Difference between revisions of "Invasive micropapillary carcinoma of the breast"

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#redirect [[Invasive_breast_cancer#Invasive_micropapillary_carcinoma_of_the_breast]]
{{ 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]].
 
==General==
*Poor prognosis.
*[[Lymphovascular invasion]] common.<ref name=pmid20304650>{{Cite journal  | last1 = Yu | first1 = JI. | last2 = Choi | first2 = DH. | last3 = Park | first3 = W. | last4 = Huh | first4 = SJ. | last5 = Cho | first5 = EY. | last6 = Lim | first6 = YH. | last7 = Ahn | first7 = JS. | last8 = Yang | first8 = JH. | last9 = Nam | first9 = SJ. | title = Differences in prognostic factors and patterns of failure between invasive micropapillary carcinoma and invasive ductal carcinoma of the breast: matched case-control study. | journal = Breast | volume = 19 | issue = 3 | pages = 231-7 | month = Jun | year = 2010 | doi = 10.1016/j.breast.2010.01.020 | PMID = 20304650 }}</ref>
 
==Microscopic==
Features:<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>
*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".<ref name=pmid20444748>{{Cite journal  | last1 = Yamaguchi | first1 = R. | last2 = Tanaka | first2 = M. | last3 = Kondo | first3 = K. | last4 = Yokoyama | first4 = T. | last5 = Kaneko | first5 = Y. | last6 = Yamaguchi | first6 = M. | last7 = Ogata | first7 = Y. | last8 = Nakashima | first8 = O. | last9 = Kage | first9 = M. | title = Characteristic morphology of invasive micropapillary carcinoma of the breast: an immunohistochemical analysis. | journal = Jpn J Clin Oncol | volume = 40 | issue = 8 | pages = 781-7 | month = Aug | year = 2010 | doi = 10.1093/jjco/hyq056 | PMID = 20444748 | URL = http://jjco.oxfordjournals.org/content/40/8/781.long }}</ref>
**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 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 }}
</ref>
 
Note:
*[[Invasive ductal carcinoma of the breast|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 [[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===
<gallery>
Image:Breast Breast MicropapillaryCarcinoma Invasive PA.JPG|Breast - Invasive Micropapillary Carcinoma - High power (SKB)
Image:Breast MicropapillaryCarcinoma Invasive 2 PA.JPG|Breast - Invasive Micropapillary Carcinoma - High power (SKB)
</gallery>
www:
*[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>
 
==IHC==
*[[EMA]] +ve (periphery of nests); described as inside-out pattern.<ref name=pmid20444748>{{Cite journal  | last1 = Yamaguchi | first1 = R. | last2 = Tanaka | first2 = M. | last3 = Kondo | first3 = K. | last4 = Yokoyama | first4 = T. | last5 = Kaneko | first5 = Y. | last6 = Yamaguchi | first6 = M. | last7 = Ogata | first7 = Y. | last8 = Nakashima | first8 = O. | last9 = Kage | first9 = M. | title = Characteristic morphology of invasive micropapillary carcinoma of the breast: an immunohistochemical analysis. | journal = Jpn J Clin Oncol | volume = 40 | issue = 8 | pages = 781-7 | month = Aug | year = 2010 | doi = 10.1093/jjco/hyq056 | PMID = 20444748 | URL = http://jjco.oxfordjournals.org/content/40/8/781.long }}</ref>
*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.<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>
 
==See also==
*[[Invasive breast cancer]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Invasive breast cancer]]

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

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

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:

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

  1. ↑ 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.
  2. ↑ 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. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ URL: http://www.breast-cancer.ca/type/micropapillary-breast-carcinoma.htm. Accessed on: 30 May 2012.
  7. ↑ 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.
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