Invasive micropapillary carcinoma of the breast

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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

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.