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Wang S, Zhang Q, Zhang T, Mao X. Invasive papillary carcinoma of the breast: A case report. Oncol Lett 2024; 28:300. [PMID: 38765791 PMCID: PMC11099954 DOI: 10.3892/ol.2024.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Invasive papillary carcinoma (IPC) of the breast is a rare form of cancer. The current report documents a case of IPC characterized by a large tumor size and skin involvement. Surgical exploration revealed no evidence of axillary lymph node metastasis in breast cancer. Due to financial constraints, the patient opted solely for anastrozole endocrine therapy at a dosage of 1 mg/day for a period of 5 years post-surgery, foregoing other treatments such as radiotherapy and chemotherapy. Since discharge, 2.5 years have passed, during which the patient has been followed up via phone every 3 months, showing a good prognosis. A literature review indicated that IPC is prevalent amongst the elderly population and can be misdiagnosed due to its morphological, cytomorphological and immunophenotypic overlap with other types of papillary neoplasms. This tumor exhibits a more favorable prognosis compared with IDC, primarily attributed to its advantageous gene and molecular expression patterns, coupled with its decreased invasiveness. Despite limited evidence-based research on the treatment of IPC, the present case report, albeit with limitations, underscores the importance of avoiding over-treatment and suggests the feasibility of combining surgery with endocrine therapy for IPC.
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Affiliation(s)
- Shijing Wang
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qingfu Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Tangbo Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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2
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Wang S, Zhang Q, Mao X. Invasive papillary carcinoma of the breast. Front Oncol 2024; 14:1374091. [PMID: 38601769 PMCID: PMC11004302 DOI: 10.3389/fonc.2024.1374091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Invasive papillary carcinoma is a rare form of breast cancer that is more likely to occur in postmenopausal women. Previous studies have been limited to case reports and small retrospective studies, leading to low awareness of this type of tumor and difficult clinical management. According to the available literature, invasive papillary carcinoma exhibits unique pathological features and biological behaviors. Invasive papillary carcinoma is mostly luminal type, with a low rate of lymph node metastasis, which underlies its favorable prognosis. The effectiveness of adjuvant therapy in reducing tumor burden and improving prognosis in patients with invasive papillary carcinoma remains uncertain. Due to the rarity of the lesion, conducting prospective clinical trials is impractical. The use of biological models, such as organoids, can help alleviate the impact of the scarcity of this condition on research. In addition, invasive papillary carcinoma is affected by specific genomic events, and more extensive studies of gene expression profiling may provide molecular-level insights to make optimal therapeutic decisions.
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Affiliation(s)
- Shijing Wang
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qingfu Zhang
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoyun Mao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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3
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Wells VA, Medeiros I, Shevtsov A, Fishman MDC, Selland DLG, Dao K, Rives AF, Slanetz PJ. Demystifying Breast Disease Markers. Radiographics 2023; 43:e220151. [PMID: 37676826 DOI: 10.1148/rg.220151] [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: 09/09/2023]
Abstract
Breast imaging radiologists regularly perform image-guided biopsies of suspicious breast lesions based on features that are associated with a likelihood of malignancy ranging from 2% to greater than 95% (Breast Imaging Reporting and Data System categories 4 and 5). As diagnostic partners, pathologists perform histopathologic assessment of these tissue samples to confirm a diagnosis. Correlating the imaging findings with the histopathologic results is an integral aspect of multidisciplinary breast care. Assessment of radiologic-pathologic concordance is vital in guiding appropriate management, as it enables identification of discordant results, minimizing the chance of misdiagnosis. Undersampling can lead to false-negative results, with the frequencies of false-negative diagnoses varying on the basis of multiple factors, including biopsy type (eg, core needle, vacuum-assisted needle), needle gauge, and type of lesion sampled at biopsy (ie, mass, calcifications, asymmetry, architectural distortion). Improving a radiologist's knowledge of macroscopic and microscopic breast anatomy and more common breast diseases and their expected imaging findings ensures more accurate radiologic-pathologic correlation and management recommendations. The histopathologic and molecular characteristics of biopsy-sampled breast lesions aid in making an accurate diagnosis. Hematoxylin-eosin staining provides critical morphologic details, whereas immunohistochemical staining enables molecular characterization of many benign and malignant lesions, which is critical for tailored treatment. The authors review commonly encountered benign and malignant breast diseases, their corresponding histopathologic phenotypes, and the histopathologic markers that are essential to clinching the diagnosis of these entities. As part of a multidisciplinary team that provides optimal patient care, radiologists should be knowledgeable of the foundations of histopathologic diagnosis and the implications for patient management to ensure appropriate radiologic-pathologic concordance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Victoria A Wells
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Isabela Medeiros
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Artem Shevtsov
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Michael D C Fishman
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Donna-Lee G Selland
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Kevin Dao
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Anna F Rives
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
| | - Priscilla J Slanetz
- From the Departments of Radiology (V.A.W., M.D.C.F., D.L.G.S., K.D., A.F.R., P.J.S.) and Pathology (I.M., A.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, FGH Building, 4th Floor, Boston, MA 02118
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Zhang X, Huang B, Wu K, Fu S. Infiltrative solid papillary carcinoma of the breast with axillary lymph node metastasis: a case report. BMC Womens Health 2023; 23:453. [PMID: 37641067 PMCID: PMC10464273 DOI: 10.1186/s12905-023-02596-6] [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: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Solid papillary carcinoma (SPC) is a rare breast papillary tumor variant. The main histological features of SPC consist of neoplastic cell-rich nodules with thin fibrovascular cores, often accompanied by mucous secretion and neuroendocrine differentiation. Infiltrative solid papillary carcinoma (ISPC) tumor cells have an invasive, map-like growth pattern with serrated irregular growth. Due to its unique clinicopathological features, SPC is classified as two pathological tissue types based on the 2019 WHO classification of breast tumors: SPC in situ and ISPC. CASE PRESENTATION We report a case of a 55-year-old female patient who was admitted to the hospital due to a painless left breast mass that had persisted for two years. Mammography suggested a mass in the left upper outer quadrant (BI-RADS 4B), and ultrasound of the breast demonstrated a cystic mass of the left breast (US_BI_RADS 4 C) with multiple enlarged lymph nodes in the left axilla. Postoperative pathology revealed ISPC with one lymph node metastasis in the left breast. Modified radical mastectomy was performed on the left breast. Subsequently, the patient received letrozole endocrine therapy, epirubicin hydrochloride and cyclophosphamide chemotherapy, and radiotherapy of the left chest wall and left upper and lower clavicular regions. After 17 months of follow-up, there was no evidence of recurrence or distant metastasis. CONCLUSIONS SPC is a group of heterogeneous tumors. SPC in situ has a good prognosis. In contrast, ISPC has a unique histological morphology and growth pattern with invasive biological behavior that can lead to lymph node and distant metastases.
