Difference between revisions of "Invasive micropapillary carcinoma of the breast"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Breast MicropapillaryCarcinoma Invasive 2 PA.JPG | |||
| Width = | |||
| Caption = Invasive micropapillary carcinoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = small micropapillary tufts of tumour cells or tubuloalveolar structures, central '''avascular''' stromal core, lear spaces/clefting around the small clusters of tumor cells, +/-lymphovascular invasion | |||
| Subtypes = | |||
| LMDDx = IDC NST with micropapillary features, metastatic [[serous carcinoma]] | |||
| Stains = | |||
| IHC = [[EMA]] +ve (periphery of nests) - described as inside-out pattern | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = [[breast grossing]] | |||
| Staging = [[breast cancer staging]] | |||
| Site = [[breast]] - see ''[[invasive breast cancer]]'' | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = rare | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = | |||
| Tx = surgical excision | |||
}} | |||
'''Invasive micropapillary carcinoma of the breast''', also '''micropapillary carcinoma''', is a rare type of [[invasive breast cancer]]. | '''Invasive micropapillary carcinoma of the breast''', also '''micropapillary carcinoma''', is a rare type of [[invasive breast cancer]]. | ||
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*Abundant finely granular cytoplasm. | *Abundant finely granular cytoplasm. | ||
*Mucin cytoplasmic but not in the surrounding clear spaces. | *Mucin cytoplasmic but not in the surrounding clear spaces. | ||
*Nuclear atypia is moderate or severe. | *[[Nuclear atypia]] is moderate or severe. | ||
*Mixed(micropapillary + other) histological pattern common. | *Mixed(micropapillary + other) histological pattern common. | ||
*Can show | *Can show [[psammoma bodies]] or other calcifications. | ||
DDX | DDX | ||
*Invasive mammary carcinoma of no special type with micropapillary features. | *[[Invasive ductal carcinoma of the breast|Invasive mammary carcinoma of no special type]] with micropapillary features. | ||
*Metastatic papillary serous carcinoma of the ovary (WT1, PAX8 positive).<ref>{{Cite journal | last1 = Nonaka | first1 = D. | last2 = Chiriboga | first2 = L. | last3 = Soslow | first3 = RA. | title = Expression of pax8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas. | journal = Am J Surg Pathol | volume = 32 | issue = 10 | pages = 1566-71 | month = Oct | year = 2008 | doi = 10.1097/PAS.0b013e31816d71ad | PMID = 18724243 }} | *Metastatic papillary [[serous carcinoma of the ovary]] (WT1, PAX8 positive).<ref>{{Cite journal | last1 = Nonaka | first1 = D. | last2 = Chiriboga | first2 = L. | last3 = Soslow | first3 = RA. | title = Expression of pax8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas. | journal = Am J Surg Pathol | volume = 32 | issue = 10 | pages = 1566-71 | month = Oct | year = 2008 | doi = 10.1097/PAS.0b013e31816d71ad | PMID = 18724243 }} | ||
</ref> | </ref> | ||
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*Even a minor component of this tumor type should be identified and reported due to the high rate of associated lymphatic invasion and nodal involvement. | *Even a minor component of this tumor type should be identified and reported due to the high rate of associated lymphatic invasion and nodal involvement. | ||
*Skin involvement has been reported to be strongly correlated with a poor prognosis for this subtype. | *Skin involvement has been reported to be strongly correlated with a poor prognosis for this subtype. | ||
*Micropapillary architectural is retained in node metastases, dermal lymphatic invasion, and recurrences.<ref>{{Cite journal | last1 = Pettinato | first1 = G. | last2 = Manivel | first2 = CJ. | last3 = Panico | first3 = L. | last4 = Sparano | first4 = L. | last5 = Petrella | first5 = G. | title = Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. | journal = Am J Clin Pathol | volume = 121 | issue = 6 | pages = 857-66 | month = Jun | year = 2004 | doi = 10.1309/XTJ7-VHB4-9UD7-8X60 | PMID = 15198358 }}</ref> | *Micropapillary architectural is retained in [[lymph node metastasis|node metastases]], dermal lymphatic invasion, and recurrences.<ref name=pmid15198358>{{Cite journal | last1 = Pettinato | first1 = G. | last2 = Manivel | first2 = CJ. | last3 = Panico | first3 = L. | last4 = Sparano | first4 = L. | last5 = Petrella | first5 = G. | title = Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. | journal = Am J Clin Pathol | volume = 121 | issue = 6 | pages = 857-66 | month = Jun | year = 2004 | doi = 10.1309/XTJ7-VHB4-9UD7-8X60 | PMID = 15198358 }}</ref> | ||
===Images=== | ===Images=== | ||
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Image:Breast MicropapillaryCarcinoma Invasive 2 PA.JPG|Breast - Invasive Micropapillary Carcinoma - High power (SKB) | Image:Breast MicropapillaryCarcinoma Invasive 2 PA.JPG|Breast - Invasive Micropapillary Carcinoma - High power (SKB) | ||
</gallery> | </gallery> | ||
www: | |||
*[http://www.flickr.com/photos/euthman/5300126397/ Invasive micropapillary carcinoma (flickr.com/euthman)]. | *[http://www.flickr.com/photos/euthman/5300126397/ Invasive micropapillary carcinoma (flickr.com/euthman)]. | ||
*[http://www.breast-cancer.ca/images/invasive-micropapillary-breast-carcinoma-cells1.jpg Invasive micropapillary carcinoma - poor quality image (breast-cancer.ca)].<ref>URL: [http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm]. Accessed on: 30 May 2012.</ref> | *[http://www.breast-cancer.ca/images/invasive-micropapillary-breast-carcinoma-cells1.jpg Invasive micropapillary carcinoma - poor quality image (breast-cancer.ca)].<ref>URL: [http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm]. Accessed on: 30 May 2012.</ref> | ||
Latest revision as of 11:35, 8 September 2016
| Invasive micropapillary carcinoma of the breast | |
|---|---|
| Diagnosis in short | |
 Invasive micropapillary carcinoma. H&E stain. | |
|
| |
| LM | small micropapillary tufts of tumour cells or tubuloalveolar structures, central avascular stromal core, lear spaces/clefting around the small clusters of tumor cells, +/-lymphovascular invasion |
| LM DDx | IDC NST with micropapillary features, metastatic serous carcinoma |
| IHC | EMA +ve (periphery of nests) - described as inside-out pattern |
| Grossing notes | breast grossing |
| Staging | breast cancer staging |
| Site | breast - see invasive breast cancer |
|
| |
| Prevalence | rare |
| Prognosis | poor |
| Treatment | surgical excision |
Invasive micropapillary carcinoma of the breast, also micropapillary carcinoma, is a rare type of invasive breast cancer.
