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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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2
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Koufopoulos N, Pateras IS, Gouloumis AR, Ieronimaki AI, Zacharatou A, Spathis A, Leventakou D, Economopoulou P, Psyrri A, Arkadopoulos N, Panayiotides IG. Diagnostically Challenging Subtypes of Invasive Lobular Carcinomas: How to Avoid Potential Diagnostic Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12112658. [PMID: 36359501 PMCID: PMC9689338 DOI: 10.3390/diagnostics12112658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Invasive lobular carcinoma is the most common special breast carcinoma subtype, with unique morphological (discohesive cells, single-cell files, targetoid pattern) and immunohistochemical (loss of E-cadherin and β-catenin staining) features. Moreover, ILC displays a poor response to neoadjuvant therapy, a different metastatic pattern compared to invasive breast carcinoma of no special type, as well as unique molecular characteristics. In addition to the classic variant of invasive lobular carcinoma, several other well-recognized variants exist, including classic, alveolar, tubulolobular, solid, pleomorphic, signet-ring, and mixed. Furthermore, three novel variants of invasive lobular carcinoma, i.e., with extracellular mucin production, papillary features, and tubular elements, have been described during the last decade. We herewith focus on the unique morphological and immunohistochemical characteristics of these novel varieties of invasive lobular carcinoma, as well as differential diagnostic considerations and potential diagnostic pitfalls, especially when dealing with biopsy specimens.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
- Correspondence: ; Tel.: +30-697-203-0941
| | - Ioannis S. Pateras
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Alina Roxana Gouloumis
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Argyro Ioanna Ieronimaki
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Andriani Zacharatou
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Aris Spathis
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Danai Leventakou
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Panagiota Economopoulou
- Medical Oncology Unit, 2nd Department of Internal Medicine-Propaedeutic, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, 2nd Department of Internal Medicine-Propaedeutic, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
| | - Ioannis G. Panayiotides
- Second Department of Pathology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece
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3
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Soong TR, Dillon DA, Rice-Stitt TL, Wieczorek TJ, Baker GM, Darvishian F, Collins LC, Lester SC, Schnitt SJ, Harrison BT. Invasive lobular carcinoma with extracellular mucin (ILCEM): clinicopathologic and molecular characterization of a rare entity. Mod Pathol 2022; 35:1370-1382. [PMID: 35477749 DOI: 10.1038/s41379-022-01084-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Invasive lobular carcinoma with extracellular mucin (ILCEM) is a rare histologic subtype of breast cancer. Little is known about the pathologic or genomic signatures that distinguish ILCEM from classic invasive lobular carcinoma (ILC) or mucinous carcinoma. We studied 17 breast cancers with lobular morphology and extracellular mucin. Thirteen tumors with sufficient tissue for DNA extraction were analyzed by a next generation sequencing (NGS) assay that interrogates 447 genes for mutations and copy number variations (CNVs). Median patient age was 66 yrs (range: 31-77 yrs). Sixteen patients presented with masses, 7 of which were >2 cm. Seven patients had lymph node metastases. The cases of ILCEM were moderately (n = 13) or poorly differentiated (n = 4), frequently exhibiting variant morphology that has not been previously described or emphasized, including grade 3 nuclei (n = 11), diffuse signet ring cells (n = 10), solid growth (n = 4), tumor necrosis (n = 3) or apocrine features (n = 2). All tumors showed absent or reduced membranous E-cadherin expression. Concurrent lobular carcinoma in situ (LCIS) was seen in 11/17 cases, 1 of which was a striking example of signet ring cell LCIS with extracellular mucin. Receptor profiles were ER+/HER2- (n = 15) and ER+/HER2+ (n = 2). With a median follow-up of 83.5 months (range: 3-171 months) in 12 patients with available information, 8 patients had recurrences resulting in 4 cancer-related deaths. The most common CNVs were 16q loss (n = 11) and 1q gain (n = 9). CDH1 gene-level alterations were detected in all but one case, including frameshift (n = 7), nonsense (n = 2), and donor splice site (n = 1) mutations and indels (n = 2). Recurrent mutations were also seen in PIK3CA (n = 3), POLQ (n = 3), TP53 (n = 3), ERBB3 (n = 3), ERBB2 (n = 2), and RUNX1 (n = 2). Genes with recurrent amplifications included GATA3 (n = 4), FOXA1 (n = 3), CCND1 (n = 2). Our data highlights ILCEM as a distinct variant of ILC that often presents with higher-grade and variant morphologic features and is associated with an aggressive clinical course. NGS data support an overall lobular-type molecular profile and reveal potentially targetable alterations in a subset of cases with recurrence.
