1
|
Zhang GN, Susnik B, Paulsen EJ, Lyons LL, Delma KS, Jorda M, Epstein JI, Kryvenko ON. Metastatic Pleomorphic Lobular Carcinoma of the Breast to the Urinary Bladder: A Report of 10 Cases and Assessment of TRPS1 in the Differential Diagnosis With Plasmacytoid Urothelial Carcinoma. Arch Pathol Lab Med 2024; 148:1110-1118. [PMID: 38217332 DOI: 10.5858/arpa.2023-0379-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/15/2024]
Abstract
CONTEXT.— Metastatic pleomorphic lobular carcinoma (MPLC) to the bladder is rare and has considerable histologic and immunohistochemical overlap with plasmacytoid urothelial carcinoma (PUC). OBJECTIVE.— To distinguish MPLC from PUC morphologically and immunohistochemically, including a newer marker, TRPS1. DESIGN.— Ten MPLCs to the bladder were reassessed and stained with estrogen, progesterone, and androgen receptors; GATA3; keratin 5/6; HMWK; GCDFP-15; and TRPS1. Sixteen PUCs constituted controls. RESULTS.— We studied 4 transurethral resections of bladder tumors and 6 biopsies from 10 women (median age, 69 years) who had breast cancer on average 15 years prior. Microscopic patterns included single cells and cords of cells (n = 4), nests/sheets of dyscohesive cells (n = 2), or both (n = 4). All tumors had cells with voluminous eosinophilic cytoplasm and eccentric nuclei mimicking PUC, and 7 of 10 tumors had signet ring cells. MPLCs were positive for estrogen (8 of 10), progesterone (3 of 7), and androgen (4 of 10) receptors; GCDFP-15 (7 of 10); GATA3 (9 of 10); HMWK (7 of 8); and TRPS1 (7 of 10). No MPLCs stained for keratin 5/6 (n = 9). Of 16 PUCs, 2 showed faint and 2 demonstrated strong TRSP1 staining; 7 of 16 were negative for p63. CONCLUSIONS.— MPLC to bladder often presents in patients with a remote history of breast cancer, exhibiting significant histologic and immunohistochemical overlap with PUC. Based on prior works and the current study, estrogen receptor (particularly SP-1), mammaglobin, and p63 help differentiate MPLC from PUC. Keratin 5/6 may aid in distinguishing a less frequent basal-type PUC because it is typically negative in MPLC. Some PUCs express TRPS1. Caution should be exercised because immunophenotypes of these tumors greatly overlap, and ramifications of misclassification are major.
Collapse
MESH Headings
- Humans
- Female
- Urinary Bladder Neoplasms/diagnosis
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/metabolism
- Diagnosis, Differential
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/metabolism
- DNA-Binding Proteins/metabolism
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/analysis
- Middle Aged
- Repressor Proteins/metabolism
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Aged, 80 and over
- Immunohistochemistry
- GATA3 Transcription Factor/metabolism
- GATA3 Transcription Factor/analysis
- Transcription Factors/metabolism
- Carcinoma, Transitional Cell/diagnosis
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/secondary
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
Collapse
Affiliation(s)
- Guan-Nan Zhang
- From the Departments of Pathology and Laboratory Medicine (Zhang, Susnik, Delma, Jorda, Kryvenko) and Radiation Oncology (Kryvenko), the Desai Sethi Urology Institute (Jorda, Kryvenko), and the Sylvester Comprehensive Cancer Center (Susnik, Jorda, Kryvenko), University of Miami Miller School of Medicine, Miami, Florida
| | - Barbara Susnik
- From the Departments of Pathology and Laboratory Medicine (Zhang, Susnik, Delma, Jorda, Kryvenko) and Radiation Oncology (Kryvenko), the Desai Sethi Urology Institute (Jorda, Kryvenko), and the Sylvester Comprehensive Cancer Center (Susnik, Jorda, Kryvenko), University of Miami Miller School of Medicine, Miami, Florida