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Affiliation(s)
- Xiaowei Zhang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, P. R. China
| | - Bifei Huang
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, P. R. China
| | - Kangbin Wu
- Department of Breast Disease Diagnosis and Treatment Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, P. R. China
| | - Saiping Fu
- Department of Breast Disease Diagnosis and Treatment Center, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, P. R. China.
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Shankaralingappa A, Rajagopal P, Anthony ML. Plasmacytoid Cells in Aspiration Smears of the Breast: Every Time a New Surprise. J Cytol 2023; 40:150-152. [PMID: 37745804 PMCID: PMC10516150 DOI: 10.4103/joc.joc_77_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/19/2023] [Accepted: 07/18/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
| | - Poongodi Rajagopal
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Michael L. Anthony
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
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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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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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Papillary Carcinoma of Breast: Clinicopathological Characteristics, Management, and Survival. Int J Breast Cancer 2022; 2022:5427837. [PMID: 36275485 PMCID: PMC9584724 DOI: 10.1155/2022/5427837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To study clinicopathological features, treatment strategies, and prognosis of papillary carcinoma of breast. Material and Methods. Data from 58 patients were retrospectively reviewed from January 2010 to December 2016. Four types of papillary carcinoma (on final resected specimen) were included, i.e., invasive papillary carcinoma (IPC), intracystic (encapsulated) papillary carcinoma (EPC), solid papillary carcinoma (SPC), and papillary DCIS (ductal carcinoma in situ). Various features of the four types were observed and compared. Results Of the 58 patients, 8 were males (13.7%). The mean age at presentation was 61 years; the mean tumor size was 33 mm. The frequency of each histological type was as follows: IPC (n = 22/38%), EPC (n = 22/38%), SPC (n = 12/20.6%), and papillary DCIS (n = 2/3.4%). Only two patients were ER negative (both IPC). HER-2 Neu was positive in 3 patients only, out of which 2 died of progressive disease (one EPC and one IPC). LN metastasis was present in 3 (5%) patients (one in each of 1st three types) and only one died of bone metastasis that was also Her-2Neu positive. All patients underwent upfront surgery except two patients who had synchronous IDC on the contralateral side. Breast conservation surgery (BCS) was performed in 34 (58.6%) and mastectomy in 22 (37.9%) patients. 13 patients did not undergo invasive axillary staging; the rest of 43 (74%) patients did (32 sentinel biopsy and 11 axillary dissection). Chemotherapy was given to 18 patients (31%), mostly to IPC (n = 12). Only 2 patients had bone metastasis (one was IPC and one EPC). Cancer-related death was observed in 3 patients. For all groups combined, 5-year OS was 98% and DFS was 92%. Conclusion Overall, papillary carcinoma of the breast has an excellent prognosis, even though less intense treatment modalities were used. It is still difficult to define the optimum management and avoid overtreatment, given the limited data in the literature.
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Burrai GP, Baldassarre V, Brunetti B, Iussich S, Maniscalco L, Mariotti F, Sfacteria A, Cocumelli C, Grieco V, Millanta F, Paciello O, Papparella S, Rasotto R, Romanucci M, Zappulli V. Canine and feline in situ mammary carcinoma: A comparative review. Vet Pathol 2022; 59:894-902. [PMID: 35735255 DOI: 10.1177/03009858221105060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Carcinoma in situ of the breast is a well-known entity in humans. In veterinary medicine, particularly in canine and feline mammary literature, there is no agreement whether the term in situ should be used to indicate a specific carcinoma histotype or the noninvasive status of a carcinoma of any histotype. Moreover, in the most recent histologic classification of mammary tumors published by the Davis-Thompson Foundation, it is suggested to abandon the term carcinoma in situ given the lack of standardized criteria defining this entity, replacing it with epitheliosis or ductal/lobular hyperplasia with severe atypia. This publication presents a critical review of the term in situ in human and veterinary medicine considering the evolution of the term over the years and its heterogeneous use by different authors, including variations in immunohistochemical markers for classification. This review aims to point out the lack of uniformity in the nomenclature and classification issues in veterinary medicine regarding the use of the term in situ, laying the ground for a process of standardization in future publications.
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Affiliation(s)
| | | | | | | | - Lorella Maniscalco
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Italy
| | | | | | - Cristiano Cocumelli
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana M. Aleandri, Rome, Italy
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Morgan S, Dodington D, Wu JM, Turashvili G. Solid Papillary Carcinoma and Encapsulated Papillary Carcinoma of the Breast: Clinical-Pathologic Features and Basement Membrane Studies of 50 Cases. Pathobiology 2021; 88:359-373. [PMID: 34265775 DOI: 10.1159/000517189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Solid papillary carcinoma (SPC) and encapsulated papillary carcinoma (EPC) of the breast are usually considered in situ lesions due to favorable prognosis, despite the variable presence of myoepithelial cells. We aimed to describe clinical-pathologic features including basement membrane (BM) studies in these tumors. METHODS Patients diagnosed with SPC and EPC in 2000-2019 were retrospectively identified. Microscopic slides and clinical history were reviewed. Immunohistochemical stains for BM and myoepithelial markers were performed. RESULTS Of 23 SPCs and 27 EPCs, there were 5/23 (21.7%) pure SPCs and 9/27 (33.3%) pure EPCs, while 4/23 (17.4%) and 12/27 (44.5%) were associated with ductal carcinoma in situ (DCIS), and 6/23 (26.1%) and 6/27 (22.2%) with invasive carcinoma, respectively; 8/23 (34.8%) SPCs were considered invasive. The median tumor size was 1.7 cm (range 0.1-16). All tumors were positive for hormone receptors and negative for HER2. Myoepithelial cells were absent in 20 tumors (40%) and focally present in 30 (60%). Collagen IV and laminin were negative in most invasive lesions, but they were expressed in 21/21 (100%) and 18/21 (85.7%) of EPCs without invasion, and 16/17 (94.1%) and 10/17 (58.8%) SPCs, including invasive SPCs, respectively. Lymph node involvement was identified in 3/26 (11.5%) patients, including micrometastasis in 1 EPC associated with DCIS, macrometastasis in 1 EPC associated with invasive carcinoma, and isolated tumor cells in 1 invasive SPC. Of 31 patients with outcome data (median follow-up 35 months, range 1-85), 2 (6.5%; 1 SPC, 1 EPC) developed local recurrence, both associated with invasive carcinoma. No distant recurrences or deaths were observed. CONCLUSIONS Our study confirms favorable prognosis of SPCs and EPCs, with 2 local recurrences occurring in the presence of invasion. SPCs are more commonly associated with invasive carcinoma or considered invasive compared to EPCs (60.9 vs. 22.2%). The presence of BM material and lack of lymph node involvement in most cases indicates that the majority of these tumors may represent in situ lesions; however, some may behave as low-grade invasive malignancy with metastatic potential even in the absence of conventional invasion.
