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Mihara Y, Yamaguchi R, Takahashi R, Yano Y, Yano H. Intraductal papilloma with atypical ductal hyperplasia and neuroendocrine differentiation as a possible precursor lesion of solid papillary carcinoma. Med Mol Morphol 2023; 56:227-232. [PMID: 37284860 DOI: 10.1007/s00795-023-00357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023]
Abstract
Breast papillary neoplasms include a wide range of tumor types, and their pathological diagnosis is sometimes difficult. Furthermore, the etiology of these lesions is still not fully understood. We report the case of a 72-years-old woman referred to our hospital with bloody discharge from the right nipple. An imaging study detected a cystic lesion, including a solid component contiguous with the mammary duct, in the subareolar region. The lesion was then removed by segmental mastectomy. Pathological examination of the resected specimen revealed an intraductal papilloma with atypical ductal hyperplasia. Moreover, the atypical ductal epithelial cells expressed neuroendocrine markers. The presence of an intraductal papillary lesion with neuroendocrine differentiation suggests solid papillary carcinoma. Thus, this case suggests that intraductal papilloma could be a precursor of solid papillary carcinoma.
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Affiliation(s)
- Yutaro Mihara
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan.
| | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Japan
| | - Ryuji Takahashi
- Department of Surgery, Social Insurance Tagawa Hospital, Tagawa, Japan
| | - Yuta Yano
- Department of Pathology, Social Insurance Tagawa Hospital, Tagawa, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
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2
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Yamada M, Otsuki Y, Ikeya T, Shimizu SI, Tanioka F, Ogawa H, Kobayashi H. Cytological study of 44 cases with solid papillary carcinoma and a systemic review of solid papillary carcinoma and neuroendocrine tumor of the breast. Diagn Cytopathol 2023; 51:341-348. [PMID: 36748676 DOI: 10.1002/dc.25112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Solid-papillary carcinoma (SPC) of the breast is a rare variant of low-grade in situ and invasive carcinoma but there are only a few of the cytologic studies. METHODS We examined 44 cases of SPC of the breast to define the cytologic features. We also made a systemic review of reported cases of SPC and neuroendocrine tumor (NET) of the breast. RESULTS Both of our and the reviewed cases with SPC were very similar in the cytologic finding. It included hypercellularity, highly discohesive clusters, numerous isolated cells, small nuclei, finely granular chromatin of salt-and-pepper appearance, inconspicuous nucleoli, low nuclear-cytoplasmic ratio, and a plasmacytoid appearance. Moreover, SPC and NET had frequently all of these features in common. Capillary vessels structures and mucinous substance were not frequently seen in our and the reviewed cases with SPC. Rosette and pseudorosette were very rare in the cytologic specimen. The immunocytochemistry with our 9 cases with SPC indicated diffuse positivity for chromogranin A and/or synaptophysin. CONCLUSION Many cytologic features are frequently shared by SPC and NET of the breast. However, the vascular structure may not be a precise criterion for SPC. Rosette and pseudorosette are rarely helpful for the cytologic diagnosis.
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Affiliation(s)
- Makoto Yamada
- Department of Clinical Laboratory, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomonari Ikeya
- Department of Clinical Laboratory, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shin-Ichi Shimizu
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Fumihiko Tanioka
- Division of Pathology and Laboratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Hiroshi Ogawa
- Department of Pathology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroshi Kobayashi
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Japan
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3
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Joneja U, Palazzo J. The Spectrum of Mucinous Lesions of the Breast. Arch Pathol Lab Med 2023; 147:19-29. [PMID: 36577093 DOI: 10.5858/arpa.2022-0054-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 12/29/2022]
Abstract
CONTEXT.— Mucinous lesions of the breast encompass many entities ranging from benign to malignant and nonneoplastic to neoplastic. Lesions discussed under this category are mucocele-like lesion, mucinous carcinoma, mucinous micropapillary carcinoma, solid papillary carcinoma, mucinous cystadenocarcinoma, mucoepidermoid carcinoma, invasive lobular carcinoma with extracellular mucin, mucinous ductal carcinoma in situ, and metastasis. OBJECTIVE.— To review clinical, pathologic, and molecular features of mucinous lesions of the breast, their differential diagnoses, and challenging features on core needle biopsies. DATA SOURCES.— The existing scientific and clinical literature as of December 2021. CONCLUSIONS.— The category of mucinous lesions of the breast is vast and the differential diagnosis can be challenging, especially on core needle biopsies. In all cases, clinical, radiologic, and pathologic correlation is necessary to reach a comprehensive diagnosis. Given that the prognosis and management of each entity is different, being aware of these entities and their nuances is critical for a pathologist to guide accurate management.
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Affiliation(s)
- Upasana Joneja
- From the Department of Pathology, Cooper University Hospital, Camden, New Jersey (Joneja)
| | - Juan Palazzo
- The Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Palazzo)
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4
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Ravi PY, Walsh NM, Archibald C, Pasternak S. Endocrine Mucin-Producing Sweat Gland Carcinoma: Emerging Evidence of Multicentric Cutaneous Origin and Occasional Concurrence With Analogous Breast Tumors. Am J Dermatopathol 2022; 44:321-326. [PMID: 35170475 DOI: 10.1097/dad.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a low-grade carcinoma with predilection for the eyelid. It is analogous to solid papillary carcinoma of the breast with both expressing neuroendocrine markers and the potential to progress to invasive mucinous carcinoma (IMC). Although over 80 cases of EMPSGC have been reported, few multicentric cases have been described in the literature. In this article, we report 9 cases of EMPSGC including 3 with multicentric disease. METHODS A computerized search was performed for EMPSGC and IMC of the eyelid from January 2000 to February 2021. Records were reviewed for age, sex, tumor location, and clinical impression. RESULTS Eight EMPSGC (7 associated with IMC) and 1 IMC of the eyelid were identified. Lesions were slightly more common in men (55%) than women. The mean age of presentation was 76 years (range, 59-98 years). Lesions ranged from 2.5 to 12 mm. Three cases had multicentric synchronous lesions on the skin. Histologically, these were well-circumscribed dermal tumors with solid or partially cystic nodules. Tested tumors expressed at least 1 neuroendocrine marker and were positive for CK7, ER/PR, 1 or more of GCDFP-15, mammaglobin, and GATA-3. One case had an associated IMC of the breast, and another case was associated with an intraductal papilloma of the breast in a man. There was no evidence of metastasis. CONCLUSION EMPSGC is a low-grade adnexal neoplasm, commonly affecting the eyelid of the elderly. Lesions often progress to IMC, metastases being exceptionally rare. EMPSGC can be bilateral and multicentric. Concurrence with breast neoplasms has been observed and deserves investigation.
