Difference between revisions of "Invasive breast cancer"

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Invasive breast cancer (view source)

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The above is not applied clinically. A panel of [[immunostains]] (ER, PR, HER2, EGFR, CK5/6) can reproduce the molecular groupings.<ref name=pmid19704256>{{Cite journal  | last1 = Tang | first1 = P. | last2 = Skinner | first2 = KA. | last3 = Hicks | first3 = DG. | title = Molecular classification of breast carcinomas by immunohistochemical analysis: are we ready? | journal = Diagn Mol Pathol | volume = 18 | issue = 3 | pages = 125-32 | month = Sep | year = 2009 | doi = 10.1097/PDM.0b013e31818d107b | PMID = 19704256 }}</ref>
The above is not applied clinically. A panel of [[immunostains]] (ER, PR, HER2, EGFR, CK5/6) can reproduce the molecular groupings; however, these groupings originate from gene expression profiling studies<ref name=pmid19704256>{{Cite journal  | last1 = Tang | first1 = P. | last2 = Skinner | first2 = KA. | last3 = Hicks | first3 = DG. | title = Molecular classification of breast carcinomas by immunohistochemical analysis: are we ready? | journal = Diagn Mol Pathol | volume = 18 | issue = 3 | pages = 125-32 | month = Sep | year = 2009 | doi = 10.1097/PDM.0b013e31818d107b | PMID = 19704256 }}</ref>


Basal-like breast cancer  
Basal-like breast cancer  


*Overview  
*Overview  
**A type of breast cancer that is defined by expression of basal markers (CK14, p63, calponin, SMA)
**A type of breast cancer defined by gene expression profiling
**Can be identified by expression of basal markers (CK14, p63, calponin, SMA)
**Not derived from myoepithelial cells, merely express a phenotype more in keeping with basal cells than ductal cells
**Not derived from myoepithelial cells, merely express a phenotype more in keeping with basal cells than ductal cells
**Most triple negative (ER, PgR, Her-2); therefore cannot be treated with the usual therapeutic agents  
**Most triple negative (ER, PgR, Her-2); therefore cannot be treated with the usual therapeutic agents  
**There is an association in young women between basal-like breast cancer and BRCA mutation  
**There is an association in young women between basal-like breast cancer and BRCA mutation.
**Sporadic basal-like cancers do not have a BRCA mutation but may have a dysfunctional BRCA1 pathway.


*Classic Morphological clues:
*This molecular group includes a variety of morphologic phenotypes including:
**High grade invasive ductal mammary carcinoma of no special type.
**Medullary-like mammary carcinoma (a carcinoma with some but not all the features of medullary carcinoma).
**Medullary mammary carcinomas
**Metaplastic mammary carcinomas
**Mammary adenoid cystic carcinoma
**Secretory mammary carcinoma
 
*Classic morphological clues of a basal type cancer usually refer to medullary carcinoma features:
**Relatively circumscribed  
**Relatively circumscribed  
**Geographic necrosis  
**Geographic necrosis  
**Abundant mitoses
**Abundant mitoses
 
**Pushing margins
*However, this molecular group includes a variety of phenotypes including:
**Central fibrosis or necrosis
**Medullary carcinomas
**High histological grade
**Medullary-like carcinomas - tumors with some, but not all, the histologic features of medullary carcinomas
**Exceptionally high mitotic rate
**Metaplastic carcinomas
**Pushing borders
**High grade invasive ductal carcinoma of no special type
**Conspicuous lymphocytic infiltrate


*Behaviour  
*Behaviour  
**Basal-like breast cancer is a heterogeneous group  
**Basal-like breast cancer is a heterogeneous group.
**The behaviour of basal-like breast cancer appears to fall into two groups:
**The behaviour of basal-like breast cancer appears to fall into two groups:
***The tumours that do not metastasise have a better prognosis than other grade 3 IDC
***The tumours that do not metastasise have a better prognosis than other grade 3 IDC
***Tumours with early metastasis – greater tendency to metastasise to visceral sites associated with poorer prognosis (such as lung and brain)  instead of to nodes and bone
***Tumours with early metastasis
****Hematogenous spread -greater tendency to metastasise to visceral sites associated with poorer prognosis (such as lung and brain)  instead of to nodes and bone


Triple Negative Breast Carcinomas
Triple Negative Breast Carcinomas
**Triple-negative and basal-like phenotypes are not synonymous but overlap (60–90% of triple-negative tumours are basal-like)
**About 15% of breast carcinomas.
**The classic phenotype of a triple negative tumor includes high histological grade (particularly high mitotic count), circumscribed edge, central fibrosis, necrosis, prominent lymphocytic infiltrate, syncytial growth and spindle cells.
**Important group due to a lack of tailored therapies for this group
**Triple-negative and basal-like phenotypes are not synonymous but overlap  
***About 70% of triple-negative tumours are basal-like.
***About 70% of basal-like tumors are triple-negative tumours are.
**Classic morphological clues of a basal type cancer usually refer to medullary carcinoma features.


==Immunostains for typing and diagnosis==
==Immunostains for typing and diagnosis==
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