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Affiliation(s)
- Sarah Morgan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David Dodington
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jessie M Wu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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11
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François A, Galant C, Berlière M, Van Bockstal MR. Artefactual Epithelial Displacement in a Papilloma with Extensive Usual Duct Hyperplasia Mimics a Solid Papillary Carcinoma with Invasive Growth. Int J Surg Pathol 2021; 29:395-399. [PMID: 33736513 DOI: 10.1177/1066896921991587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mammary solid papillary carcinoma and usual duct hyperplasia (UDH) of the breast are morphological look-alikes, characterized by cellular streaming, solid growth, and a lack of high-grade nuclear atypia. Here, we report a challenging papillary lesion in the breast of a 48-year-old woman that presented with a double pitfall. A core needle biopsy showed a solid papillary proliferation of epithelial cells with oval to round overlapping nuclei, surrounded by a sclerotic stroma. This distorted lesion contained peripheral clefts and cellular streaming, without high-grade nuclear atypia. Immunohistochemistry showed diffuse heterogenous immunoreactivity for estrogen receptor and cytokeratin 5, and no immunoreactivity for chromogranin and synaptophysin. The immunohistochemical profile distinguished this sclerosed papilloma with extensive UDH from a solid papillary carcinoma. The lumpectomy specimen revealed a second challenge, where multiple epithelial islets without surrounding myoepithelial cells were observed near the papilloma, mimicking an invasive carcinoma. These islets displayed the same immunohistochemical profile as the sclerosed papilloma and they were surrounded by steatonecrosis and reactive fibroblasts, indicating epithelial displacement within the biopsy needle tract. A sclerosed papilloma with extensive UDH is a morphologically challenging mimic of a solid papillary carcinoma. Immunohistochemistry is helpful to distinguish both entities from one another. Extensive epithelial displacement in the biopsy tract made this case particularly challenging, as the displaced epithelial islets mimicked an invasive carcinoma. Pathologists should be aware of this uncommon double pitfall to prevent misdiagnosis.
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Affiliation(s)
- Aline François
- 70492Cliniques Universitaires Saint-Luc Bruxelles, Woluwé-Saint-Lambert, Belgium
| | - Christine Galant
- 70492Cliniques Universitaires Saint-Luc Bruxelles, Woluwé-Saint-Lambert, Belgium.,Institut de Recherche Expérimentale et Clinique, 83415Université Catholique de Louvain, Brussels, Belgium
| | - Martine Berlière
- Institut de Recherche Expérimentale et Clinique, 83415Université Catholique de Louvain, Brussels, Belgium.,Breast Clinic, King Albert II Cancer Institute, 70492Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mieke R Van Bockstal
- 70492Cliniques Universitaires Saint-Luc Bruxelles, Woluwé-Saint-Lambert, Belgium.,Institut de Recherche Expérimentale et Clinique, 83415Université Catholique de Louvain, Brussels, Belgium
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12
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[A distinct breast tumor in an elderly woman]. Ann Pathol 2021; 41:228-230. [PMID: 33494951 DOI: 10.1016/j.annpat.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/01/2019] [Accepted: 09/14/2020] [Indexed: 11/20/2022]
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13
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Purohit V, Hosseini H, Unger P, Cai S. Solid papillary breast carcinoma arising in the male axilla: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nuñez DL, González FC, Ibargüengoitia MC, Fuentes Corona RE, Hernández Villegas AC, Zubiate ML, Vázquez Manjarrez SE, Ruiz Velasco CC. Papillary lesions of the breast: a review. BREAST CANCER MANAGEMENT 2020. [DOI: 10.2217/bmt-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.
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Affiliation(s)
- Denny Lara Nuñez
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Candanedo González
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa Ibargüengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana Licano Zubiate
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos Casian Ruiz Velasco
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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15
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Sood N, Gupta R, Gupta S. Invasive solid papillary carcinoma: Report of the first case presenting as an occult breast carcinoma in a male. INDIAN J PATHOL MICR 2020; 63:S141-S142. [PMID: 32108647 DOI: 10.4103/ijpm.ijpm_822_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neelam Sood
- Department of Pathology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India
| | - Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, India
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16
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Hashmi AA, Iftikhar SN, Haider R, Haider R, Irfan M, Ali J. Solid Papillary Carcinoma of Breast: Clinicopathologic Comparison With Conventional Ductal Carcinoma of Breast. Cureus 2020; 12:e11172. [PMID: 33262909 PMCID: PMC7689949 DOI: 10.7759/cureus.11172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction Solid papillary carcinoma (SPC) is a distinct rare subtype of breast tumour that often exhibits a neuroendocrine differentiation. Due to the rarity of these tumours, few studies have assessed the clinicopathological features of these tumours. Therefore, in this study, we evaluated the clinical and pathological profiles of SPC and compared the pathologic features with conventional invasive ductal carcinoma (IDC) in our population. Methods It was a retrospective cross-sectional study conducted at Liaquat National Hospital and Medical College from January 2013 until December 2019 over seven years. Cases with histological diagnosis of SPC and IDC were included in the study, and clinicopathological characteristics were compared. Results We included 39 cases of SPC in our study diagnosed during the study period. During the same timeline, 634 cases of IDC were reported and therefore included in the study for comparison. The mean age of the patients with SPC was 53.97 ± 12.15 years, and the mean tumour size was 3.42 ± 1.87 cm. Axillary metastasis was noted in 15.4% of cases. 94.9% of cases of SPC were invasive. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2/neu) and synaptophysin positivity was seen in 84.6%, 87.2%, 10.3%, and 59% respectively. Recurrence was noted in 10.3% of cases with 94.9% survival rate. Cases of SPC had significantly lower grade (grade I + II), tumour (T) and nodal (N) stage than IDC. Moreover, the frequency of hormonal receptor expression (ER and PR) was higher, and the frequency of human epidermal growth factor receptor 2 (HER2/neu) expression was lower compared to IDC. Conclusion SPC is a distinct variant of malignant papillary breast tumours with overall better prognostic parameters than IDC. Therefore, it is essential to recognize the histological features of this rare breast tumour.