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Affiliation(s)
- T Rinda Soong
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Deborah A Dillon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Tad John Wieczorek
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Pathology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Gabrielle M Baker
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Farbod Darvishian
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
| | - Laura C Collins
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Susan C Lester
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Beth T Harrison
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Metaplastic Matrix-Producing Carcinoma and Apocrine Lobular Carcinoma In Situ Associated with Microglandular Adenosis: A Unique Case Report. Diagnostics (Basel) 2022; 12:diagnostics12061458. [PMID: 35741268 PMCID: PMC9221961 DOI: 10.3390/diagnostics12061458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 06/10/2022] [Indexed: 12/14/2022] Open
Abstract
Microglandular adenosis is a non-lobulocentric haphazard proliferation of small round glands composed of a single layer of flat to cuboidal epithelial cells. The glandular structures lack a myoepithelial layer; however, they are surrounded by a basement membrane. Its clinical course is benign, when it is not associated with invasive carcinoma. In around 30% of cases, there is a gradual transition to atypical microglandular adenosis, carcinoma in situ, and invasive breast carcinoma of several different histologic subtypes, including an invasive carcinoma of no special type, metaplastic matrix-producing carcinoma, secretory carcinoma, metaplastic carcinoma with squamous differentiation, acinic cell carcinoma, spindle cell carcinoma, and adenoid cystic carcinoma. Recent molecular studies suggest that microglandular adenosis is a non-obligate precursor of triple-negative breast carcinomas. In this manuscript, we present a unique case of microglandular adenosis associated with metaplastic matrix-producing carcinoma and HER-2 neu oncoprotein positive pleomorphic lobular carcinoma in situ with apocrine differentiation in a 79-year-old patient.
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Burky MJ, Ray EM, Ollila DW, O’Connor SM, Hertel JD, Calhoun BC. Pleomorphic Invasive Lobular Carcinoma of the Breast With Extracellular Mucin and HER2 Amplification. Breast Cancer (Auckl) 2020; 14:1178223420976383. [PMID: 33281451 PMCID: PMC7691944 DOI: 10.1177/1178223420976383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive lobular carcinoma with extracellular mucin is an uncommon pattern of invasive breast carcinoma. The 5th Edition of the World Health Organization Classification of Breast Tumors states that it is unknown whether these tumors are a subtype of mucinous carcinoma or invasive lobular carcinoma. Invasive lobular carcinoma with extracellular mucin frequently presents as a palpable mass and may be more likely to be grade 2 to 3 and HER2-positive than classic invasive lobular carcinoma. This case of pleomorphic invasive lobular carcinoma with extracellular mucin was detected by imaging only and was HER2-amplified, suggesting that a subset of these tumors may be clinically occult with an aggressive phenotype. Invasive lobular carcinoma with extracellular mucin is infrequently encountered and awareness of this entity is helpful in avoiding misdiagnosis.
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Affiliation(s)
- Matthew J Burky
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Emily M Ray
- Division of Oncology, Department of
Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
| | - David W Ollila
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
- Division of Surgical Oncology,
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Siobhan M. O’Connor
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Johann D. Hertel
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
| | - Benjamin C Calhoun
- Anatomic Pathology, Department of
Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC,
USA
- Lineberger Comprehensive Cancer Center,
University of North Carolina, Chapel Hill, NC, USA
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