General
- Poor prognosis.
- Lymphovascular invasion common.[1]
Microscopic
Features:[2]
- Small micropapillary tufts of tumour cells or tubuloalveolar structures.
- Central avascular stromal core.
- Clear spaces/clefting around the small clusters of tumor cells - diffuse/through-out the tumour - key feature.
- Described as "small clusters of tumour lying within dilated vascular channel-like spaces".[3]
- Can appear sponge like or swiss cheese like.
- Abundant finely granular cytoplasm.
- Mucin cytoplasmic but not in the surrounding clear spaces.
- Nuclear atypia is moderate or severe.
- Mixed(micropapillary + other) histological pattern common.
- Can show psammoma bodies or other calcifications.
DDX
- Invasive mammary carcinoma of no special type with micropapillary features.
- Metastatic papillary serous carcinoma of the ovary (WT1, PAX8 positive).[4]
Note:
- Ductal carcinoma commonly has clefting... but it isn't diffuse.
- Even a minor component of this tumor type should be identified and reported due to the high rate of associated lymphatic invasion and nodal involvement.
- Skin involvement has been reported to be strongly correlated with a poor prognosis for this subtype.
- Micropapillary architectural is retained in node metastases, dermal lymphatic invasion, and recurrences.[5]
Images
Breast - Invasive Micropapillary Carcinoma - High power (SKB)
Breast - Invasive Micropapillary Carcinoma - High power (SKB)
www:
- Invasive micropapillary carcinoma (flickr.com/euthman).
- Invasive micropapillary carcinoma - poor quality image (breast-cancer.ca).[6]
IHC
- EMA +ve (periphery of nests); described as inside-out pattern.[3]
- E-cadherin +ve (centre of nests). (???)
- p63 +ve/-ve.
EMA limited to the cytoplasmic membrane oriented toward the stroma. E-cadherin absent on the cytoplasmic membrane oriented toward the stroma. Hypothesized to indicate an inversion of cell polarization and a disturbance in the cell adhesion molecules.[7]
See also
References
- ↑ Yu, JI.; Choi, DH.; Park, W.; Huh, SJ.; Cho, EY.; Lim, YH.; Ahn, JS.; Yang, JH. et al. (Jun 2010). "Differences in prognostic factors and patterns of failure between invasive micropapillary carcinoma and invasive ductal carcinoma of the breast: matched case-control study.". Breast 19 (3): 231-7. doi:10.1016/j.breast.2010.01.020. PMID 20304650.
- ↑ Pettinato, G.; Manivel, CJ.; Panico, L.; Sparano, L.; Petrella, G. (Jun 2004). "Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior.". Am J Clin Pathol 121 (6): 857-66. doi:10.1309/XTJ7-VHB4-9UD7-8X60. PMID 15198358.
- ↑ 3.0 3.1 Yamaguchi, R.; Tanaka, M.; Kondo, K.; Yokoyama, T.; Kaneko, Y.; Yamaguchi, M.; Ogata, Y.; Nakashima, O. et al. (Aug 2010). "Characteristic morphology of invasive micropapillary carcinoma of the breast: an immunohistochemical analysis.". Jpn J Clin Oncol 40 (8): 781-7. doi:10.1093/jjco/hyq056. PMID 20444748.
- ↑ Nonaka, D.; Chiriboga, L.; Soslow, RA. (Oct 2008). "Expression of pax8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas.". Am J Surg Pathol 32 (10): 1566-71. doi:10.1097/PAS.0b013e31816d71ad. PMID 18724243.
- ↑ Pettinato, G.; Manivel, CJ.; Panico, L.; Sparano, L.; Petrella, G. (Jun 2004). "Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior.". Am J Clin Pathol 121 (6): 857-66. doi:10.1309/XTJ7-VHB4-9UD7-8X60. PMID 15198358.
- ↑ URL: http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm. Accessed on: 30 May 2012.
- ↑ Pettinato, G.; Manivel, CJ.; Panico, L.; Sparano, L.; Petrella, G. (Jun 2004). "Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior.". Am J Clin Pathol 121 (6): 857-66. doi:10.1309/XTJ7-VHB4-9UD7-8X60. PMID 15198358.