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Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Syeda N Iftikhar
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Rimsha Haider
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK.,Emergency Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Raviha Haider
- Internal Medicine, Ziauddin Medical University, Karachi, PAK
| | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Javaria Ali
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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17
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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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18
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Vdovenko AA. Pathology of breast papillary neoplasms: Community hospital experience. Ann Diagn Pathol 2020; 49:151605. [PMID: 32920473 DOI: 10.1016/j.anndiagpath.2020.151605] [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: 06/22/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
In this study, 550 breast papillary neoplasms collected in a community hospital over more than ten years were reviewed and analyzed. This included 457 intraductal papillomas, 53 papillary carcinomas, 35 papillary DCIS and five invasive papillary carcinomas. The diagnostic rate of papillary neoplasms increased over time, likely due to better recognition by pathologists. Intraductal papillomas occurred most frequently in the upper outer quadrants and contained ADH/DCIS in 19% of cases. A total of 28% of non-incidental papillomas were associated with ADH/DCIS, and 29% of patients with papillomas had ADH/DCIS in adjacent tissue; nearly half of papillomas that were > 1 cm in size contained ADH/DCIS in the papilloma or adjacent to it. No single feature could predict an upgrade on excision for non-atypical intraductal papillomas diagnosed on core biopsy. There was no significant difference in the association of ADH/DCIS with central or peripheral papillomas. The overall upgrade rate of non-atypical intraductal papillomas to DCIS on excision was 2%, which justifies the conservative management of non-atypical sub-centimeter lesions. Papillary carcinomas occurred in older than intraductal papilloma patients and were most frequent in the upper quadrants. Although classically devoid of a myoepithelial cell layer, papillary carcinomas may contain some residual or even an ample myoepithelial cell layer in the papillae. An association between papillary carcinoma and conventional invasive carcinoma was found in 40% of EPCs and 89% of SPCs. Papillary DCIS was usually low- or intermediate-grade. The presence of a myoepithelial cell layer in the papillae was not inconsistent with this diagnosis. Invasive papillary carcinoma may have two histologic patterns: papillary and cribriform.
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Affiliation(s)
- Alexandre A Vdovenko
- Hartford Pathology Associates, PC, Hospital of Central Connecticut, New Britain, CT, USA..
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19
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Motoda N, Ohashi R, Makino T, Manabe E, Makita M, Naito Z. Utility of duct-washing cytology for detection of early breast cancer in patients with pathological nipple discharge: A comparative study with fine-needle aspiration cytology. Diagn Cytopathol 2020; 48:1273-1281. [PMID: 32767835 DOI: 10.1002/dc.24572] [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: 12/13/2019] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pathological nipple discharge (PND) is a relatively common symptom of breast cancer affecting the nipple. Mammary ductscopy (MD) allows direct visualization of the ductal lumen and collection of a cytological specimen using duct-washing cytology (DWC). Herein, we clarified the diagnostic efficacy of DWC for the detection of breast cancers with PND, compared with fine-needle aspiration cytology (FNAC). METHODS We retrospectively examined 48 patients with PND who underwent DWC by MD (ductosccopy group; histologically determined by intraductal biopsy [IDB] or surgical specimen). The results of sensitivity and specificity of DWC were compared with that of FNAC (conventional group; histologically determined by core needle biopsy). Clinicopathological factors were compared between the ductoscopy and the conventional groups. RESULTS Of eight histologically malignant cases in the ductoscopy group, one case was cytologically judged as malignant and three as indeterminate. Sensitivity and specificity of DWC were 50.0% and 82.5%, respectively. Malignant cases were mostly solid papillary carcinomas (SPCs), and benign cases were intraductal papillomas (IDPs). In the conventional group, sensitivity and specificity of FNAC were 88.0% and 38.2%, respectively, and malignant cases were mainly invasive carcinomas of no special type. Tumors in the ductocsopy group had more favorable prognostic features than those in the conventional group. CONCLUSION DWC has limited diagnostic value due to the high incidence of SPC, whose cytological features are indistinguishable from IDP. As DWC alone may be unreliable, comprehensive examination with IDB and MD findings is recommended.