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Affiliation(s)
- Priyanka Y Ravi
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences, Nova Scotia Health (Central Zone), Halifax, Nova Scotia, Canada ; and
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences, Nova Scotia Health (Central Zone), Halifax, Nova Scotia, Canada ; and
- Departments of Pathology
- Medicine, and
| | - Curtis Archibald
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences, Nova Scotia Health (Central Zone), Halifax, Nova Scotia, Canada ; and
- Departments of Pathology
- Medicine, and
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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5
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Li Z, Dabbs DJ. Avoiding "False Positive" and "False Negative" Immunohistochemical Results in Breast Pathology. Pathobiology 2022; 89:309-323. [PMID: 35249034 DOI: 10.1159/000521682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Immunohistochemistry (IHC) plays an important role in the evaluation of breast pathology specimens to provide both diagnostic and prognostic/therapeutic information. Although most IHCs used in breast pathology can be easily interpreted, pitfalls do exist, especially in some uncommon scenarios. This review intends to focus on the challenging areas such as the interpretation of myoepithelial cell markers in differentiating benign proliferation and in situ carcinoma from invasive carcinoma, lobular cell markers in differentiating lobular from ductal carcinoma, cytokeratin and other markers in diagnosing metaplastic carcinoma, and breast tissue origin markers in diagnosing breast primary carcinoma. The challenges in interpreting prognostic and predictive markers will be also discussed.
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Affiliation(s)
- Zaibo Li
- The Ohio State University, Columbus, Ohio, USA
| | - David J Dabbs
- Chief of Pathology and Director of Second Opinion Service, PreludeDx, Laguna Hills, California, USA
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6
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Papillary neoplasms of the breast-reviewing the spectrum. Mod Pathol 2021; 34:1044-1061. [PMID: 33462367 DOI: 10.1038/s41379-020-00732-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022]
Abstract
Papillary neoplasms of the breast encompass a wide range of tumor types ranging from the benign intraductal papilloma to in situ and invasive papillary carcinomas. In this review, we considered each tumor entity listed under the Papillary Neoplasms category in the latest WHO Classification of Breast Tumors (5th edition), namely intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma, solid-papillary carcinoma, and invasive papillary carcinoma. We examined their pathological features, current issues pertaining to diagnosis and prognostication, as well as the latest molecular findings. We also briefly addressed adenomyoepithelioma and the newly included tall cell carcinoma with reversed polarity, highlighting areas where they overlap with papillary neoplasms.
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7
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Froehlich MH, Conti KR, Norris II, Allensworth JJ, Ufkes NA, Nguyen SA, Bruner ET, Cook J, Day TA. Endocrine Mucin-Producing Sweat Gland Carcinoma: A Systematic Review and Meta-Analysis. J DERMATOL TREAT 2021; 33:2182-2191. [PMID: 34057875 DOI: 10.1080/09546634.2021.1937479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endocrine Mucin-Producing Sweat Gland Carcinoma is a rare, under-reported cutaneous adnexal tumor that is often misdiagnosed and has an unknown incidence of metastasis. OBJECTIVE To determine the incidence of metastasis and tumor recurrence, as well as diagnostic accuracy and current trends in treatment modality. METHODS A search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Tumor pathology and clinical data concerning demographics, presentation, diagnosis, treatment and follow-up were assessed. RESULTS A total of 36 publications with 110 cases were identified. Initial pathological diagnosis was incorrect in 45.5% of cases. One case of metastatic disease was reported. The incidence of locoregional recurrence was 10.6% over a mean follow-up period of 21.3 months. Of cases with known methods of resection, 34.6% were resected by excisional biopsy, 42.8% were resected by wide surgical excision, and 31.3% were cleared by Mohs micrographic surgery. LIMITATIONS The low reported incidence and level of evidence was suboptimal with only case reports and retrospective case studies being reported. CONCLUSION Reported cases of this pathology demonstrate poor diagnostic accuracy. High rates of misdiagnosis and inadequate definitive treatment suggest the need for more comprehensive work-up and management of lesions suspicious for this pathology.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keith R Conti
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ivy I Norris
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jordan J Allensworth
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole A Ufkes
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evelyn T Bruner
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joel Cook
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Brogi E, Krystel-Whittemore M. Papillary neoplasms of the breast including upgrade rates and management of intraductal papilloma without atypia diagnosed at core needle biopsy. Mod Pathol 2021; 34:78-93. [PMID: 33106592 DOI: 10.1038/s41379-020-00706-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Abstract
Papillary neoplasms of the breast are a heterogeneous group of epithelial tumors nearly entirely composed of papillae. Their classification rests on the characteristics of the epithelium and the presence and distribution of the myoepithelial cells along the papillae and around the tumor. Papillary neoplasms of the breast can be diagnostically challenging, especially if only core needle biopsy (CNB) material is available. This review summarizes salient morphological and immunohistochemical features, clinical presentation, and differential diagnoses of papillary neoplasms of the breast. We include a contemporary appraisal of the upgrade rate to carcinoma (invasive carcinoma and ductal carcinoma in situ [DCIS]) and atypical hyperplasias in surgical excision specimens obtained following CNB diagnosis of papilloma without atypia, and a review of the available follow-up data in cases without immediate surgical excision.
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Affiliation(s)
- Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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An Update on Endocrine Mucin-producing Sweat Gland Carcinoma: Clinicopathologic Study of 63 Cases and Comparative Analysis. Am J Surg Pathol 2020; 44:1005-1016. [PMID: 32452870 DOI: 10.1097/pas.0000000000001462] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm with predilection for the periorbital skin of older women. Histologically and immunophenotypically, EMPSGC is analogous to another neoplasm with neuroendocrine differentiation, solid papillary carcinoma of the breast. Both lesions are spatially associated with neuroendocrine mucinous adenocarcinomas of the skin and breast, respectively. EMPSGC is ostensibly a precursor of neuroendocrine-type mucinous sweat gland adenocarcinoma (MSC), a lesion of uncertain prognosis. Non-neuroendocrine MSC has been deemed locally aggressive with metastatic potential, and previous works speculated that EMPSGC-associated (neuroendocrine-type) MSC had similar recurrence and metastatic potential with implications for patient follow-up. Only 96 cases of EMPSGC have been reported (12 cases in the largest case series). Herein, we present 63 cases diagnosed as "EMPSGC" in comparison with aggregated results from known published EMPSGC cases. We aim to clarify the clinicopathologic features and prognostic significance of the neuroendocrine differentiation of EMPSGC and its associated adenocarcinoma and to determine the nosological relevance of EMPSGC association in the spectrum of MSC histopathogenesis. Results established an overall female predominance (66.7%) and average presenting age of 64 years. EMPSGC lesions were associated with adjacent MSC in 33.3% of cases. The recurrence rate for neuroendocrine-type MSC was ~21%, less than the reported 30% for non-neuroendocrine MSC. There were no cases of metastasis. EMPSGC and neuroendocrine-type MSC are distinct entities with more indolent behavior than previously reported, supporting a favorable prognosis for patients.
