Difference between revisions of "Collagenous spherulosis"

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#redirect [[Breast_pathology#Collagenous_spherulosis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Collagenous_spherulosis_-_very_high_mag.jpg
| Width      =
| Caption    = Collagenous spherulosis. [[H&E stain]].
| Synonyms  = mucinous spherulosis, spherulosis
| Micro      = tubular/cribriform architecture with intratubular eosinophilic material (classical arranged like the spokes of a wheel ("radial spikes"), granules ~ 1-2 micrometers),
no mitotic activity, epithelial & myoepithelial - like benign breast
| Subtypes  =
| LMDDx      = [[atypical ductal hyperplasia]], [[cribriform DCIS]], [[adenoid cystic carcinoma of the breast]]
| Stains    =
| IHC        = CD10 +ve, ER +ve, PR +ve, p63 +ve, SMA +ve, CD117 -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = usu. asymptomatic
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        = none required, usu. incidental finding
}}
'''Collagenous spherulosis''' is a benign change of the [[breast]] that can be confused for a malignancy.
 
It is also known as '''mucinous spherulosis''', and '''spherulosis'''.<ref name=stanford_collspher>URL: [http://surgpathcriteria.stanford.edu/breast/collspher/ http://surgpathcriteria.stanford.edu/breast/collspher/]. Accessed on: 4 September 2011.</ref>
 
==General==
*Benign.
*Usually an incidental (microscopic) finding.<ref name=pmid12523815>{{Cite journal  | last1 = Jan | first1 = YJ. | last2 = Li | first2 = MC. | last3 = Ho | first3 = WL. | title = Collagenous spherulosis presenting as a mass of the breast. | journal = Zhonghua Yi Xue Za Zhi (Taipei) | volume = 65 | issue = 10 | pages = 494-7 | month = Oct | year = 2002 | doi =  | PMID = 12523815 }}</ref>
*Can mimic [[ADH]], [[cribriform DCIS]], [[adenoid cystic carcinoma of the breast|adenoid cystic carcinoma]].<ref name=pmid16330938>{{Cite journal  | last1 = Resetkova | first1 = E. | last2 = Albarracin | first2 = C. | last3 = Sneige | first3 = N. | title = Collagenous spherulosis of breast: morphologic study of 59 cases and review of the literature. | journal = Am J Surg Pathol | volume = 30 | issue = 1 | pages = 20-7 | month = Jan | year = 2006 | doi =  | PMID = 16330938 }}</ref>
**Epidemiologically, it may be associated with [[LCIS]].<ref name=pmid16330938/>
 
==Gross==
*Usually small, typically 1-3 mm.<ref name=pmid16330938/>
 
Note:
*May present as a larger mass.<ref name=pmid18476887>{{Cite journal  | last1 = Hill | first1 = P. | last2 = Cawson | first2 = J. | title = Collagenous spherulosis presenting as a mass lesion on imaging. | journal = Breast J | volume = 14 | issue = 3 | pages = 301-3 | month =  | year =  | doi = 10.1111/j.1524-4741.2008.00580.x | PMID = 18476887 }}</ref><ref>{{Cite journal  | last1 = Jan | first1 = YJ. | last2 = Li | first2 = MC. | last3 = Ho | first3 = WL. | title = Collagenous spherulosis presenting as a mass of the breast. | journal = Zhonghua Yi Xue Za Zhi (Taipei) | volume = 65 | issue = 10 | pages = 494-7 | month = Oct | year = 2002 | doi =  | PMID = 12523815 }}</ref>
 
==Microscopic==
Features:<ref name=stanford_collspher>URL: [http://surgpathcriteria.stanford.edu/breast/collspher/ http://surgpathcriteria.stanford.edu/breast/collspher/]. Accessed on: 4 September 2011.</ref><ref>URL: [http://www.hsc.stonybrook.edu/breast-atlas/V-33.htm http://www.hsc.stonybrook.edu/breast-atlas/V-33.htm]. Accessed on: 31 August 2011.</ref>
*Tubular/cribriform architecture.
*Intratubular eosinophilic material - '''key feature'''.
**Classical: Arranged like the spokes of a wheel ("radial spikes").
**Atypical: Granules ~ 1-2 micrometers.
*No mitotic activity.
*Two cells populations (epithelial & myoepithelial) - like a well-behaved breast gland.
 
Notes:
*Usually small lesions: < 50 spherules per lesion, <100 micrometers.
*May be multifocal.
*+/-Calcifications - may prompt biopsy.
 
DDx:
*[[Atypical ductal hyperplasia]].
*[[Cribriform DCIS]].
*[[Adenoid cystic carcinoma of the breast]].
 
===Images===
<gallery>
Image:Collagenous_spherulosis_-_intermed_mag.jpg | Collagenous spherulosis - intermed. mag. (WC/Nephron)
Image:Collagenous_spherulosis_-_high_mag.jpg | Collagenous spherulosis - high mag. (WC/Nephron)
Image:Collagenous_spherulosis_-_very_high_mag.jpg | Collagenous spherulosis - very high mag. (WC/Nephron)
</gallery>
www:
*[http://www.hsc.stonybrook.edu/breast-atlas/V-33.htm Collagenous spherulosis (stonybrook.edu)].
 