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Affiliation(s)
- Norio Motoda
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan.,Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Takahiro Makino
- Department of Diagnostic Pathology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Eriko Manabe
- Department of Breast Surgery, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masujiro Makita
- Department of Breast Surgery, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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20
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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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21
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Ginter PS, Tang X, Shin SJ. A review of mucinous lesions of the breast. Breast J 2020; 26:1168-1178. [PMID: 32419267 DOI: 10.1111/tbj.13878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocele-like lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin-producing carcinoma. The finding of free-floating or stromal mucin accumulations is a diagnostic challenge of which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between benign and malignant mucin-producing lesions, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with associated with mucinous, myxoid, or matrix material.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Xiaoyu Tang
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
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22
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Zhou WP, Zan XY, Hu XY, Liu X, Sudarshan SKP, Yang SD, Guo YJ, Fang XM. Characterization of breast lesions using diffusion kurtosis model-based imaging: An initial experience. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:157-169. [PMID: 31815728 DOI: 10.3233/xst-190590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the characterization of breast lesions using diffusion kurtosis model-based imaging. METHODS This prospective study included 120 consecutive patients underwent preoperative DCE-MRI examinations and multi-b-value diffusion-weighted imaging (DWI). Among them, 88 malignant lesions and 44 benign lesions were detected, 56 normal fibroglandular breast tissue were selected as normal control. Conventional apparent diffusion coefficient (ADC), DKI-based parameters mean kurtosis (MK) and mean diffusivity (MD) were analyzed by lesions types and histological subtypes using one-way ANOVA and receiver operating characteristic (ROC) curve. RESULTS (1) The malignant group showed significantly lower ADC and MD (1.07±0.32×10-3 mm2/s and 1.30±0.40×10-3 mm2/s, respectively) and higher MK (0.87±0.18) than those in the benign group (1.29±0.26×10-3 mm2/s, 1.62±0.31×10-3 mm2/s and 0.67±0.18) and control group (1.67±0.33×10-3 mm2/s, 2.24±0.28×10-3 mm2/s and 0.52±0.08) with all P < 0.001. (2) Areas under ROC curve (AUC) for diagnosing malignant lesions were 0.936 for MD, 0.911 for MK and 0.897 for ADC, respectively. AUC for MD was significantly higher than that for ADC (P = 0.015). The optimal cut-off value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were as follow: ADC = 1.18×10-3mm2/s, 78.3%, 93.2%, 81.2%, 81.6%, 81.4%; MD = 1.48×10-3mm2/s, 82.2%, 98.3%, 84.4%, 87.8%, 86.2%; MK = 0.78, 91.5%, 85.3%, 89.0%, 85.8%, 87.2%. (3) Invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS) and mucinous adenocarcinoma also showed significant differences among ADC, MD and MK (with P < 0.05). CONCLUSIONS MR-DKI parameters enable to improve breast lesion characterization and have diagnostic potential applying to different pathological subtypes of breast cancers.
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Affiliation(s)
- Wei-Ping Zhou
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Xing-You Zan
- Department of Ultrasound, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiao-Yun Hu
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiao Liu
- Department of Thyroid Breast Surgery, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | | | - Shu-Dong Yang
- Department of Pathology, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Yu-Jiang Guo
- Department of Thyroid Breast Surgery, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiang-Ming Fang
- Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Jiangsu, China
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23
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Mizushima Y, Morita M, Yamaguchi R. Ultrasound Findings in Three Complex Cystic Breast Carcinomas: Correlation with Intrinsic Tumor Subtype. Kurume Med J 2019; 65:99-104. [PMID: 31406039 DOI: 10.2739/kurumemedj.ms653002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In ultrasound examinations, mixed mammary gland masses are divided into either intracystic masses that contain a solid component in the cyst or solid masses that contain a fluid component in the mass. The histological types and subtypes of three complex cystic masses that showed different internal compositions in ultrasound were determined using the ultrasound findings of three patients. Case 1: The mass showed a large cystic component (bleeding) inside and a broad-based solid lesion at the margin in the ultrasound finding. The histological type was encapsulated papillary carcinoma and the subtype was luminal A. Case 2: The mass was lobulated with a small cystic component at the margin. The histological type was solid papillary carcinoma and the subtype was luminal A. Case 3: The mass was lobulated with a circumscribed margin. Cystic components suspected of being hemorrhagic necrosis were observed at the margin and within the solid component. The histological type was squamous cell carcinoma and the subtype was triple negative. Case 2 was a solid mass in appearance, but a cystic component noted at the margin was possibly an intracystic mass. For Case 3, findings suggestive of necrosis were observed both at the margin and in the solid component and this suggested a mass with fluid degeneration. Complex cystic masses are usually examined with a focus on the solid component seen on ultrasound images; however, it is also important to observe the cystic composition. This can help determine the subtypes in addition to the histological types.
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Affiliation(s)
- Yasuko Mizushima
- Department of Laboratory Medicine, Kurume University Medical Center
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Rin Yamaguchi
- Department of Laboratory Medicine, Kurume University Medical Center.,Department of Pathology, Kurume University Medical Center
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24
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Rosa M, Agosto-Arroyo E. Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry. Ann Diagn Pathol 2019; 43:151407. [PMID: 31634810 DOI: 10.1016/j.anndiagpath.2019.151407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.
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Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| | - Emmanuel Agosto-Arroyo
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
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25
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Osamura RY, Matsui N, Okubo M, Chen L, Field AS. Histopathology and Cytopathology of Neuroendocrine Tumors and Carcinomas of the Breast: A Review. Acta Cytol 2019; 63:340-346. [PMID: 31163417 DOI: 10.1159/000500705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
Neuroendocrine tumors (NET) and carcinomas (NEC) of the breast are rare diseases, but NEC has attracted attention in both cytopathology and surgical pathology because of its specific management and prognosis. Fine-needle aspiration biopsy (FNAB) cytology can make the diagnosis in many cases particularly with high-grade NEC, with definitive diagnosis based on histopathology and immunohistochemistry. This review describes the characteristics of the disease based on the WHO classification 2012 and recent literature and -includes discussion related to the International Academy of Cytology Yokohama System of Reporting Breast FNAB -cytology.
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Affiliation(s)
- Robert Y Osamura
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan,
- Division of Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki, Japan,
| | - Naruaki Matsui
- Division of Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki, Japan
| | - Misa Okubo
- Division of Pathology, Yamachika Memorial Hospital Odawara City, Odawara, Japan
| | - Lan Chen
- Department of Pathology, Beijing Hospital and National Center of Gerontology, Beijing, China
| | - Andrew S Field
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
- University of NSW and Notre Dame University Medical Schools, Sydney, New South Wales, Australia
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26
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Kaur M, Tiwana KK, Singla N. Rare Breast Malignancy Subtypes: A Cytological, Histological, and Immunohistochemical Correlation. Niger J Surg 2019; 25:70-75. [PMID: 31007516 PMCID: PMC6452754 DOI: 10.4103/njs.njs_27_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Breast malignancies encompass various subtypes which differ in their clinical presentations, outcomes, and response to the treatment regimens. Thus, a proper histological diagnosis and a special mention of the rare histologic subtypes are required to formulate clear recommendations of their treatment protocols. Materials and Methods: This is a 1-year retrospective study highlighting the rarely encountered subtypes on the mastectomy specimens received. Results: We encountered only 11 rare cases out of the total 153 mastectomy specimens received. The rare subtypes were as follows mucinous cystadenocarcinoma (0.6%), mucinous carcinoma (0.6%), dermatofibrosarcoma protuberans (0.6%), Squamous cell carcinoma (0.6%), papillary carcinoma (2.6%), medullary carcinoma (0.6%), and malignant mesenchymal tumor (1.3%). Conclusion: Our data suggest that these variants are distinct clinicopathological entities with a unique hormonal receptor status. Scant information is available on the rare breast tumor subtypes.
