Breast cancer. | PathXchange

07/07/2010

Breast cancer.

California Hospital Medical Center

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60-year-old female with breast cancer.

Procedure: modified radical mastectomy with axillary dissection.

Gross: One firm mass lesion is identified in the midportion of the breast parenchyma, and measuring about 3 x 2 x 2 cm. The mass lesion is about 2.5 cm. away from the inked deep resection margin. The specimen is sectioned. Representative sections are submitted.

Micro: Sections through the firm mass lesion show an invasive ductal carcinoma with presence of extensive ductal carcinoma in situ. The invasive tumor is composed of cords and nests of tumor cells with relatively high N/C ratio and pink cytoplasm. The tumor cell nuclei exhibits opened chromatin, prominent nuclei, and scattered mitotic figures. The tumor cells are relatively big with features of apocrine carcinoma. Extensive apocrine ductal in situ carcinoma (ADCIS) and comedo type of intraductal tumor necrosis are also noted. H & E stain.

IHC stains:

ER Positive (about 95% of tumor cells, favorable)
PR Positive (about 90% of tumor cells, favorable)
Ki-67 Positive (about 15 - 20% tumor cells, unfavorable)
HER-2/neu 2 - 3+ (amplified)

Case Overview
Diagnosis

Case Overview
Diagnosis

Diagnosis:

Invasive apocrine carcinoma with extensive high grade apocrine ductal carcinoma in situ (ADCIS), micropapillary pattern, with areas of central necrosis.

Discussion:

Apocrine ductal carcinoma in situ (ADCIS) has been called a special type of ductal carcinoma in situ (DCIS) because the histologic grading is considered difficult using the classification schemes that have been proposed for common DCIS. However, ADCIS encompasses a spectrum of lesions with different morphologic aspects ranging from minimally atypical to overtly malignant. To define a classification scheme for ADCIS, 35 cases (22 pure and 13 associated with invasive carcinoma) were selected on the basis of conventional morphology on hematoxylin and eosin (H&E)-stained sections. Each case was assigned to 1 of 3 histologic grades (low, intermediate, and high) based on nuclear morphology and the presence of necrosis. In addition, the expression of hormone receptors p53, bcl-2, c-erbB-2, and Ki-67 was evaluated by immunohistochemistry, and the DNA ploidy was determined by image cytometry. Fifteen cases were classified as high histologic grade, 10 as low histologic grade, and the other 10 as intermediate grade. All but 4 cases, irrespective of grade, had the same hormonal immunophenotype: androgen receptor positivity (97.1%) and estrogen receptor and progesterone receptor negativity (94.3% and 97.1% respectively). Twenty-one cases (61.8%) showed p53 expression, and 47.1% of the cases were positive for c-erbB-2. The median positivity for Ki-67 was 5.2%. ADCIS has a unique morphologic and hormonal profile, distinct from common DCIS, deserving a specific classification. The proposed classification scheme allows for categorization of ADCIS according to the most important morphologic features already seen in common DCIS, ie, nuclear grade and necrosis. The expression of biologic markers other than hormonal receptors and bcl2 in ADCIS seems in general to be similar to that in common DCIS. Ki-67 and c-erbB-2 are expressed more frequently in intermediate and high histologic grade ADCIS.

References:

Leal C, Henrique R, Monteiro P, Lopes C, Bento MJ, De Sousa CP, Lopes P, Olson S, Silva MD, Page DL. Apocrine ductal carcinoma in situ of the breast: histologic classification and expression of biologic markers. Hum Pathol. 2001 May;32(5):487-93.