| | - Emma J Paulsen
- the Department of Pathology, Virginia Piper Cancer Institute, Minneapolis, Minnesota (Paulsen, Lyons)
| | - Lisa L Lyons
- the Department of Pathology, Virginia Piper Cancer Institute, Minneapolis, Minnesota (Paulsen, Lyons)
| | - Katiana S Delma
- From the Departments of Pathology and Laboratory Medicine (Zhang, Susnik, Delma, Jorda, Kryvenko) and Radiation Oncology (Kryvenko), the Desai Sethi Urology Institute (Jorda, Kryvenko), and the Sylvester Comprehensive Cancer Center (Susnik, Jorda, Kryvenko), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Departments of Pathology and Laboratory Medicine (Zhang, Susnik, Delma, Jorda, Kryvenko) and Radiation Oncology (Kryvenko), the Desai Sethi Urology Institute (Jorda, Kryvenko), and the Sylvester Comprehensive Cancer Center (Susnik, Jorda, Kryvenko), University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan I Epstein
- the Departments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland (Epstein)
| | - Oleksandr N Kryvenko
- From the Departments of Pathology and Laboratory Medicine (Zhang, Susnik, Delma, Jorda, Kryvenko) and Radiation Oncology (Kryvenko), the Desai Sethi Urology Institute (Jorda, Kryvenko), and the Sylvester Comprehensive Cancer Center (Susnik, Jorda, Kryvenko), University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
2
|
Göker M, Deblaere S, Denys H, Vergauwen G, Naert E, Veldeman L, Monten C, Van den Broecke R, Van Dorpe J, Braems G, Van de Vijver K. Tumor-Infiltrating Lymphocytes and PD-L1 Expression in Pleomorphic Lobular Breast Carcinoma. Cancers (Basel) 2023; 15:cancers15112894. [PMID: 37296857 DOI: 10.3390/cancers15112894] [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: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The prognostic and predictive role of stromal tumor-infiltrating lymphocytes (sTILs) is undetermined in pleomorphic invasive lobular cancer (pILC). The same applies for the expression of PD-1/PD-L1 in this rare breast cancer subtype. Here, we aimed to investigate the expression of sTILs and analyze the PD-L1 expression levels in pILC. METHODS Archival tissues from sixty-six patients with pILC were collected. The sTIL density was scored as a percentage of tumor area using the following cut-offs: 0%; <5%; 5-9%; and 10-50%. The PD-L1 expression was analyzed using IHC on formalin-fixed, paraffin-embedded tissue sections using SP142 and 22C3 antibodies. RESULTS A total of 82% of the sixty-six patients were hormone receptor positive and 8% of cases were triple negative (TN), while 10% showed human epidermal growth factor receptor 2 (HER2) amplification. sTILs (≥1%) were present in 64% of the study population. Using the SP142 antibody, 36% of tumors demonstrated a positive PD-L1 score of ≥1%, and using the 22C3 antibody, 28% had a positive PD-L1 score of ≥1. There was no correlation between sTILs or PD-L1 expression and tumor size, tumor grade, nodal status, expression of estrogen receptor (ER), or amplification of HER2. Our data did not show any difference in survival between the three molecular subtypes of pILC with respect to sTILs and PD-L1 expression. CONCLUSION This study shows that pILCs show some degree of sTILs and PD-L1 expression; however, this was not associated with a survival improvement. Additional large trials are needed to understand immune infiltration in lobular cancer, especially in the pleomorphic subtype.