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10
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Lin X, Matsumoto Y, Nakakimura T, Ono K, Umeoka S, Torii M, Yoshibayashi H, Toi M. Invasive solid papillary carcinoma with neuroendocrine differentiation of the breast: a case report and literature review. Surg Case Rep 2020; 6:143. [PMID: 32562013 PMCID: PMC7305294 DOI: 10.1186/s40792-020-00905-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Solid papillary carcinoma (SPC) of the breast is a rare breast cancer that accounts for less than 1% of all breast cancers. The optimal clinical management of SPC remains controversial. Here, we report a case of invasive SPC with neuroendocrine differentiation in addition to review of the current literature. Case presentation A premenopausal 46-year-old female presented with a mass in her left breast that tended to increase in size over a 10-month period. Mammography and ultrasonography revealed a mass in the left upper-inner quadrant. The resulting images suggested a category 3 breast tumor according to the Breast Imaging Reporting and Data System (BI-RADS). A core needle biopsy (CNB) was performed, and the pathological findings showed a solid papillary pattern and atypical cells suggestive of noninvasive SPC. After a left partial mastectomy and sentinel lymph node biopsy (SLNB), the specimens were sent for histopathological analysis for further investigation. Postoperative pathological findings suggested invasive SPC. Whole-breast radiation therapy and adjuvant hormonal therapy were performed as postoperative treatments. Three years after surgery, multiple lung metastases were detected, and the patient was treated with a gonadotropin-releasing hormone agonist and an aromatase inhibitor. Five months later, multiple liver metastases and bone metastases appeared, and oral 5-fluorouracil was chosen for the subsequent treatment. The patient has been treated for 5 years to date, and she is continuing to take oral 5-fluorouracil and is alive without any further disease progression. Conclusions We report a rare case of premenopausal invasive SPC with multiple metastases. Further study is needed to clarify the molecular characteristics and clinical behaviors of SPC and to explore the optimal treatment strategy.
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Affiliation(s)
- Xue Lin
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan. .,Department of Breast Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yoshiaki Matsumoto
- Department of Breast Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomomi Nakakimura
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Shigeaki Umeoka
- Department of Diagnostic Radiology, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Hiroshi Yoshibayashi
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Tariq MU, Idress R, Qureshi MB, Kayani N. Solid papillary carcinoma of breast; a detailed clinicopathological study of 65 cases of an uncommon breast neoplasm with literature review. Breast J 2020; 26:211-215. [PMID: 31532003 DOI: 10.1111/tbj.13521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/25/2022]
Abstract
Solid papillary carcinoma (SPC) is an uncommon breast tumor whose prognosis depends on invasive component. We studied clinicopathological features of SPC by reviewing 65 cases. Invasive component was seen in 75.4% cases. Almost all tumors with grade III nuclei had invasive component. Mean patients' age of invasive tumors was significantly higher than that of non-invasive tumors (P = .036). All patients were alive and disease free except for a single patient who developed distant metastasis and died of disease. SPC have excellent clinical course. Careful search for invasive component is mandatory, especially in tumors with older patient's age and higher nuclear grade.
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Affiliation(s)
- Muhammad Usman Tariq
- Histopathology Section, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idress
- Histopathology Section, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Madiha Bilal Qureshi
- Histopathology Section, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Naila Kayani
- Histopathology Section, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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12
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Maeda I, Tajima S, Kanemaki Y, Tsugawa K, Takagi M. Use of immunohistochemical analysis of CK5/6, CK14, and CK34betaE12 in the differential diagnosis of solid papillary carcinoma in situ from intraductal papilloma with usual ductal hyperplasia of the breast. SAGE Open Med 2018; 6:2050312118811542. [PMID: 30455948 PMCID: PMC6236862 DOI: 10.1177/2050312118811542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives: The aim of this study was to use immunohistochemistry to differentiate solid
papillary carcinoma in situ from intraductal papilloma with usual ductal
hyperplasia (IPUDH). Three types of high-molecular-weight cytokeratins (CKs)
– CK5/6, CK14, and CK34betaE12 – were targeted. Methods: We studied 17 patients with solid papillary carcinoma in situ and 18 patients
with IPUDH diagnosed by at least two pathologists. Immunohistochemical
analyses used antibodies to CK5/6, CK14, and CK34betaE12 to make the
differential diagnosis of solid papillary carcinoma in situ versus IPUDH.
Immunohistochemical staining was scored as 0–5 using Allred score. Results: Immunohistochemistry with CK5/6 and CK14 antibodies produced scores of 0–3 in
all patients with solid papillary carcinoma in situ and 2–5 in all patients
with IPUDH. Immunohistochemical staining with CK34betaE12 antibody produced
scores of 1–3 in all patients with solid papillary carcinoma and 3–5 in all
patients with IPUDH. In tissues from patients with IPUDH, significantly more
cells were stained with CK34betaE12 than CK5/6
(p < 0.05) or CK14 (p < 0.05). Conclusion: The immunoreactivity of CK5/6, CK14, and CK34betaE12 antibodies was useful to
differentiate solid papillary carcinoma in situ from IPUDH. CK34betaE12 is
especially useful for distinguishing solid papillary carcinoma from
IPUDH.
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Affiliation(s)
- Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shinya Tajima
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihide Kanemaki
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
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Held L, Ruetten A, Kutzner H, Palmedo G, John R, Mentzel T. Endocrine mucin-producing sweat gland carcinoma: Clinicopathologic, immunohistochemical, and molecular analysis of 11 cases with emphasis on MYB immunoexpression. J Cutan Pathol 2018; 45:674-680. [PMID: 29882219 DOI: 10.1111/cup.13290] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/20/2018] [Accepted: 06/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare low-grade primary cutaneous sweat gland carcinoma with predilection for the periorbital skin in elderly female patients. METHODS We describe 11 cases of EMPSGC using a broad panel of immunohistochemical markers including BerEP4, cytokeratin 7, CAM 5.2, synaptophysin, chromogranin, cytokeratin 20, Ki67, progesterone receptor, and estrogen receptor. Calponin (1A4) and p63 were used to detect surrounding myoepithelial cells. We also examined staining with a relatively new marker, MYB. Previous studies of MYB on EMPSGC remain limited. As mucin-rich basal cell carcinoma (BCC) represents a main differential diagnosis and primary cutaneous mucinous carcinoma (PCMC) could appear synchronous with EMPSGC, these lesions were also stained for MYB. RESULTS We found strong and homogenous nuclear MYB-expression in 10 EMPSGC cases stained for MYB. MYB staining was not performed in one case. Furthermore, PCMC and mucin-rich BCCs did not express MYB. CONCLUSION The strong nuclear MYB-positivity in EMPSGC could be useful as a new surrogate marker, especially in mucin-poor EMPSGC cases. Additionally, the staining of PCMC revealed absent MYB-expression leading to the conclusion that EMPSGC might not represent a precursor lesion for primary cutaneous mucinous carcinoma.
