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Turashvili G. Nonneoplastic and neoplastic sclerosing lesions of the breast. Histopathology 2024; 85:383-396. [PMID: 38923027 DOI: 10.1111/his.15252] [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] [Indexed: 06/28/2024]
Abstract
Sclerosing lesions of the breast encompass a spectrum of benign and malignant entities and often pose a diagnostic challenge. Awareness of key morphologic features and pitfalls in the assessment of morphology and immunophenotype is essential to avoid over- or underdiagnosis and ensure optimal clinical management. This review summarizes nonneoplastic sclerosing lesions such as radial scar/complex sclerosing lesion, sclerosing adenosis, sclerosing intraductal papilloma, sclerosing variants of ductal adenoma and nipple adenoma, and fibroadenoma with extensive sclerosis, including their clinical presentation, characteristic morphology, differential diagnostic considerations, appropriate immunohistochemical work-up, when needed, and the clinical significance. In addition, atypical or neoplastic entities (such as atypical ductal hyperplasia, ductal carcinoma in situ, low-grade adenosquamous carcinoma, and fibromatosis-like metaplastic carcinoma) that can involve these sclerosing lesions are also briefly discussed.
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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2
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Bachert SE, Cornea V, Bocklage T. Adenosquamous proliferation in radial sclerosing lesions: Histologic spectrum and key features in systematic review of 247 lesions. Breast 2023; 71:99-105. [PMID: 37566996 PMCID: PMC10432801 DOI: 10.1016/j.breast.2023.08.002] [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: 12/08/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
Adenosquamous proliferation (ASP) is known to occur in the central nidus of radial sclerosing lesions (RSL) of the breast. However, their significance is debated and remains largely unknown. In addition, there is a histologic overlap between ASP and low-grade adenosquamous carcinomas (LGASC). We conducted a large retrospective review of 247 RSLs to evaluate the prevalence of ASP and quantitatively analyze associated histologic features of RSLs including size, stromal cellularity, and presence of chronic inflammation. The central nidus of RSLs were classified as hyalinized in 121 cases (49%), cellular in 37 cases (15%), and equally mixed hyalinized and cellular in 89 (36%). ASP occurred in 92 of 247 RSLs (37.2%). Cases with ASP were significantly associated with a cellular stroma; 78.4% of RSLS with cellular stroma had ASP versus just 11.6% of hyalinized RSLs. In our large cohort, inflammation is commonly found in RSLs with ASP (p= <0.001). In conclusion, we confirm that ASP is statistically more likely to be found in RSLs with a cellular stroma. In addition, ASP is commonly associated with chronic inflammation. The finding challenges the notion that prominent lymphocytes are a diagnostic clue to LGASC on limited biopsy material.
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Affiliation(s)
- S Emily Bachert
- University of Kentucky, Department of Pathology and Laboratory Medicine, USA.
| | - Virgilius Cornea
- University of Kentucky, Department of Pathology and Laboratory Medicine, USA
| | - Thérèse Bocklage
- University of Kentucky, Department of Pathology and Laboratory Medicine, USA
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3
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Wilsher MJ, Shubbar S, Mugalaasi H, Poyastro-Pearson E, Chen Yuan L, Petrizan MV, MacMahon S. Syringomatous tumour of the nipple: histological, immunophenotypical and genomic characteristics. Pathology 2022; 54:941-945. [PMID: 35307203 DOI: 10.1016/j.pathol.2021.12.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Mark James Wilsher
- North West London Pathology, NWLP, Imperial College Healthcare NHS Trust (ICHNT), Department of Histopathology, Charing Cross Hospital, London, UK; Unilabs IHS, London, UK.