Collapse
Affiliation(s)
- Menekse Göker
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Stephanie Deblaere
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannelore Denys
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Glenn Vergauwen
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Eline Naert
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Liv Veldeman
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | - Chris Monten
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Radiotherapy, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Jo Van Dorpe
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Geert Braems
- Department of Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (GRIG), Ghent University, 9000 Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| |
Collapse
|
3
|
Biomarker profile of invasive lobular carcinoma: pleomorphic versus classic subtypes, clinicopathological characteristics and prognosis analyses. Breast Cancer Res Treat 2022; 194:279-295. [PMID: 35666367 DOI: 10.1007/s10549-022-06627-y] [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: 02/15/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the clinicopathologic features and prognosis of pleomorphic invasive lobular carcinoma (P-ILC) and classic ILC (C-ILC) according to the biomarker profile. METHODS A total of 667 C-ILCs and 133 P-ILCs between 2011 and 2021 were included. Clinicopathologic features and stromal tumor-infiltrating lymphocytes (sTILs) status were evaluated. P-ILCs were divided into subtypes based on ER/PR and HER2 expression. The overall survival and disease-free survival (DFS) of patients were compared among matched P-ILCs, C-ILCs, and invasive ductal carcinomas (IDCs) with biomarker subtypes. RESULTS Compared to C-ILCs, P-ILCs had greater tumor sizes and stages, fewer ER-positive, more HER2-positive, triple negative (TN), and Ki-67 > 20% tumors (P < 0.05). P-ILCs were subdivided into ER+ (63.1%), HER2+ (21.1%) and TN (15.8%). ER+ P-ILCs were mainly showed trabecular and solid growth patterns. Apocrine and solid features were more strongly associated with HER2+ P-ILCs and TN-P-ILCs, respectively. The prognosis of each biomarker group (ER+, HER2+ and TN) differed by subtype. The P-ILC biomarker subtypes had worse prognosis than the same subtypes in the IDC group, while there was no difference between the P-ILC and the C-ILC counterparts. Solid variants of P-ILC had the worst prognosis. Bone was the most common metastatic site in ER+ P-ILCs and TN-P-ILCs. HER2+ P-ILCs tended to metastasize to the brain and liver. DFS of HER2+ P-ILCs and TN-P-ILCs were worse than that of ER+ P-ILCs. Lacking lobular carcinoma in situ and sTILs ≤ 10% were associated with worse survival of ER+ P-ILCs and TN-P-ILCs, respectively. For HER2+ P-ILCs, Ki-67 > 20% and sTILs ≤ 10% were significant factors for lower DFS. CONCLUSION P-ILCs is an aggressive subtype of ILCs. Analyzing the prognostic factors of P-ILCs with heterogeneous morphological and biomarker characteristics is helpful for creating an individualized treatment.
Collapse
|
4
|
Zheng L, Saluja K, Guo T. Invasive Lobular Carcinoma Mimicking Encapsulated Papillary Carcinoma with a Literature Review: A Rare Variant Detected Serendipitously. Int J Surg Pathol 2022; 30:912-920. [PMID: 35656761 DOI: 10.1177/10668969221088878] [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] [Indexed: 01/01/2023]
Abstract
Invasive lobular carcinoma with papillary features is a newly proposed variant which presents as a relatively well-circumscribed mass lesion with at least partial peripheral thickened fibrous capsule and central delicate fibrovascular cores, morphologically mimicking encapsulated papillary carcinoma or solid papillary carcinoma. There are only 5 cases described in literature. We here report an interesting example of invasive lobular carcinoma with papillary growth pattern surrounded by a thick fibrous capsule, mimicking encapsulated papillary carcinoma (EPC). The lobular nature of the tumor was confirmed by the absence of membranous expression of E-cadherin and p120 catenin. The lobular cytological features are subtle in this variant and may be overlooked. Differentiation of this variant from papillary carcinomas is crucial for correct tumor categorization, staging and most importantly, proper treatment.
Collapse
Affiliation(s)
- Lan Zheng
- Department of Pathology and Laboratory Medicine, McGovern Medical School, 12340The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karan Saluja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, 12340The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tianhua Guo
- Department of Pathology and Laboratory Medicine, McGovern Medical School, 12340The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|