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Affiliation(s)
- Manmeet Kaur
- Department of Pathology, GGS Medical College and Hospital, Faridkot, Punjab, India
| | | | - Nisha Singla
- Department of Pathology, GGS Medical College and Hospital, Faridkot, Punjab, India
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27
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Domoto H, Watanabe A, Sakata M, Shimada A, Mukai K. Invasive Solid Papillary Carcinoma of the Nipple With Pagetoid Extension and Nodal Metastasis. Int J Surg Pathol 2018; 26:573-577. [PMID: 29580118 DOI: 10.1177/1066896918766237] [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: 12/26/2022]
Abstract
We report a case of invasive solid papillary carcinoma (SPC) of the nipple with Pagetoid extension to the skin and lymph node metastasis. SPC is an uncommon primary breast cancer accounting for less than 1% of all breast cancers. Only 2 cases occurring in the nipple have been reported. However, both cases were without Pagetoid extension or lymph node metastasis. The presently reported tumor consisted of irregularly shaped solid cell nests with delicate fibrovascular cores. The tumor cells had round nuclei with low-grade atypia and eosinophilic cytoplasm. Neuroendocrine differentiation was confirmed by immunohistochemical positivity for CD56, synaptophysin, and chromogranin A. Immunohistochemistry also confirmed the absence of myoepithelial cells around the tumor cell nests. Therefore, a diagnosis of invasive SPC was made. Additionally, tumor cell deposits in the intramammary and axillary lymph nodes were identified, and these deposits had the same histological characteristics as the invasive SPC of the nipple. The invasiveness of SPC can be difficult to determine. However, the tumor cell nests in the current case exhibited a retraction artifact, which is known to be associated with invasive carcinoma and a poor prognosis, as well as morphological patterns that have been previously identified as characteristic of invasive SPC. Although SPC is widely recognized as having a favorable outcome, the existence of exceptionally aggressive cases occurring in the nipple must be recognized. Additional cases of invasive SPC of the nipple are needed to analyze the clinicopathological correlation.
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Rakha EA, Miligy IM, Gorringe KL, Toss MS, Green AR, Fox SB, Schmitt FC, Tan PH, Tse GM, Badve S, Decker T, Vincent-Salomon A, Dabbs DJ, Foschini MP, Moreno F, Wentao Y, Geyer FC, Reis-Filho JS, Pinder SE, Lakhani SR, Ellis IO. Invasion in breast lesions: the role of the epithelial-stroma barrier. Histopathology 2018; 72:1075-1083. [DOI: 10.1111/his.13446] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Emad A Rakha
- Department of Histopathology; Nottingham City Hospital NHS Trust; Nottingham University; Nottingham UK
| | - Islam M Miligy
- Department of Histopathology; Nottingham City Hospital NHS Trust; Nottingham University; Nottingham UK
| | - Kylie L Gorringe
- Cancer Genomics Program; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- The Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Vic. Australia
| | - Michael S Toss
- Department of Histopathology; Nottingham City Hospital NHS Trust; Nottingham University; Nottingham UK
| | - Andrew R Green
- Department of Histopathology; Nottingham City Hospital NHS Trust; Nottingham University; Nottingham UK
| | - Stephen B Fox
- Pathology Department; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology (IPATIMUP) and Medical Faculty; University of Porto; Porto Portugal
| | - Puay-Hoon Tan
- Department of Pathology; Singapore General Hospital; Singapore
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology; Prince of Wales Hospital; Hong Kong
| | - Sunil Badve
- Departments of Pathology and Internal Medicine; Clarian Pathology Laboratory of Indiana University; Indianapolis IN USA
| | - Thomas Decker
- Breast-Screening-Pathology; Reference Centre Munster; Gerhard Domagk-Institute of Pathology; University Hospital Münster; Münster Germany
| | | | - David J Dabbs
- University of Pittsburgh Medical Centre; Pittsburgh PA USA
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences; Section of Anatomic Pathology at Bellaria Hospital; University of Bologna; Bologna Italy
| | - Filipa Moreno
- Anatomic Pathology Department; Centro Hospitalar do Porto; Porto Portugal
| | - Yang Wentao
- Pathology; Fudan University Shanghai Cancer Center; Shanghai China
| | - Felipe C Geyer
- Department of Pathology; Memorial Sloan Kettering Cancer Centre; New York NY USA
| | - Jorge S Reis-Filho
- Department of Pathology; Memorial Sloan Kettering Cancer Centre; New York NY USA
| | - Sarah E Pinder
- Division of Cancer Studies; King's College London; Guy's Hospital; London UK
| | - Sunil R Lakhani
- Discipline of Molecular & Cellular Pathology; Faculty of Medicine; University of Queensland; The Royal Brisbane & Women's Hospital; Brisbane QLD Australia
| | - Ian O Ellis
- Department of Histopathology; Nottingham City Hospital NHS Trust; Nottingham University; Nottingham UK
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Zhang X, Shi J, Zhou Y, Mao F, Lin Y, Guan J, Liang Z, Sun Q. A rare mixed breast cancer of intraductal and solid papillary with tubular carcinoma histotypes in a young woman. J Thorac Dis 2017; 9:E792-E796. [PMID: 29221345 DOI: 10.21037/jtd.2017.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mixed breast cancer, especially of uncommon breast cancer histotypes, is rare, limiting our understanding of the disease and influencing diagnostic and management outcomes. We report a case of mixed breast cancer, with features of intraductal and solid papillary and tubular carcinomas, which appeared in a young patient. Physical examination, ultrasonography, molybdenum target mammography, and histopathology were performed for a definitive diagnosis. Tumor resection followed by radiotherapy and adjuvant chemotherapy was selected as the therapeutic strategy, and the patient was followed up thrice post treatment. We discuss the detailed diagnosis, treatment, and follow-up, together with a literature review of mixed breast cancer, to help optimize clinical management of mixed breast cancer.