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Affiliation(s)
- Laura Held
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Arno Ruetten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Heinz Kutzner
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | | | - Rahel John
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Thomas Mentzel
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
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14
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Ki-67 Expression as a Factor Predicting Recurrence of Ductal Carcinoma In Situ of the Breast: A Systematic Review and Meta-Analysis. Clin Breast Cancer 2018; 18:157-167.e6. [DOI: 10.1016/j.clbc.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 12/14/2022]
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15
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Endocrine Mucin-Producing Sweat Gland Carcinoma of the Eyelid Associated With Mucinous Adenocarcinoma. Ophthalmic Plast Reconstr Surg 2018; 34:e37-e38. [DOI: 10.1097/iop.0000000000001002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Tsai TH, Hsieh PP, Hong YC, Yeh CH, Yu LHL, Yu MS. Metastatic primary neuroendocrine carcinoma of the breast (NECB). JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Rakha EA, Ellis IO. Diagnostic challenges in papillary lesions of the breast. Pathology 2018; 50:100-110. [DOI: 10.1016/j.pathol.2017.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 01/20/2023]
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18
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Abstract
Primary neuroendocrine tumors of the breast are a rare and underrecognized subtype of mammary carcinoma. Neuroendocrine tumors of the breast occur predominately in postmenopausal women. The tumors are subclassified into well-differentiated and poorly differentiated neuroendocrine tumors, and invasive breast carcinoma with neuroendocrine features. Well-differentiated tumors show architectural similarity to carcinoids of other sites but lack characteristic neuroendocrine nuclei. Poorly differentiated neuroendocrine tumors are morphologically identical to small cell carcinoma of the lung. Neuroendocrine differentiation, seen in up to 30% of invasive breast carcinomas, is most commonly associated with mucinous and solid papillary carcinomas. The diagnosis of neuroendocrine differentiation requires expression of the neuroendocrine markers synaptophysin or chromogranin. The main differential diagnosis is a metastatic neuroendocrine tumor from an extramammary site. Neuroendocrine tumors of the breast are treated similarly to other invasive breast carcinomas. Although no consensus has been reached on the prognosis, most studies suggest a poor outcome.
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Affiliation(s)
- Lauren Elizabeth Rosen
- From the Department of Pathology, The University of Chicago Medicine, Chicago, Illinois (Dr Rosen); and the Department of Pathology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois (Dr Gattuso)
| | - Paolo Gattuso
- From the Department of Pathology, The University of Chicago Medicine, Chicago, Illinois (Dr Rosen); and the Department of Pathology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois (Dr Gattuso)
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Ueno N, Kuroda H, Kozuka Y, Harada O, Kato H, Kubota K, Imai Y. Dimorphic variant of ductal carcinoma in situ of the breast. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Chong Y, Lee YS, Kim TJ, Park WC, Kang CS, Lee EJ. Fine needle aspiration of spindle cell ductal carcinoma in situ of the breast: A case report and the use of ancillary tests for the differential diagnosis of metaplastic carcinoma. Cytojournal 2017; 14:23. [PMID: 29021812 PMCID: PMC5634337 DOI: 10.4103/cytojournal.cytojournal_3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
Spindle cell ductal carcinoma in situ (DCIS) is a recently recognized subtype of DCIS, which is associated with a very rare and unique morphology. Although the histologic features have been relatively well described in a few reports, the cytologic features have not. Even though the distinction of this lesion from usual DCIS is not crucial clinically, it should be noted that this lesion might simulate the features of metaplastic carcinoma on fine needle aspiration cytology. Here, we report a case of spindle cell DCIS in a 45-year-old female, with the detailed cytologic features, both on conventional and liquid-based preparations, along with some useful immunohistochemical staining markers for the differential diagnosis.
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Affiliation(s)
- Yosep Chong
- Address: Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Sub Lee
- Address: Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Jung Kim
- Address: Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo-Chan Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Suk Kang
- Address: Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jung Lee
- Address: Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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21
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A challenging breast cancer type; Differentiation to neuroendocrine tumors. JOURNAL OF SURGERY AND MEDICINE 2017. [DOI: 10.28982/josam.342305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Nagahara R, Kimura M, Itahashi M, Sugahara G, Kawashima M, Murayama H, Yoshida T, Shibutani M. Canine mammary minute oncocytomas with neuroendocrine differentiation associated with multifocal acinar cell oncocytic metaplasia. J Vet Diagn Invest 2016; 28:722-728. [PMID: 27698175 DOI: 10.1177/1040638716664381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two solitary and minute tumors of 1 and 1.5 mm diameter were identified by microscopy in the left fourth mammary gland of a 13-year-old female Labrador Retriever dog, in addition to multiple mammary gland tumors. The former tumors were well circumscribed and were composed of small-to-large polyhedral neoplastic oncocytes with finely granular eosinophilic cytoplasm, and were arranged in solid nests separated by fine fibrovascular septa. Scattered lumina of variable sizes containing eosinophilic secretory material were evident. Cellular atypia was minimal, and no mitotic figures were visible. One tumor had several oncocytic cellular foci revealing cellular transition, with perivascular pseudorosettes consisting of columnar epithelial cells surrounding the fine vasculature. Scattered foci of mammary acinar cell hyperplasia showing oncocytic metaplasia were also observed. Immunohistochemically, the cytoplasm of neoplastic cells of the 2 microtumors showed diffuse immunoreactivity to anti-cytokeratin antibody AE1/AE3, and finely granular immunoreactivity for 60-kDa heat shock protein, mitochondrial membrane ATP synthase complex V beta subunit, and chromogranin A. One tumor also had oncocytic cellular foci forming perivascular pseudorosettes showing cellular membrane immunoreactivity for neural cell adhesion molecule. The tumors were negative for smooth muscle actin, neuron-specific enolase, vimentin, desmin, S100, and synaptophysin. Ultrastructural observation confirmed the abundant mitochondria in the cytoplasm of both neoplastic and hyperplastic cells, the former cells also having neuroendocrine granule-like electron-dense bodies. From these results, our case was diagnosed with mammary oncocytomas accompanied by neuroendocrine differentiation. Scattered foci of mammary oncocytosis might be related to the multicentric occurrence of these oncocytomas.