==IHC==
Features:<ref name=pmid22658481>{{Cite journal  | last1 = Cabibi | first1 = D. | last2 = Giannone | first2 = AG. | last3 = Belmonte | first3 = B. | last4 = Aragona | first4 = F. | last5 = Aragona | first5 = F. | title = CD10 and HHF35 actin in the differential diagnosis between Collagenous spherulosis and adenoid-cystic carcinoma of the breast. | journal = Pathol Res Pract | volume = 208 | issue = 7 | pages = 405-9 | month = Jul | year = 2012 | doi = 10.1016/j.prp.2012.05.002 | PMID = 22658481 }}</ref>
*CD10 +ve. ‡
*Muscle-specific actin +ve. ‡
*ER +ve. ‡
*PR +ve. ‡
*CD117 -ve. ‡
 
Others:<ref name=pmid22658481/>
*SMA +ve.
*p63 +ve.
*CK 5/6 +ve.
 
Note:
* ‡ The opposite pattern is seen in ''adenoid cystic carcinoma''.
 
==See also==
*[[Breast pathology]].
*[[Adenoid cystic carcinoma]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Breast pathology]]

Latest revision as of 20:56, 16 February 2014

Collagenous spherulosis
Diagnosis in short

Collagenous spherulosis. H&E stain.
Synonyms mucinous spherulosis, spherulosis
LM

tubular/cribriform architecture with intratubular eosinophilic material (classical arranged like the spokes of a wheel ("radial spikes"), granules ~ 1-2 micrometers),

no mitotic activity, epithelial & myoepithelial - like benign breast
LM DDx atypical ductal hyperplasia, cribriform DCIS, adenoid cystic carcinoma of the breast
IHC CD10 +ve, ER +ve, PR +ve, p63 +ve, SMA +ve, CD117 -ve
Site breast
Symptoms usu. asymptomatic
Prevalence uncommon
Prognosis benign
Treatment none required, usu. incidental finding

Collagenous spherulosis is a benign change of the breast that can be confused for a malignancy.

It is also known as mucinous spherulosis, and spherulosis.[1]

General

Gross

  • Usually small, typically 1-3 mm.[3]

Note:

  • May present as a larger mass.[4][5]

Microscopic

Features:[1][6]

  • Tubular/cribriform architecture.
  • Intratubular eosinophilic material - key feature.
    • Classical: Arranged like the spokes of a wheel ("radial spikes").
    • Atypical: Granules ~ 1-2 micrometers.
  • No mitotic activity.
  • Two cells populations (epithelial & myoepithelial) - like a well-behaved breast gland.

Notes:

  • Usually small lesions: < 50 spherules per lesion, <100 micrometers.
  • May be multifocal.
  • +/-Calcifications - may prompt biopsy.

DDx:

Images

  • Collagenous spherulosis - intermed. mag. (WC/Nephron)

  • Collagenous spherulosis - high mag. (WC/Nephron)

  • Collagenous spherulosis - very high mag. (WC/Nephron)

www:

IHC

Features:[7]

  • CD10 +ve. ‡
  • Muscle-specific actin +ve. ‡
  • ER +ve. ‡
  • PR +ve. ‡
  • CD117 -ve. ‡

Others:[7]

  • SMA +ve.
  • p63 +ve.
  • CK 5/6 +ve.

Note:

  • ‡ The opposite pattern is seen in adenoid cystic carcinoma.

See also

References

  1. ↑ 1.0 1.1 URL: http://surgpathcriteria.stanford.edu/breast/collspher/. Accessed on: 4 September 2011.
  2. ↑ Jan, YJ.; Li, MC.; Ho, WL. (Oct 2002). "Collagenous spherulosis presenting as a mass of the breast.". Zhonghua Yi Xue Za Zhi (Taipei) 65 (10): 494-7. PMID 12523815.
  3. ↑ 3.0 3.1 3.2 Resetkova, E.; Albarracin, C.; Sneige, N. (Jan 2006). "Collagenous spherulosis of breast: morphologic study of 59 cases and review of the literature.". Am J Surg Pathol 30 (1): 20-7. PMID 16330938.
  4. ↑ Hill, P.; Cawson, J.. "Collagenous spherulosis presenting as a mass lesion on imaging.". Breast J 14 (3): 301-3. doi:10.1111/j.1524-4741.2008.00580.x. PMID 18476887.
  5. ↑ Jan, YJ.; Li, MC.; Ho, WL. (Oct 2002). "Collagenous spherulosis presenting as a mass of the breast.". Zhonghua Yi Xue Za Zhi (Taipei) 65 (10): 494-7. PMID 12523815.
  6. ↑ URL: http://www.hsc.stonybrook.edu/breast-atlas/V-33.htm. Accessed on: 31 August 2011.
  7. ↑ 7.0 7.1 Cabibi, D.; Giannone, AG.; Belmonte, B.; Aragona, F.; Aragona, F. (Jul 2012). "CD10 and HHF35 actin in the differential diagnosis between Collagenous spherulosis and adenoid-cystic carcinoma of the breast.". Pathol Res Pract 208 (7): 405-9. doi:10.1016/j.prp.2012.05.002. PMID 22658481.
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