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Affiliation(s)
- Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jie Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Abstract
Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocelelike lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin-producing carcinoma. The most important diagnostic challenge is the finding of free-floating or stromal mucin accumulations for which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between mucocelelike lesions and mucinous carcinoma, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with myxoid stroma ("stromal mucin") and foreign material.
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Affiliation(s)
- Beth T Harrison
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA.
| | - Deborah A Dillon
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA
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Zhang L, Zhuang L, Shi C, Miao Y, Zhang W, Song Q, Kang J, Lang Z, Xin X, Liu A, Hu J. A pilot evaluation of magnetic resonance imaging characteristics seen with solid papillary carcinomas of the breast in 4 patients. BMC Cancer 2017; 17:525. [PMID: 28784112 PMCID: PMC5547522 DOI: 10.1186/s12885-017-3518-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/01/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Solid papillary carcinoma (SPC) is a rare variant of breast papillary carcinoma with unique pathological morphology and biological behavior. There is only one case report on T1-MRI of SPC. In this study, we report our findings on this new category of papillary carcinoma to fill the gap in MRI characterization of SPC. METHODS This retrospective study included four pathology-confirmed in situ SPC patients. Conventional MRI, diffusion weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) were performed with a 1.5 T whole-body MR scanner before surgical operation. The following characteristics of each lesion were recorded: signal intensity on T2WI/STIR and T1FSPGR, morphology, maximum lesion size, and time intensity curve (TIC) on dynamic contrast enhancement MRI (DCE-MRI), apparent diffusion coefficient (ADC) value from DWI, and Cho peak from MRS. RESULTS Signal intensities of all lesions were heterogenous on T2WI/STIR and T1FSPGR. Mass enhancements were observed for all lesions with either oval or irregular shapes on DCE-MRI. The maximum lesion size ranged from 0.8 cm to 3.2 cm. All lesion margins were circumscribed, and internal enhancements were homogeneous or heterogeneous from DCE-MRI. TIC appeared with a rapid increase in initial contrast phases of all lesions. All lesions on DWI (b = 1000s/mm2) were slightly hyperintense with an ADC value range of 1.3 × 10-3 mm2/s to 1.9 × 10-3 mm2/s. Cho peak was absent at 3.2 ppm for all lesions. CONCLUSIONS MRI characteristics of SPC include heterogeneous signal intensity within the lesion on T2WI/STIR and T1FSPGR, mass enhancement with circumscribed margins, either oval or irregular shapes, and a rapid initial enhancement of TIC on DCE-MRI. ADC values and the absence of Cho peak may provide valuable information to distinguish SPC from other invasive breast carcinomas.
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Affiliation(s)
- Lina Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Ling Zhuang
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Chang Shi
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanwei Miao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Weisheng Zhang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Jianyun Kang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Zhijin Lang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xuegang Xin
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Ailian Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, USA.
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The 21-gene recurrence score in special histologic subtypes of breast cancer with favorable prognosis. Breast Cancer Res Treat 2017; 165:65-76. [PMID: 28577081 DOI: 10.1007/s10549-017-4326-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE The 21-gene recurrence score (RS) assay predicts the likelihood of distant recurrence and chemotherapy benefit in early-stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. Data on the RS of special histologic subtypes of invasive breast carcinoma with favorable prognosis are limited. METHODS We reviewed our institutional database to identify patients with special histologic subtypes of breast cancer associated with favorable prognosis and available RS results. Our cohort consists of fifty-seven women: thirty-three patients with pure mucinous carcinoma (MC), ten with tubular carcinoma (TC), nine with encapsulated papillary carcinoma (EPC), and five with solid papillary carcinoma (SPC). RESULTS Most (44/57, 77.2%) carcinomas had low RS (≤17), and none had high RS (≥31). All EPCs had low RS, but other subtypes had RS 18-30. Higher RS was associated with lower progesterone receptor (PR) expression by immunohistochemistry and lower PR mRNA scores (P ≤ 0.007). No morphologic feature (tumor grade, biopsy site changes, cellular stroma, inflammatory cells) was associated with RS ≥ 18. At a median follow-up of 40 months, the distant recurrence-free survival was 100%. One patient with SPC developed locoregional recurrence at 22 months. CONCLUSIONS As the largest series to date, our study raises the question of whether the RS assay is necessary for breast cancers with favorable histology. Reflex testing of node-negative, ER+/HER2- breast cancers may be deferred for these special histologic subtypes, emphasizing the need for multidisciplinary discussions between breast pathologists and other members of the breast cancer team.
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Toll A, Joneja U, Palazzo J. Pathologic Spectrum of Secretory and Mucinous Breast Lesions. Arch Pathol Lab Med 2017; 140:644-50. [PMID: 27362569 DOI: 10.5858/arpa.2015-0250-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -The morphologic spectrum of secretory breast lesions encompasses benign, borderline, and malignant lesions. They are characterized by luminal pink, proteinaceous secretions and variable degrees of cytologic atypia ranging from low grade to high grade, with frequent papillary formations. Other lesions, benign and malignant, can also show luminal and extraluminal secretions and share similar features with secretory lesions, making them diagnostically challenging. OBJECTIVE -To discuss the differential diagnosis of secretory breast lesions, emphasizing the most important diagnostic features of benign and malignant lesions. Lesions with intraluminal secretions discussed at length in this review include pregnancy-like hyperplasia, cystic hypersecretory hyperplasia, collagenous spherulosis, microglandular adenosis, hypersecretory carcinoma, and secretory carcinoma. Lesions with extravasated mucin, such as mucocele-like lesions and mucinous carcinoma, are also briefly discussed. DATA SOURCES -Published articles obtained from a PubMed search of the English literature were the primary source for this review. CONCLUSIONS -Lesions with secretory features described in this review show a pathologic spectrum, sometimes even within the same lesion. As a consequence, one should employ a low threshold for recommending reexcision on a core biopsy containing benign-appearing hypersecretory glands and use all ancillary data, including clinical presentation, imaging findings, morphology, immunohistochemistry, and molecular pathology, to render a final diagnosis.