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Affiliation(s)
- Rei Nagahara
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Masayuki Kimura
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Megu Itahashi
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Go Sugahara
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Masashi Kawashima
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Hirotada Murayama
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Toshinori Yoshida
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
| | - Makoto Shibutani
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Tokyo, Japan (Nagahara, Kimura, Itahashi, Kawashima, Murayama, Yoshida, Shibutani)Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, Kanagawa, Japan (Sugahara)
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23
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GATA3 Positivity in Endocrine Mucin-Producing Sweat Gland Carcinoma and Invasive Mucinous Carcinoma of the Eyelid: Report of 2 Cases. Am J Dermatopathol 2016; 38:789-91. [DOI: 10.1097/dad.0000000000000561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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25
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Endocrine Mucin-Producing Sweat Gland Carcinoma of the Eyelid: A Report of a Case With Molecular Analysis. Am J Dermatopathol 2016; 38:636-8. [DOI: 10.1097/dad.0000000000000449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Rakha EA, Ahmed MA, Ellis IO. Papillary carcinoma of the breast: diagnostic agreement and management implications. Histopathology 2016; 69:862-870. [PMID: 27270947 DOI: 10.1111/his.13009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/04/2016] [Indexed: 12/11/2022]
Abstract
AIMS Papillary carcinoma (PC), which is a rare type of breast cancer, comprises a heterogeneous group of tumours. The diagnostic categorization of PC as in-situ and invasive disease remains a matter of debate with respect to interpretation of its overlapping histological features, and with respect to the uncertainty in clinical behaviour that this dilemma raises. The aim of this study was to assess the diagnostic agreement regarding PC among reporting breast pathologists. METHODS AND RESULTS Six cases of PC included in the UK National Health Service Breast Screening Programme breast pathology interpretive external quality assurance scheme in the last 10 years were reviewed. In this scheme, one representative haematoxylin and eosin-stained slide from each case is circulated to an average of 600 participants. Data on diagnostic categories were collected and slides were reviewed according to the World Health Organization (WHO) diagnostic criteria. The number of final diagnoses of malignancy (in situ or invasive) was highest for invasive PC (99% of the participants diagnosed it as malignant), followed by solid PC (94% and 95%, respectively), encapsulated PC (92% and 92%, respectively), and papillary ductal carcinoma in situ (DCIS) (88%). Most cases of papillary DCIS were correctly classified as in-situ disease (77%), but 28% of the participants classified invasive PC cases as in-situ disease. Of the participants, 24% reported encapsulated PC as invasive disease. Of the two solid PC cases, one showed some features consistent with the WHO description of invasive solid PC, whereas the other showed features of classic (non-invasive) solid PC. Both cases were reported as invasive by 75% and 77% of participants, respectively. Breast specialists more frequently classified PC as an in-situ carcinoma than did non-specialist participants, and the difference was significant (P = 0.013). CONCLUSIONS Recognition of PC as a malignant entity (in situ or invasive) is high, but concordance of its classification into in-situ and invasive disease is low. Histological features that can define invasion in PC should be better defined. These rare lesions require additional diagnostic work-up, and difficult cases should trigger consensus opinion or expert referral.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital, Nottingham, UK. ,
| | - Mohamed A Ahmed
- Department of Histopathology, Nottingham City Hospital, Nottingham, UK
| | - Ian O Ellis
- Department of Histopathology, Nottingham City Hospital, Nottingham, UK
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27
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Agoumi M, Giambattista J, Hayes MM. Practical Considerations in Breast Papillary Lesions: A Review of the Literature. Arch Pathol Lab Med 2016; 140:770-90. [DOI: 10.5858/arpa.2015-0525-ra] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Diagnosis of papillary breast lesions, especially in core biopsies, is challenging for most pathologists, and these lesions pose problems for patient management. Distinction between benign, premalignant, and malignant components of papillary lesions is challenging, and the diagnosis of invasion is problematic in lesions that have circumscribed margins. Obtaining a balance between overtreatment and undertreatment of these lesions is also challenging.
Objectives.—To provide a classification and a description of the histologic and immunohistochemical features and the differential diagnosis of papillary breast lesions, to provide an update on the molecular pathology of papillary breast lesions, and to discuss the recommendations for further investigation and management of papillary breast lesions. This review provides a concise description of the histologic and immunohistochemical features of the different papillary lesions of the breast.
Data Sources.—The standard pathology text books on breast pathology and literature on papillary breast lesions were reviewed with the assistance of the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed).
Conclusions.—Knowledge of the clinical presentation, histology, immunoprofile, and behavior of papillary breast lesions will assist pathologists with the diagnosis and optimal management of patients with papillary breast lesions.
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Affiliation(s)
| | | | - Malcolm M. Hayes
- From the Department of Pathology, DynaLIFEDx Diagnostic Laboratory Services, Edmonton, Alberta, Canada (Dr Agoumi); the Departments of Pathology (Drs Agoumi and Hayes) and Radiation Oncology (Dr Giambattista), British Columbia Cancer Agency, Vancouver, Canada; and the Department of Pathology, University of British Columbia, Vancouver (Dr Hayes)
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28
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Guo S, Wang Y, Rohr J, Fan C, Li Q, Li X, Wang Z. Solid papillary carcinoma of the breast: A special entity needs to be distinguished from conventional invasive carcinoma avoiding over-treatment. Breast 2016; 26:67-72. [DOI: 10.1016/j.breast.2015.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/02/2015] [Accepted: 12/29/2015] [Indexed: 01/29/2023] Open
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Bogina G, Munari E, Brunelli M, Bortesi L, Marconi M, Sommaggio M, Lunardi G, Gori S, Massocco A, Pegoraro MC, Zamboni G. Neuroendocrine differentiation in breast carcinoma: clinicopathological features and outcome. Histopathology 2015; 68:422-32. [PMID: 26114478 DOI: 10.1111/his.12766] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/22/2015] [Indexed: 12/27/2022]
Abstract
AIMS Primary neuroendocrine (NE) breast carcinoma (BC) is an entity with a wide range of prevalence and poorly defined clinical behaviour. We evaluated the prevalence, clinicopathological features and clinical outcome of NEBC. METHODS AND RESULTS Immunohistochemical staining for synaptophysin and chromogranin A was performed on whole sections from 1232 consecutive cases of invasive BC. We divided NEBC into focal (10-49% positive cells) and diffuse (≥50% positive cells) and compared the outcome of patients with NEBC with strictly matched non-NEBC. A total of 128 BC showed NE differentiation (10.4%): 84 diffuse (6.8%) and 44 focal (3.6%). NE differentiation showed a significant association with T4 stage (P = 0.001), solid-papillary and mucinous histotype (P < 0.0001), G2 grading (P = 0.002), positive oestrogen receptor (ER) (P = 0.003) and progesterone receptor (PR) (P = 0.002). Almost 90% of NEBC were ER(+) /HER2(-) and more than half ER(+) /HER2(-) /Ki67≥14%. Kaplan-Meier analysis revealed that patients with NEBC showed worse disease-free survival (DFS) (P = 0.04) compared to matched non-NEBC. We did not find significant differences regarding clinicopathological features, DFS and CSS between diffuse and focal neuroendocrine BC. CONCLUSIONS This study demonstrates that NEBC represents 7-10% of invasive BC and that NE differentiation does not affect the prognosis of BC in terms of CSS.
