mammary carcinoma, providing evidence of sebaceous metaplasia. Sebaceous differentiation in a mammary gland tumor is possible, because skin appendages and ductal apparatus of the mammary gland share a common anlagen. This tumor had an aggressive behavior with lymphatic metastasis. Consequentially, the dog had a poor prognosis.

Sebaceous carcinoma of the breast: case report and review of the literature

Sebaceous differentiation has been described in only limited examples of benign and malignant epithelial lesions of the breast. We report a rare case of mammary sebaceous carcinoma to further delineate its morphologic features. Microscopically, the tumor, arising in the right mammary gland of a 63-year-old woman, was composed of well-defined solid sheets or lobules of atypical epithelial cells including many large pale or clear cells with often scalloped nuclei and coarsely vacuolated cytoplasm, in which abundant lipid droplets were identified with oil-red-O staining. Immunohistochemical expressions of cytokeratin, epithelial membrane antigen, and receptors of estrogen and progesterone were detected, whereas GCDFP-15, S-100 protein, vimentin, alpha-smooth muscle actin, p63, androgen receptor, and the HER2/neu protein were not expressed. Besides, a subset of the tumor cells co-expressed synaptophysin, neurofilament, and PGP9.5, suggesting neuroendocrine differentiation that is a hitherto undescribed phenomenon in the mammary tumors with sebaceous features. This case would expand the morphologic diversity of carcinoma of the breast.

Sebaceous carcinoma of the breast

We report on a rare distinctive variant of infiltrating ductal carcinoma characterized by sebaceous differentiation of tumor cells. The neoplasm was identified in a lumpectomy specimen from a 45-year-old woman with extensive metastatic disease. In addition to conventional in situ and invasive ductal components, approximately half of the tumor cells exhibited a phenotype resembling tumors of the sebaceous skin appendage with coarsely vacuolated cytoplasm and peripherally displaced nuclei. The sebaceous moiety was also present in the distant metastatic deposits. There was no evidence of mucin production by tumor cells. Ultrastructurally, empty-appearing non-membrane bound vacuoles attested to the sebaceous cells' lipid content. The immunoprofile of the lesion included positivity for cytokeratin and epithelial membrane antigen. Vimentin, S100 protein and carcinoembryonic antigen were not expressed. Most tumor cell nuclei reacted with antibodies to oestrogen and progesterone receptors but failed to show overexpression of the HER2/neu protein. The MIB-1 labeling index averaged 16%. At variance with sebaceous breast carcinomas on record, the present case is notable for its prolonged clinical course.