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Affiliation(s)
- Adam Toll
- From the Department of Pathology, St Luke's University Health Network, Bethlehem, Pennsylvania (Dr Toll); and the Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Drs Joneja and Palazzo)
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Special Types of Breast Cancer and Non-epithelial Tumors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Khazai L, Rosa M. Use of Immunohistochemical Stains in Epithelial Lesions of the Breast. Cancer Control 2016; 22:220-5. [PMID: 26068768 DOI: 10.1177/107327481502200214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND During the last few decades, immunohistochemistry (IHC) has become an integral part of pathology. Although hematoxylin and eosin (H & E) stain remains the fundamental basis for diagnostic pathology of the breast, IHC stains provide useful and sometimes vital information. Moreover, considering the role of hormonal therapy in hormone receptor-positive breast tumors, as well as the availability of targeted chemotherapeutic agents for HER2-positive cases, IHC studies represent a major part of workups. METHODS A literature search was performed to explore the uses of IHC stains related to the diagnoses of breast lesions and prognostic/predictive information. RESULTS Selective use of IHC stains in conjunction with H & E examination helps resolve most diagnostic issues encountered by surgical pathologists during their day-to-day practice. Pathologists should be familiar with the use of each immunostain and its limitations to avoid interpretative errors. CONCLUSIONS IHC stains help guide the differential diagnosis of challenging epithelial lesions of the breast. They should be selectively and judiciously used and their findings must be interpreted with the differential diagnoses in mind and with an understanding of possible pitfalls.
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Affiliation(s)
- Laila Khazai
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Fernandez-Flores A, Cassarino DS. Endocrine mucin-producing sweat gland carcinoma: a study of three cases and CK8, CK18 and CD5/6 immunoexpression. J Cutan Pathol 2015; 42:578-86. [PMID: 25925290 DOI: 10.1111/cup.12512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 12/31/2022]
Abstract
Endocrine mucin-producing sweat gland carcinoma is a cutaneous adnexal tumor that is rarely reported in the literature. We identified only 29 previously reported cases. All these cases share some clinical morphologic and immunohistochemical features. Among the immunohistochemical markers, cytokeratins 5/6, 8 and 18 (CK5/6, CK8 and CK18) had not been previously studied in this tumor. Although studies with cytokeratin Cam5.2 exist, we know at present that this marker does not correspond to antibodies CK8/18, but rather to CK7 and CK8. We studied three examples of endocrine mucin-producing sweat gland carcinoma with 18 immunostains. Our cases showed an immunoprofile CK8+, CK18+, CK5/6- (or only focally positive), CK7+, GCDFP-15+ (2 cases), estrogen receptor+, progesterone receptor+, HER2-, neuron-specific enolase + (2 cases), anti-synaptophysin+, chromogranin A +, CD56 variable (1 case +, 1 case-), CD57-, anti-human D2-40- (two cases), p63- or focally positive, smooth muscle actin + with variable pattern of expression and smooth muscle myosin heavy chain expressed in a peripheral discontinuous layer in some nodules, but absent in most.
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Affiliation(s)
| | - David S Cassarino
- Department of Pathology, Southern California Kaiser Permanente, Los Angeles Medical Center (LAMC), Los Angeles, CA, USA
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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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Abstract
Papillary lesions of the breast encompass a spectrum of both benign and malignant lesions despite sharing a similar basic architecture. A reliable distinction between the different entities is possible even in biopsies with precise knowledge of the diagnostic criteria and using immunohistochemistry as a diagnostic adjunct. These include papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma and solid papillary carcinoma. Architectural features, cellular composition and distribution of myoepithelial cells as highlighted by immunohistochemistry are the major diagnostic criteria. In this review the most useful morphological and immunohistochemical criteria for routine diagnostic practice are presented.
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Affiliation(s)
- F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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Acevedo C, Amaya C, López-Guerra JL. Rare breast tumors: Review of the literature. Rep Pract Oncol Radiother 2013; 19:267-74. [PMID: 25061520 DOI: 10.1016/j.rpor.2013.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/31/2013] [Accepted: 08/22/2013] [Indexed: 12/31/2022] Open
Abstract
Breast cancer tumors have different morphological phenotypes and specific histopathological types with particular prognostic and clinical characteristics. The treatment of rare malignant lesions is frequently controversial due to the absence of trials to determine the optimal managements. This review describes the spectrum of rare breast tumors indicating the clinical, epidemiological and treatment characteristics.
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Affiliation(s)
- Catalina Acevedo
- Department of Radiation Oncology, Fundación Valle del Lili, Cali, Colombia
| | - Claudia Amaya
- Department of Radiation Oncology, Fundación Valle del Lili, Cali, Colombia
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Synchronous bilateral solid papillary carcinomas of the breast. Case Rep Surg 2013; 2013:812129. [PMID: 23844308 PMCID: PMC3703433 DOI: 10.1155/2013/812129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/30/2013] [Indexed: 11/25/2022] Open
Abstract
We herein report a case of synchronous bilateral solid papillary carcinoma of the breast. A 73-year-old female had a mass that was detected in the right breast on mammography. An ultrasound examination revealed one intracystic tumor in the right breast and two tumors in the left breast. A fine-needle aspiration biopsy of these three tumors was performed, which revealed a diagnosis of malignancy. A magnetic resonance imaging examination of the breasts showed diffuse small nodules surrounding these tumors bilaterally. Bilateral partial mastectomy and a sentinel lymph node biopsy were performed. Lymph node metastasis was detected in the right axilla, and additional lymph node dissection was performed. The pathological diagnosis was synchronous bilateral breast cancer, invasive ductal carcinoma NOS of the right breast, mucinous carcinomas of the left breast, and bilateral SPCs. A wide range of surgical margins were positive for SPCs, and additional bilateral total mastectomy was then performed. To the best of our knowledge, little is known about synchronous bilateral SPCs. Our case indicates that some SPCs can be widely scattered and make up a variety of invasive carcinomas. It is difficult to make a correct preoperative evaluation in such cases.
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