Tall Cell Carcinoma with Reversed Polarity: Case Report of a Rare Special Type of Breast Cancer and Review of the Literature

Background: Tall cell carcinoma of the breast with reversed polarity (TCCRP) is a rare type of invasive breast cancer with overlapping features with papillary thyroid carcinoma and a characteristic molecular profile. Few cases have been reported in the literature since the first case was described in 2003. Case presentation: We present the case of a 41-year-old female with a symptomatic left breast lump. Image-guided core biopsy was diagnosed as triple-negative apocrine carcinoma. Surgical excision revealed an invasive carcinoma with solid papillary pattern, nuclei arranged away from the basement membrane (reversed polarity) and luminal eosinophilic colloid-like material. The tumour was GATA3-, CK5-, CK14- and CK7-positive and TTF1-negative. Specialist opinion and the identification of hotspot mutations in the IDH2 p.Arg172 gene via PCR confirmed the diagnosis of TCCRP. Conclusions: TCCRP is a relatively recently recognised papillary epithelial neoplasm with characteristic morphological features and molecular profile. Due to its rarity, TCCRP can be diagnostically challenging, and features can be mistaken for benign and malignant lesions. Accurate diagnosis is important in effective treatment of this indolent malignant triple-negative breast cancer, which carries an excellent prognosis.

EP-276 Tall Cell Carcinoma with Reverse Polarity (TCCRP) of the breast; a rare form of breast cancer

Aim

A case report on the diagnosis and treatment of this rare low grade triple negative breast cancer.

Case Report

A 41 year old female presented with a palpable left breast lump. Family history includes a sister with a rare myeloproliferative disorder. On examination, a left breast lower outer quadrant 2–3 cm hard irregular lump was palpable. Mammography and ultrasound revealed a 25 mm suspicious lesion (which was biopsied), with normal appearing lymph nodes.

Results

Biopsy revealed a grade 2 invasive apocrine carcinoma. Oestrogen and Herceptin receptors negative. Breast conserving surgery with sentinel lymph node biopsy was performed. Histology revealed a 22 mm well circumscribed tumour with nests of epithelial cells in micropapillary pattern with apocrine like appearance. The most striking feature was that the nuclei were at the apical rather than the basal poles of the epithelial cells (reverse polarity). No lymphovascular invasion present. Lymph nodes were negative (0/3). Diagnosis was then confirmed by molecular testing.

Conclusion

Tall cell carcinoma with reverse polarity (TCCRP)1, a rare cancer resembling tall cell variant of papillary thyroid carcinoma, was first reported by Eusebi et al in 20032. Although morphologically similar to metastatic papillary thyroid cancer, neither the immunohistochemical markers nor genetic profiles have established any connection3. Accurate diagnosis of TCCRP is important as it carries an excellent prognosis. Treatment is local regional radiotherapy. There is no indication for systemic therapy in this case, due to its indolent low metastatic potential.

Extracellular regulated kinase-2 immunoreactivity increases in parallel with cervical intraepithelial neoplasia grade in cervical neoplasia

The cell cycle control system includes cyclins, cyclin-dependent kinases (CDK), and their inhibitors (CDK1). Extracellular regulated kinase (ERK1/2) (p44 and p42 mitogen-activated protein kinases [MAPKs]) is a component of the MAPK pathway, which is associated with cyclin D1 and CDK. It is a critical signaling system for the induction of cell proliferation, differentiation, and cell survival. The aim of this study was to investigate the usefulness of ERK2 expression as a marker of biological aggressiveness complementary to cervical intraepithelial neoplasia (CIN) grade as well as to compare its expression in preinvasive lesions with that in invasive carcinoma. Paraffin-embedded sections of 146 CIN lesions (32 CIN I, 49 CIN II, and 43 CIN III) and 22 invasive cervical carcinomas (13 squamous and 9 adenocarcinomas) were used for the standard immunohistochemical procedure with the application of the ERK2 monoclonal antibody. ERK2 staining displayed a cytoplasmic and nuclear pattern. The staining intensity was gradually increased according to the severity of the dysplastic lesions; ERK2 immunoreactivity was significantly increased in high-grade dysplastic lesions (CIN II and CIN III) and invasive carcinomas by comparison to low-grade dysplastic lesions (CIN I) (P < 0.001). When high-grade lesions were separately assessed, the differences between each one of them and CIN I retained their statistical significance: CIN II versus CIN I (P < 0.001) and CIN III versus CIN I (P < 0.001). In conclusion, our study found a direct relationship between the increasing grade of the dysplastic cervical lesions and the intensity of ERK2 staining, thus implying a role of ERK2 as an early event in cervical carcinogenesis.

Trace element content in breasts with fibrocystic disease

The trace elements antimony, bromine, cesium, cobalt, iron, rubidium, scandium, strontium and zinc were determined by instrumental neutron activation analysis in breast tissue samples with fibrocystic disease and in samples with fibroadenoma tumors. The histological lesions of each breast sample with fibrocystic disease were recorded, and a statistical analysis of the lesions in combination with the determined trace elements was carried out. The results showed that the element mean values in fibroadenoma tumors are higher than those of fibrocystic disease. Some other remarkable results of statistical examination are also presented.