| | - Sara Shubbar
- North West London Pathology, NWLP, Imperial College Healthcare NHS Trust (ICHNT), Department of Histopathology, Charing Cross Hospital, London, UK
| | - Hood Mugalaasi
- North Thames Genomic Laboratory Hub, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Emma Poyastro-Pearson
- North Thames Genomic Laboratory Hub, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Lina Chen Yuan
- North Thames Genomic Laboratory Hub, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Mikel Valganon Petrizan
- North Thames Genomic Laboratory Hub, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Suzanne MacMahon
- North Thames Genomic Laboratory Hub, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
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4
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Priyadarshini S, Singh N, Ali H, Kasireddy V. Adenosquamous Carcinoma of the Breast: Case Report and Literature Review. Cureus 2022; 14:e25940. [PMID: 35711248 PMCID: PMC9197327 DOI: 10.7759/cureus.25940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Low-grade adenosquamous breast carcinoma (LGASC) is an atypical variant of metaplastic breast cancer. It differs from metaplastic carcinoma and has an indolent behavior. It usually presents as a palpable lump, unlike in our case, which had an incidental presentation. Because of its rarity, it often creates a clinical and diagnostic challenge. With the risk of local recurrence, the current management is aggressive with excision. Chemoradiation has been used in a few cases, but optimal management is unclear. Our manuscript aims to add to the existing knowledge on LGASC.
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Breast carcinomas of low malignant potential. Virchows Arch 2021; 480:5-19. [PMID: 34292391 DOI: 10.1007/s00428-021-03163-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
Some breast carcinomas have a very low likelihood of metastasis to regional lymph nodes and distant sites and may be considered carcinomas of low malignant potential. In this article, we review the clinical, pathologic, immunophenotypic, and molecular features of selected breast carcinomas of low malignant potential including low-grade adenosquamous carcinoma, fibromatosis-like metaplastic carcinoma, encapsulated papillary carcinoma, solid papillary carcinoma, and tall cell carcinoma with reversed polarity.
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6
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Wilsher MJ. Significance of adenosquamous proliferation in breast lesions. J Clin Pathol 2021; 74:559-567. [PMID: 33380461 DOI: 10.1136/jclinpath-2020-207097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
Adenosquamous proliferation (ASP), characterised by ductal structures with a dual glandular and squamous phenotype within desmoplastic stroma, is essentially a hallmark of various sclerosing lesions of the breast (SL) and breast lesions with sclerosis (BLWS), not including sclerosing adenosis. In radial scar/complex sclerosing lesion (RS/CSL), clonality has been previously demonstrated in microdissected ASP. SL/BLWS encompass a diverse range of pathological entities that historically have an equally diverse list of names, often for histologically alike or identical lesions at different anatomical locations. In common they are comprised of one or more components of fibrocystic or proliferative breast disease and papillomata, which become distorted and even obliterated by a sclerosing process that appears to be associated with and/or secondary to ASP, which in an individual lesion may be inconspicuous at the time of biopsy. The histological overlap of various SL/BLWS with RS/CSL, in which a nidus containing ASP is pathognomonic of early lesions, also supports a common element of ASP across various SL/BLWS. SL/BLWS show an interesting association with low-grade metaplastic carcinoma, particularly low-grade adenosquamous carcinoma (LGASC) with which, they appear to form a histological and possible biological spectrum because ASP and LGASC share similar histological and immunophenotypical characteristics. The presentation of ASP in various SL/BLWS will be discussed.
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Nam G, Strenger R, Cutitar M, Wang Y. Low-grade adenosquamous carcinoma of the breast: A case with pathogenic germline mutation in the BRIP1 gene. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wilsher MJ, Desai AJ, Pinder SE. Low‐grade adenosquamous carcinoma arising in association with a nipple adenoma. Histopathology 2020; 76:784-787. [DOI: 10.1111/his.14033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Eccrine ductal and acrosyringeal metaplasia in breast carcinomas: report of eight cases. Virchows Arch 2018; 474:383-387. [PMID: 30467599 DOI: 10.1007/s00428-018-2488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
Eccrine ductal and acrosyringeal metaplasia was described in 2006 as the presence of tumor structures that resemble the epithelium of the eccrine skin ducts and their opening within the epidermis, the acrosyringeum. Here, we report the clinical, morphological, and phenotypic characteristics of eight breast carcinomas that we collected over the past years showing this metaplasia. Unlike squamous metaplasia, acrosyringeal and eccrine ductal metaplasia are luminated structures comprising cells with eosinophilic cytoplasm that are easily detectable in routine histological slides. These lesions invariably appeared in triple-negative carcinomas, but the cases differed in their clinical, radiological, and histological manifestations. Correct interpretation of these changes may facilitate identification of some metaplastic carcinomas.