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Affiliation(s)
- Giuseppe Bogina
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Enrico Munari
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy.,Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Laura Bortesi
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Marcella Marconi
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Marco Sommaggio
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Gianluigi Lunardi
- Department of Oncology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Stefania Gori
- Department of Oncology, Sacro Cuore Hospital of Negrar, Verona, Italy
| | - Alberto Massocco
- Department of Surgery, Sacro Cuore Hospital of Negrar, Verona, Italy
| | | | - Giuseppe Zamboni
- Department of Pathology, Sacro Cuore Hospital of Negrar, Verona, Italy
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Shon W, Salomão DR. WT1 expression in endocrine mucin-producing sweat gland carcinoma: a study of 13 cases. Int J Dermatol 2015; 53:1228-34. [PMID: 25219513 DOI: 10.1111/ijd.12470] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endocrine mucin-producing sweat gland carcinoma (EMPSGC), a low-grade sweat gland carcinoma with a predilection for the eyelids, often shows areas of benign eccrine cysts, atypical intracystic proliferation and associated mucinous carcinoma, suggesting tumor progression. Wilms tumor 1 (WT1) protein, a transcription factor, is overexpressed in many tumors and plays a role in oncogenesis. METHODS A computer-based search for tumors diagnosed between 1989 and 2009 was conducted. Clinical data were obtained from pathology reports and patient records. Biopsies were reviewed for histologic features. Immunostaining was performed for WT1, chromogranin, synaptophysin, estrogen receptor (ER), epithelial membrane antigen (EMA), polyclonal carcinoembryonic antigen (P-CEA), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and MIB-1. RESULTS Eight women and five men (mean age: 61.2 years; range: 40-77 years) presented with slow-growing eyelid nodules. Cases of EMPSGC were characterized by the presence of dermal nodules with various growth patterns. Adjacent eccrine cysts were present in five patients, atypical epithelial proliferation within the cyst wall in four patients, and an associated mucinous carcinoma in one patient. All tumors were positive for WT1, CK7, ER, P-CEA and EMA and negative for CK20. Tumors were positive for synaptophysin in 12 cases and chromogranin in nine cases. The MIB-1 proliferation index was low in most cases. No WT1 staining was observed in the overlying epidermis, adnexal structures or areas of benign eccrine cyst. WT1 expression was observed in areas of atypical epithelial proliferation, and the neoplastic cells. CONCLUSIONS The present study shows WT1 expression in the neoplastic epithelial cells of EMPSGC, areas of atypical intraductal proliferations, and mucinous carcinoma. The absence of WT1 expression in areas of benign eccrine cyst and cutaneous sweat glands suggests WT1 upregulation plays a role in tumor cell proliferation and progression of EMPSGC.
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Affiliation(s)
- Wonwoo Shon
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
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31
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Maeda I, Kanemaki Y, Uejima T, Tajima S, Nagasawa S, Ohi R, Tsugawa K, Takagi M. Portion of E-DCIS Lesion Coexisting With Intraductal Papilloma of the Breast. ACTA ACUST UNITED AC 2015. [DOI: 10.17264/stmarieng.6.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihide Kanemaki
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoko Uejima
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shinya Tajima
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoi Nagasawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryoko Ohi
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
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Oh EJ, Koo JS, Kim JY, Jung WH. Correlation between solid papillary carcinoma and associated invasive carcinoma according to expression of WT1 and several MUCs. Pathol Res Pract 2014; 210:953-8. [DOI: 10.1016/j.prp.2014.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/01/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
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Cloyd JM, Yang RL, Allison KH, Norton JA, Hernandez-Boussard T, Wapnir IL. Impact of histological subtype on long-term outcomes of neuroendocrine carcinoma of the breast. Breast Cancer Res Treat 2014; 148:637-44. [PMID: 25399232 DOI: 10.1007/s10549-014-3207-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/09/2014] [Indexed: 12/31/2022]
Abstract
Although rare, neuroendocrine carcinoma of the breast (NECB) is becoming an increasingly recognized entity. The current literature is limited to case reports and small series and therefore a comprehensive population-based analysis was conducted to investigate the clinicopathologic features and long-term outcomes associated with NECB. We included all patients in the SEER Database from 2003 to 2010 with a diagnosis of NECB. The 2012 WHO classification system was used to categorize patients based on histopathologic diagnosis: well-differentiated neuroendocrine tumors, small/oat cell or poorly differentiated neuroendocrine tumors, adenocarcinoma with neuroendocrine features (ANF), large cell neuroendocrine and carcinoid tumors. Survival analysis was performed for disease specific (DSS) and overall (OS) survival. Of the 284 cases identified, 52.1% were classified as well-differentiated, 25.7% small cell, 14.8% ANF, 4.9% large cell, and 2.5% carcinoid. In general, patients presented with advanced disease: 36.2% had positive lymph node metastases and 20.4% presented with systemic metastases. Five-year DSS rates for stage I-IV NECB were 88.1, 67.8, 60.5, and 12.4%, respectively, while five-year OS rates were 77.9, 57.3, 52.9, and 8.9%, respectively. DSS and OS were significantly different for well-differentiated neuroendocrine tumors and ANFs compared to small cell and carcinoid tumors. On univariate Cox proportional hazards regression, small cell carcinoma was significantly associated with worse DSS (OR 1.97, 95% CI 1.05-3.67) and OS (OR 2.66, 95% CI 1.49-4.72) compared to other neuroendocrine tumors. NECB is associated with advanced stage disease at presentation and an unfavorable prognosis for stage II-IV disease and small cell, large cell, and carcinoid histologic subtypes.
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Affiliation(s)
- Jordan M Cloyd
- Departments of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA, 94305, USA,
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34
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Rütten A, Mentzel T, Requena L. Endokrines muzinproduzierendes Schweißdrüsenkarzinom. DER PATHOLOGE 2014; 35:462-6. [DOI: 10.1007/s00292-014-1936-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Manes K, Delis S, Papaspyrou N, Ghiconti I, Dervenis C. Neuroendocrine breast carcinoma metastatic to the liver: Report of a case and review of the literature. Int J Surg Case Rep 2014; 5:540-3. [PMID: 25024021 PMCID: PMC4147575 DOI: 10.1016/j.ijscr.2014.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Primary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer. PRESENTATION OF CASE We herein report a case of right hepatectomy for a NEBC liver metastasis. DISCUSSION Little is known about its evolution, bilologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily. CONCLUSION Treating this kind of cancer implies both breast and hepatic surgery. Primary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer. Little is known about its evolution, biologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily. We herein report a case of right hepatectomy for a NEBC liver metastasis.
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Affiliation(s)
- Konstantinos Manes
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece.
| | - Spyridon Delis
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece
| | | | - Ioanna Ghiconti
- Pathology Department, "Konstantopouleio" General Hospital, Athens, Greece
| | - Christos Dervenis
- Surgical Department, "Konstantopouleio" General Hospital, Athens, Greece
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Asioli S, Foschini MP, Masetti R, Eusebi V. Working formulation of neuroendocrine tumors of the skin and breast. Endocr Pathol 2014; 25:141-50. [PMID: 24729037 DOI: 10.1007/s12022-014-9319-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the skin and breast, endocrine tumors are composed of a heterogeneous mixture of endocrine and exocrine cells. The definition of "pure" endocrine carcinomas is a matter for debate, and as a consequence, there is lack of uniform diagnostic criteria. There are no significant clinical differences in either overall or disease-free survival between matched neoplasms with endocrine and without endocrine differentiation nor between the degree of endocrine differentiation and tumor size, stage, or prevalence of vascular invasion for both sites (skin and breast). Here, endocrine tumors of the skin and breast are grouped respectively into three categories that include most of the neuroendocrine tumors of the skin and breast as seen in routine practice. It was felt that the number of different types of neuroendocrine tumors is so conspicuous that it is impossible to organize them in an orderly classification. It has been proposed therefore, for practical diagnostic routine purposes, to arrange these neoplasms into a working formulation. The latter includes heterogeneous lesions respectively of the skin and breast within the same group that have clinical features in common.
