Difference between revisions of "Invasive breast cancer"

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Invasive breast cancer (view source)

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==Metaplastic breast carcinoma==
==Metaplastic breast carcinoma==
*[[AKA]] ''metaplastic carcinoma''.
*[[AKA]] ''metaplastic carcinoma''.
===General===
{{Main|Metaplastic breast carcinoma}}
*May be difficult to diagnose.
*Prognosis - poor.
*Top of the [[differential diagnosis]] for [[spindle cell lesions]] of the breast.{{fact}}
 
===Microscopic===
Features - one of the following:<ref name=metaplastic>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html]. Accessed on: 28 November 2010.</ref><ref name=pmid15868445>{{Cite journal  | last1 = Barnes | first1 = PJ. | last2 = Boutilier | first2 = R. | last3 = Chiasson | first3 = D. | last4 = Rayson | first4 = D. | title = Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression. | journal = Breast Cancer Res Treat | volume = 91 | issue = 2 | pages = 173-8 | month = May | year = 2005 | doi = 10.1007/s10549-004-7260-y | PMID = 15868445 }}</ref>
#Malignant mesenchymal elements - either:
##Spindle cells.
##Osseous, chondroid or rhabdoid differentiation.
#Squamous component.
#*Non-skin [[squamous cell carcinoma]] of the breast = metaplastic breast carcinoma.
 
Notes:
*Calcifications are uncommon.
*Cytology may be very bland, i.e. it may look very benign.
*May have minimal mitotic activity.
 
DDx:
*[[Fibromatosis]].
*Malignant [[phyllodes tumour]].
*Primary mammary sarcoma.
*[[Mammary myofibroblastoma]].
*[[Nodular fasciitis]].
*[[Squamous cell carcinoma of the skin]].
 
Images:
*[http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html Metaplastic carcinoma (breastpathology.info)].<ref name=metaplastic>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html]. Accessed on: 28 November 2010.</ref>
*[http://path.upmc.edu/cases/case116.html Metaplastic carcinoma - case 1 - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case294.html Metaplastic carcinoma - case 2 - several images (upmc.edu)].
 
====Subclassification====
*There are various way to subclassify this subtype of breast cancer. This a consequence of physician automomy.
**There is a series of articles on the topic by ''Wargotz & Norris'' that is quite old... yet it is mentioned in ''Sterberg'':<ref>{{Ref Sternberg5|328}}</ref>
*#Matrix-producing carcinoma:<ref>{{Cite journal  | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma. | journal = Hum Pathol | volume = 20 | issue = 7 | pages = 628-35 | month = Jul | year = 1989 | doi =  | PMID = 2544506 }}</ref>
*#*Features: cartilaginous and/or osseous stromal matrix; '''no''' osteoclastic giant cells.
*#Spindle cell carcinoma:<ref>{{Cite journal  | last1 = Wargotz | first1 = ES. | last2 = Deos | first2 = PH. | last3 = Norris | first3 = HJ. | title = Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. | journal = Hum Pathol | volume = 20 | issue = 8 | pages = 732-40 | month = Aug | year = 1989 | doi =  | PMID = 2473024 }}</ref>
*#*Features: (non-malignant) spindle cells.
*#*Prognosis: better prognosis than other metaplastic carcinomas.
*#Carcinosarcoma:<ref>{{Cite journal  | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. III. Carcinosarcoma. | journal = Cancer | volume = 64 | issue = 7 | pages = 1490-9 | month = Oct | year = 1989 | doi =  | PMID = 2776108 }}</ref>
*#*Features: malignant mesenchymal element.
*#*Prognosis: survival worse when compared to other metaplastic carcinomas.
*#Squamous cell carcinoma of ductal origin:<ref>{{Cite journal  | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin. | journal = Cancer | volume = 65 | issue = 2 | pages = 272-6 | month = Jan | year = 1990 | doi =  | PMID = 2153044 }}</ref>
*#*Features: purely squamous; metastases are squamous cell carcinoma.
*#Metaplastic carcinoma with osteoclastic giant cells:<ref>{{Cite journal  | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. | journal = Hum Pathol | volume = 21 | issue = 11 | pages = 1142-50 | month = Nov | year = 1990 | doi =  | PMID = 2227922 }}</ref>
*#*Features: osteoclastic [[giant cells]].
**The WHO subclassifies as follows:<ref>{{Ref BP|214}}</ref>
*#Epithelial - includes: squamous cell carcinoma, adenocarcinoma with spindle cell differentiation, [[adenosquamous carcinoma]].
*#Mixed epithelial and mesenchymal - includes: carcinosarcoma, carcinoma with metaplasia (chondroid, osseous).
 
===IHC===
*S100 -ve (r/o [[melanoma]]).
*AE1/AE3 +ve (epithelial elements only).
*CK7 +ve (epithelial elements only).
*p63 +ve (epithelial elements only).
*Vimentin +ve.
*Desmin -ve.
*EMA -ve. (???)


==Invasive micropapillary carcinoma of the breast==
==Invasive micropapillary carcinoma of the breast==
Michael
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