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Bataillon G, Fuhrmann L, Girard E, Menet E, Laé M, Capovilla M, Treilleux I, Arnould L, Penault-Llorca F, Rouzier R, Marchiò C, Bieche I, Vincent-Salomon A. High rate of PIK3CA mutations but no TP53 mutations in low-grade adenosquamous carcinoma of the breast. Histopathology 2018. [PMID: 29537649 DOI: 10.1111/his.13514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS Low-grade adenosquamous carcinoma of the breast (LGASC) is a rare variant of metaplastic carcinoma characterised by a favourable outcome and histologically composed of glandular and squamous elements in a spindle cell background typically associated with a lymphocytic stromal reaction. Because of its rarity, the immunophenotypic and genetic profile of LGASC has not been sufficiently characterised. The aim of this study was to gain insights into the molecular and phenotypic characteristics of LGASC. METHODS AND RESULTS We reviewed the clinical and morphological features and detailed the immunohistochemical characteristics of a retrospective series of 13 LGASCs. Targeted sequencing of 50 genes was performed in 10 of 13 cases. Identified mutations were further assessed by Sanger sequencing in a validation series of 11 additional cases. All tumours showed a triple-negative immunophenotype, expressed 'basal' keratins, showed variable levels of epidermal growth factor receptor expression, and did not express androgen receptor. Sequencing analysis of the screening set of LGASCs revealed a high rate (seven of 10 cases) of PIK3CA mutations, whereas no TP53 mutations were found. All PIK3CA mutations were missense mutations located either in exon 20 (n = 6) or in exon 9 (n = 1). The global PIK3CA mutation rate, including the validation series, was 52% (11 of 21 cases). No disease recurrences were observed. [Correction added on 11 June 2018, after first online publication: The percentage of mutation rate was corrected to 52%] CONCLUSIONS: Our results indicate that LGASC of the breast is a low-grade triple-negative breast cancer that harbours a basal-like phenotype with no androgen receptor expression, and shows a high rate of PIK3CA mutations but no TP53 mutations.
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Affiliation(s)
- Guillaume Bataillon
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
| | - Laetitia Fuhrmann
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
| | - Elodie Girard
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
| | - Emanuelle Menet
- Institut Curie, Versailles Saint Quentin University, Pôle de médecine diagnostique et théranostique, Saint-Cloud, France
| | - Marick Laé
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
| | | | | | - Laurent Arnould
- Department of Pathology, Centre Georges François Leclerc, Dijon, France
| | | | - Roman Rouzier
- Institut Curie, Versailles Saint Quentin University, Surgery Department, Saint-Cloud, France
| | - Caterina Marchiò
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ivan Bieche
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
| | - Anne Vincent-Salomon
- Institut Curie, Paris Sciences Lettres Research University, Pôle de médecine diagnostique et théranostique, Paris, France
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11
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Wu HB, Zhang AL, Wang W, Li H. Expression of hormone receptors in low-grade adenosquamous carcinoma of the breast: A case report. Medicine (Baltimore) 2017; 96:e8785. [PMID: 29145336 PMCID: PMC5704881 DOI: 10.1097/md.0000000000008785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
RATIONALE Low-grade adenosquamous carcinoma (LGASC) is a rare subtype of metaplastic breast carcinoma which is generally recognized as a characteristic subgroup of triple-negative breast cancers previously. However, in this study, we reported for the first time a case of LGASC with hormone receptors expression. PATIENT CONCERNS Pathological analysis of breast tumor specimen obtained by a 42-year-old female patient was performed. Morphologically, it composed of glandular structures with scattered squamous differentiation accompanied by haphazard arrangement of spindle cell stroma. Immunohistochemically, all myoepithelial and squamous differentiation markers showed typical LGASC positive or negative staining pattern. Interestingly, we found that normally aberrant hormone receptors were reactivated in this case. To our knowledge, this is the first report of a hormone receptor-positive LGASC. Apart from this, in the extended resection sample, we found scattered squamous metaplasia and florid adenosquamous proliferation (ASP). Meanwhile, it was positive for CD44 variant isoforms (CD44v), which is a breast cancer stem cell (CSC) marker, and expressed in LGASC, squamous metaplasia, and ASP. DIAGNOSIS LGASC with hormone receptors expression. INTERVENTIONS The breast-extended local excision and axillary lymph node dissection were performed. OUTCOMES The patient was free of local recurrence and distant metastasis 6 months after surgical resection. LESSONS We herein report the first case of LGASC with immunoreactivity for hormone receptors, expanding its profile of immunophenotypes. CD44v may play an important role in the transition of LGASC precursor lesions into malignant processes, which may serve as a therapeutic target in LGASC.