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Affiliation(s)
- Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Section of Anatomic Pathology "M. Malpighi," Bellaria Hospital, Bologna, Italy
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Kwon JE, Jung WH, Koo JS. Expression of glycolysis-related proteins in solid papillary carcinoma of the breast according to basement membrane status. Yonsei Med J 2014; 55:576-83. [PMID: 24719122 PMCID: PMC3990068 DOI: 10.3349/ymj.2014.55.3.576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the differences of expression in glycolysis-related proteins such as Glut-1, carbonic anhydrase (CA) IX, and monocarboxylate transporter (MCT) 4 according to the myoepithelial cell (MEC) and basement membrane (BM) status in solid papillary carcinoma (SPC) of the breast. MATERIALS AND METHODS Immunohistochemical evaluation of Glut-1, CAIX, and MCT4, as well as p63 and type IV collagen, were performed on 23 SPC cases. RESULTS Six and nine cases of SPC showed the presence and absence of myoepithelial cells, respectively, and eight cases belonged to the borderline status (p63-positive MEC on some areas of the outer tumor surface but not in others). BM was partially or completely absent in 14 cases and present in nine cases. SPC lacking BM more frequently showed high expression of CAIX than SPC with BM (p=0.037). CONCLUSION In SPC of the breast, a strong expression of CAIX seems to be associated with an increasing degree of loss of BM, which can be interpreted as BM degradation due to the induction of extracellular acidity with increasing expression of CAIX.
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Affiliation(s)
- Ji Eun Kwon
- Department of Pathology, Ajou University College of Medicine, Suwon, Korea
| | - Woo-Hee Jung
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Alıcı Ö, Aydoğdu SK. A Rare Breast Tumor Confused with Ductal Carcinoma in Situ, Primary Solid Neuroendocrine Carcinoma. THE JOURNAL OF BREAST HEALTH 2014; 10:119-121. [PMID: 28331655 DOI: 10.5152/tjbh.2014.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/31/2013] [Indexed: 11/22/2022]
Abstract
The concept of pure neuroendocrine breast tumors was initially defined by Sapino et al. There are three sub-types of these tumors: solid, small cell/oat cell, and large cell neuroendocrine carcinomas. To diagnose neuroendocrine tumors, more than half of the tumor cells must have neuroendocrine differentiation. The possibility of metastatic neuroendocrine carcinoma must always be excluded in the differential diagnosis. In addition, it should be considered that solid neuroendocrine (NE) carcinomas can be confused with ductal carcinoma in situ due to their similar morphologic appearance. In this article, a patient with primary solid neuroendocrine breast cancer who had been diagnosed with ductal carcinoma in situ at another center was presented along with morphological and immunohistochemical features.
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Affiliation(s)
- Ömer Alıcı
- Department of Pathology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Serap Korkmaz Aydoğdu
- Department of Radiation Oncology, Samsun Training and Research Hospital, Samsun, Turkey
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M N, T K A, Rajpurohit S, R S. Neuroendocrine carcinoma of breast: a rare case vignette. J Clin Diagn Res 2013; 7:2585-6. [PMID: 24392410 DOI: 10.7860/jcdr/2013/7051.3621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/10/2013] [Indexed: 11/24/2022]
Abstract
Neuroendocrine tumour of breast is an extremely rare condition. It may present as focal neuroendocrine differentiation with other histological subtypes of breast cancer or primary neuroendocrine tumour of breast or a metastatic foci in breast. There are no radiologic or clinical signs specific to this subtype. With rarity of its occurrence and absence of randomised trials regarding neuroendocrine tumour of breast, very little is known about the behaviour, prognosis and proper management of this condition. Only the available case reports suggests the necessary strategies for optimal management of this minimally explored medical condition.
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Affiliation(s)
- Nandeesh M
- Assistant Professor, Department of General Surgery, DMWIMS , Kerala, India
| | - Anitha T K
- Assistant Professor, Department of Microbiology, DMWIMS , Kerala, India
| | | | - Santosh R
- Senior Resident, Department of General Surgery, DMWIMS , Kerala, India
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Abstract
This article reviews the recent dermatopathology literature regarding cutaneous adnexal neoplasms, with emphasis on new and underrecognized entities, "old entities" with new findings, advances in immunohistochemistry, and new findings in relation to inherited disorders associated with cutaneous adnexal neoplasms.
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Abstract
Ductal carcinoma in situ (DCIS) is an established precursor of invasive breast carcinoma. Immunoperoxidase stains for selected markers can assist pathologists in the diagnosis of challenging ductal epithelial proliferations, but they cannot replace morphologic evaluation as the primary and critical assessment of this disease. Molecular studies provide further insight into how DCIS progresses to invasive carcinoma and also confirm the heterogeneity of this lesion. Morphology-based knowledge, immunohistochemistry, and molecular advances in DCIS are the subjects of this review.
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Angarita FA, Rodríguez JL, Meek E, Sánchez JO, Tawil M, Torregrosa L. Locally-advanced primary neuroendocrine carcinoma of the breast: case report and review of the literature. World J Surg Oncol 2013; 11:128. [PMID: 23734899 PMCID: PMC3682896 DOI: 10.1186/1477-7819-11-128] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 05/13/2013] [Indexed: 12/14/2022] Open
Abstract
Background Primary neuroendocrine carcinoma of the breast is a heterogeneous group of rare tumors with positive immunoreactivity to neuroendocrine markers in at least 50% of cells. Diagnosis also requires that other primary sites be ruled out and that the same tumor show histological evidence of a breast in situ component. Primary neuroendocrine carcinoma of the breast rarely presents as locally advanced disease and less frequently with such widespread metastatic disease as described herein. The review accompanying this case report is the first to provide an overview of all the cases of primary neuroendocrine carcinoma of the breast published in the literature and encompasses detailed information regarding epidemiology, histogenesis, clinical and histologic diagnosis criteria, classification, surgical and adjuvant treatment, as well as prognosis. We also provide recommendations for common clinical and histologic pitfalls associated with this tumor. Case presentation We describe a case of a 51-year-old Hispanic woman initially diagnosed with locally-advanced invasive ductal carcinoma that did not respond to neodjuvant treatment. After undergoing modified radical mastectomy the final surgical pathology showed evidence of alveolar-type primary neuroendocrine carcinoma of the breast. The patient was treated with cisplatin/etoposide followed by paclitaxel/carboplatinum. Thirteen months after surgery the patient is alive, but developed pulmonary, bone, and hepatic metastasis. Conclusion The breast in situ component of primary neuroendocrine carcinoma of the breast may prevail on a core biopsy samples increasing the probability of underdiagnosing this tumor preoperatively. Being aware of the existence of this disease allows for timely diagnosis and management. Optimal treatment requires simultaneous consideration of both the neuroendocrine and breast in situ tumor features.