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Affiliation(s)
- Hai-Bo Wu
- Department of Pathology, Southern District of Anhui Provincial Hospital
| | - An-Li Zhang
- Department of Pathology, Southern District of Anhui Provincial Hospital
| | - Wei Wang
- Laboratory of Cancer Genomics and Epigenetics, High Magnetic Field Laboratory of the Chinese Academy of Sciences, Hefei, Anhui, China
| | - Heng Li
- Department of Pathology, Southern District of Anhui Provincial Hospital
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12
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Wilsher MJ, Owens TW, Allcock RJ. Next generation sequencing of the nidus of early (adenosquamous proliferation rich) radial sclerosing lesions of the breast reveals evidence for a neoplastic precursor lesion. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2017; 3:115-122. [PMID: 28451460 PMCID: PMC5402177 DOI: 10.1002/cjp2.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022]
Abstract
We sought to determine if adenosquamous proliferation of early cellular radial sclerosing lesions of the breast harbours hot spot mutations and to help clarify its relationship to low‐grade adenosquamous carcinoma as a potential form of early neoplasia. Four low‐grade adenosquamous carcinomas, early radial sclerosing lesions from 13 individuals, and 4 benign proliferative breast lesions were microdissected and assessed with a 50‐gene Hot‐spot cancer panel. Early radial sclerosing lesions were selectively microdissected concentrating on their adenosquamous proliferation (nidus). Hot spot mutations in PIK3CA were detected in ten (77% of) radial sclerosing lesions, in one low‐grade adenosquamous carcinoma, and in usual ductal hyperplasia and apocrine adenosis. Over three quarters of individuals with cellular (adenosquamous proliferation rich) early radial sclerosing lesions tested harboured somatic mutations in PIK3CA suggesting that adenosquamous proliferation is a clonal lesion. Its relationship to low‐grade adenosquamous carcinoma remains unclear in view of the small sample size and unmatched radial sclerosing lesions and low‐grade adenosquamous carcinomas.
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Affiliation(s)
- Mark J Wilsher
- Douglass Hanly Moir PathologyMacquarie ParkNew South Wales 2113Australia
| | - Thomas W Owens
- Discipline of Physiology, School of Medical Sciences & Bosch InstituteThe University of SydneyCamperdownNew South WalesAustralia
| | - Richard Jn Allcock
- School of Pathology and Laboratory MedicineUniversity of Western AustraliaNedlandsWestern Australia6009, Australia.,Pathwest Laboratory Medicine WAQEII Medical CentreNedlandsWestern Australia6009, Australia
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13
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Rakha EA, Badve S, Eusebi V, Reis-Filho JS, Fox SB, Dabbs DJ, Decker T, Hodi Z, Ichihara S, Lee AHS, Palacios J, Richardson AL, Vincent-Salomon A, Schmitt FC, Tan PH, Tse GM, Ellis IO. Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management. Histopathology 2016; 68:45-56. [PMID: 26348644 DOI: 10.1111/his.12861] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over- or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision-making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Sunil Badve
- Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA
| | - Vincenzo Eusebi
- Sezione Anatomia Istologia e Citologia Patologica 'M. Malpighi', Università-ASL Ospedale Bellaria, Bologna, Italy
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Fox
- Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia
| | - David J Dabbs
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas Decker
- German Breast-Screening Program, Reference Centres Berlin and Muenster, Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany
| | - Zsolt Hodi
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Shu Ichihara
- Department of Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Andrew H S Lee
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - José Palacios
- Department of Pathology, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - Fernando C Schmitt
- Department of Medicine and Pathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ian O Ellis
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
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Ginter PS, Shin SJ, D'Alfonso TM. Small Glandular Proliferations of the Breast With Absent or Attenuated Myoepithelial Reactivity by Immunohistochemistry: A Review Focusing on the Differential Diagnosis and Interpretative Pitfalls. Arch Pathol Lab Med 2016; 140:651-64. [PMID: 27362570 DOI: 10.5858/arpa.2015-0289-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Small glandular proliferations of the breast encompass a variety of benign, atypical, and malignant lesions that show some overlapping morphologic features. Myoepithelial stains are frequently used in the workup of these lesions in order to rule out or establish a diagnosis of invasive carcinoma. Some benign lesions show absent or diminished myoepithelial staining, and may represent an interpretative pitfall, particularly in small core biopsy samples. OBJECTIVE -To review small glandular proliferations of the breast that show absent or diminished staining with myoepithelial immunohistochemical markers. DATA SOURCES -The study comprised a review of published literature and clinical case material. CONCLUSIONS -The interpretation of myoepithelial stains in small glandular proliferations of the breast can, on some occasions, represent a challenge in diagnosing these lesions. Recognition of the key histopathologic features and immunohistochemical staining patterns of the entities in the differential diagnosis is crucial in their workup.
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Affiliation(s)
- Paula S Ginter
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
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15
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Senger JL, Meiers P, Kanthan R. Bilateral synchronous low-grade adenosquamous carcinoma of the breast: A Case report with review of the current literature. Int J Surg Case Rep 2015. [PMID: 26218176 PMCID: PMC4573407 DOI: 10.1016/j.ijscr.2015.06.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
LGASC is an uncommon form of triple-negative metaplastic breast carcinoma. Imaging, FNAC, & CNBx are usually indeterminate with no pathognomonic features. Histopathology is the gold standard for definitive diagnosis. Relationship between LGASC and benign mimickers (SAN, CSL) continues to evolve. LGASC is likely multicentric, thus mastectomy is the recommended management.
Introduction Low-grade adenosquamous carcinoma (LGASC) is a rare, unique variant of metaplastic breast carcinoma, characterized by clinical indolence and low-grade cytomorphology. Being clinically asymptomatic with indefinite imaging characteristics, diagnosis is solely dependent on histopathology. Presentation of Case A 68-year-old woman presented to the Breast Health Center with mammogram-detected left-sided retroareolar calcifications. She had a three-year history of non-progressive bilateral nipple inversion, and was otherwise asymptomatic. Left breast biopsy revealed atypical metaplastic squamous epithelial cells. Subsequently a wire-guided lumpectomy diagnosed a syringomatous adenoma of the nipple. A surveillance MRI identified a contralateral breast lesion, which on core biopsy showed an atypical adenosquamous lesion. Bilateral central mastectomies with bilateral sentinel node biopsies were undertaken. Histopathological review of both breast specimens confirmed the unique features of adenosquamous carcinoma identified by an infiltrative pattern of small rounded compressed angulated glands with squamous differentiation and low-grade cytomorphology. The tumors were triple negative [ER, PR, HER2]. The sentinel lymph nodes were negative. Conclusion Bilateral synchronous LGASC of the breasts is exceedingly uncommon and remains a diagnostic and therapeutic challenge. Despite being triple negative, due to its indolent behavior, recognition of this unusual primary breast malignancy is important as it has a more favorable prognosis. Yet, due to its rarity, there are no guidelines for best practice management regarding the role of adjuvant therapy.
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Affiliation(s)
- J L Senger
- Department of Plastic Surgery, University of Alberta, Canada
| | - P Meiers
- Department of Surgery, University of Saskatchewan, Canada
| | - R Kanthan
- Department of Pathology & Laboratory Medicine, University of Saskatchewan, Canada.
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