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Affiliation(s)
- Fernando A Angarita
- Department of Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Zhu Y, Li Q, Gao J, He Z, Sun R, Shen G, Zhang H, Xia W, Xu J. Clinical features and treatment response of solid neuroendocrine breast carcinoma to adjuvant chemotherapy and endocrine therapy. Breast J 2013; 19:382-7. [PMID: 23721399 DOI: 10.1111/tbj.12121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Solid neuroendocrine breast carcinoma (solid NEBC) is a relatively uncommon malignant tumor of the breast. The purpose of our study was to explore the incidence and clinical features of this tumor, and to evaluate the efficacy of adjuvant chemotherapy and endocrine therapy for patients with solid NEBC. Of 7542 breast cancers registered during the period from March 2004 to April 2011, 22 patients (0.29%) who underwent surgery had tumors that were histologically confirmed as solid NEBC, and were enrolled in this study. The age range of these patients was 29-77 years (mean 52.5 years). Patients were staged according to the 7th edition of the pathologic tumor-node-metastasis (pTNM) staging system. Biopsies or resection specimens were reviewed and reclassified according to the World Health Organization (WHO) 2003 classification. We recorded clinical features including gender and age, chief complaint, and past medical history, tumor characteristics including size, location, preoperative diagnosis, and pathologic and immunohistochemical findings, the therapeutic schedule, and the follow-up results. Solid NEBC is a rare and distinct category of malignant disease of the breast, with good prognosis, and in most early-stage cases, is resectable. The role of adjuvant chemotherapy and endocrine therapy in solid NEBC may be limited and should be studied further.
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Affiliation(s)
- Yuliang Zhu
- Department of Radiotherapy, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, China
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Saremian J, Rosa M. Solid papillary carcinoma of the breast: a pathologically and clinically distinct breast tumor. Arch Pathol Lab Med 2012; 136:1308-11. [PMID: 23020734 DOI: 10.5858/arpa.2011-0227-rs] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Solid papillary carcinomas are tumors morphologically characterized by round, well-defined nodules composed of low-grade ductal cells separated by fibrovascular cores. These tumors are rare and affect predominantly older women. Although they are considered in situ carcinomas, debate and uncertainty still exist regarding their true nature, because immunohistochemistry for myoepithelial cells has shown absence of myoepithelial cell layer along the epithelial-stromal interface of the tumor in many cases. Clinically, these tumors present as a palpable, centrally located mass or as bloody nipple discharge. Pathologically, solid papillary carcinomas exhibit low-grade features, and often the tumors display neuroendocrine and mucinous differentiation. In the majority of cases an associated invasive carcinoma is present, with colloid and neuroendocrine carcinomas being the most common. The pathologic differential diagnosis is broad and ranges from benign to malignant lesions. The treatment for solid papillary carcinomas is surgical excision. When invasive carcinoma is not present, the prognosis is excellent.
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Affiliation(s)
- Jinous Saremian
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
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Endocrine mucin producing sweat gland carcinoma: a clinicopathological analysis of three cases. Pathology 2012; 44:568-71. [DOI: 10.1097/pat.0b013e32835833d8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The purpose of this review is to discuss the less common variants and mimics of ductal carcinoma in situ (DCIS). DCIS lesions are heterogeneous in clinical presentation and behavior, morphology, biomarker profile, and identified genetic aberrations. DCIS is most easily recognized when presenting with classical features. The diagnosis is more challenging when a lesion displays less common cytologic features and has architectural patterns that overlap with other benign or malignant entities.
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Affiliation(s)
- Nicole B Johnson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Neuroendocrine ductal carcinoma in situ, comedo type, of the breast detected by screening mammography: a potentially pre-invasive counterpart of high grade neuroendocrine tumours. Pathology 2012; 44:273-5. [DOI: 10.1097/pat.0b013e3283513feb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kawasaki T, Mochizuki K, Yamauchi H, Yagata H, Kondo T, Tsunoda H, Nakamura S, Oishi N, Nakazawa T, Yamane T, Inoue A, Maruyama T, Inoue M, Inoue S, Fujii H, Katoh R. High prevalence of neuroendocrine carcinoma in breast lesions detected by the clinical symptom of bloody nipple discharge. Breast 2012; 21:652-6. [PMID: 22397895 DOI: 10.1016/j.breast.2012.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/18/2012] [Accepted: 01/24/2012] [Indexed: 11/28/2022] Open
Abstract
AIM Bloody nipple discharge (BND) is an important clinical symptom in breast disorders, especially cancers. However, the association between this symptom and breast neuroendocrine carcinomas (NECs) has not been sufficiently investigated or well understood. METHODS We clinicopathologically studied 89 cases using biopsy and/or resection in 144 patients who came to the hospital for a thorough examination of symptomatic BND. RESULTS Of these 89 cases examined histologically, 24 (27%) were neuroendocrine carcinomas (NECs) in which >50% of cells immuno-expressed chromogranin A and/or synaptophysin. Moreover, NECs made up 44% (24/55) of the mammary cancers found because of the BND. The frequency of diagnosing malignancy preoperatively in 24 NECs was 4% by nipple discharge cytology, 40% by fine needle aspiration cytology, 62% by core needle biopsy and 67% by mammotome biopsy. There were neither postoperative recurrences nor metastases in the NEC cases during a mean follow-up of 83.7 months. The 24 NECs were subclassified into neuroendocrine ductal carcinoma in situ (NE-DCIS) (9 cases) and microinvasive (7 cases) and invasive (8 cases) NECs with extensive NE-DCIS components. Most NECs had early-stage and low-grade pathological parameters: pTis or pT1 (96%), pN0 (96%), low nuclear grade (83%), absence of necrosis (88%), immuno-positivity of estrogen and progesterone receptors (100%) and absence of HER2 protein overexpression (100%). CONCLUSIONS NECs predominantly with NE-DCIS lesions, often under-diagnosed preoperatively, accounted for an important share of breast conditions associated with BND. It is, therefore, worth keeping this type of breast cancer in mind when performing medical examinations on patients with BND.
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Affiliation(s)
- Tomonori Kawasaki
- Department of Pathology, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan.
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Miura K, Nasu H, Ogura H. Double neuroendocrine ductal carcinomas in situ coexisting with a background of diffuse idiopathic neuroendocrine cell hyperplasia of breast: a case report and hypothesis of neuroendocrine tumor development. Pathol Int 2012; 62:331-4. [PMID: 22524661 DOI: 10.1111/j.1440-1827.2012.02786.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reports the case of a 72-year-old woman with two nodules of neuroendocrine (NE) ductal carcinoma in situ coexistent with a background of NE cell hyperplasia. Both tumors, 15 and 3 mm in size, were incidentally revealed on computed tomography without any apparent clinical symptoms. The tumors showed similar histological features, and more than 50% of the tumor cells patchily expressed NE markers, such as chromogranin A, synaptophysin, CD56, and somatostatin receptor type 2. The surrounding nontumor ductal cells also showed spotty or linear positivity for NE markers in contrast to the cells of normal atrophic breasts, which rarely present with NE cells. Moreover, focal mucin production was also observed in the peripheral ducts. It is hypothesized that idiopathic breast NE cell hyperplasia with multiple small nests of NE cells may extend to form a true mass of NE neoplasms.
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Affiliation(s)
- Katsutoshi Miura
- Departments of Health Science, Pathology and Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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