British/ Arab School of Pathology, June 2008 Slide Seminars.
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Transcript of British/ Arab School of Pathology, June 2008 Slide Seminars.
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British/ Arab School of Pathology, June 2008
Slide Seminars
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44AF51, Lt breast biopsy
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44AF51, Lt breast biopsy
Diagnosis: Intraduct papilloma with adjacent DCIS
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49F40, Nipple discharge
Diagnosis: Intraduct papilloma with in situ malignant change
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143F46, Rt breast lump
Diagnosis: Solid papillary carcinoma+ Invasive Ductal carcinoma
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Solid papillary carcinoma/Immunohistochemistry
Cytokeratin 5/6 CD10
SM Actin
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Case No. 152F 64y, Left Breast, Cystic Lump
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Case No. 152F 64y, Left Breast, Cystic Lump
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Case No. 152F 64y, Left Breast, Cystic Lump
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Case No. 152F 64y, Left Breast, Cystic Lump
K5/6 SMA
Diagnosis: Intracystic papillary Carcinoma
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Case 184
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Case 184 (CK 5/6)
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Case 184
SMA ERER
Diagnosis: Intraduct papilloma With usual type hyperplasia
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Case 185
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Case 185 (CK 5/6)
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Case 185
SMA p63
Diagnosis: Benign intraduct papillomas
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Core biopsy 54
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Core biopsy 54
SMA CK5/6
Diagnosis: Intracystic Papillary Carcinoma (B5)
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136FF67, Rt breast lump, 20mm
Diagnosis: Myoid hamartoma
SMA
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33 (for 139) F85, Lt breast, Asymmetry M3, US 8mm solid/cystic lesion
Diagnosis: Atypical Apocrine Adenosis (B4)
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Case No. 144F 71y, Lt breast Lump, 3cm
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Case No. 144F 71y, Lt breast Lump, 3cm
Diagnosis: Malignant phyllodes tumour
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145. F58, Lt breast lump
Tubular adenoma rich in myoepithelial cells
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150. F53, Rt breast lump, Stopped breast feeding 1 year ago
Extensive sclerosing adenosis (Adenosis tumour)
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Case No. 153F 58y, Rt breast Lump, Screen-detected lesion
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Case No. 153F 58y, Rt breast Lump, Screen-detected lesion
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Case No. 153F 58y, Rt breast Lump, Screen-detected lesion
Diagnosis: Adenomyoepithelioma
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Adenomyoepithelioma/Myoepithelial markers
p63
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Adenomyoepithelioma/Myoepithelial markers
CD10 SMA
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165F 40y, Right Breast Lump
Ductal or Lobular?
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165F 40y, Right Breast Lump
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E-Cadherin
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ER
In situ Invasive
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HER2
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165F 40y, Right Breast Lump
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165F 40y, Right Breast Lump
E-Cadherin
HER2
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Case No. 165F 40y, Right Breast Lump
Diagnosis: Pleomorphic in situ & Invasive Lobular Carcinoma+ DCIS
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187. F53, Rt breast lump
Benign complex sclerosing lesion
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Core 41F44y, Lt breast
microcalcification, ?fibrocystic. M3, U3
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41
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41
Microcalcification
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41
Cysts lined by cuboidal epithelium and containing mucin
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41. AB/ PAS
Diagnosis: Mucocele-like lesion (B3)
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Mucocele-like lesions First described by Rosen as mucin-filled cysts lined by flat,
cuboidal or columnar epithelium with extrusion of mucin into surrounding stroma (1)
The epithelial lining may show a cribriform or micropapillary atypical proliferative pattern, or even frank in situ malignant change. Detached epithelial cells may be sometimes found within intracystic or extracystic mucin (2)
Most cases present with mammographic coarse calcification. If presenting as mass lesion, malignancy is a high possibility
(1) Rosen PP. Am J Surg Pathol 1986; 10: 464-469 (2) Hoda SA & Rosen PP. Breast J. 2004; 10: 522-527
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Excision biopsies of mucocele-like lesions diagnosed on cores P J Carder et al (2004)*
10 cases: Excision: 3 (30%) malignant (2DCIS+ 1 mucinous carcinoma) 3 had ADH 4 benign
R Ramsaroop et al (2005)** 12 cases: Excision:
5 (41%) malignant 1 ADH 6 benign
J Wang et al (2007)*** 11 cases: Excision:
all proved to be benign
*Histopathology 45:148-154 **Breast J 11:321-325***Am J Clin Pathol 127; 124-127
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Mucocele-like lesions: B2 or B3? At the moment: Surgical excision seems to
be warranted, hence B3 may be more appropriate
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Mucocele-like lesions: Relationship to invasive mucinous carcinoma It has been suggested that there is a spectrum of
changes representing a pathway progressing through:
mucin-filled ducts to mucinous ADH, mucinous DCIS and ultimately invasive mucinous carcinoma (1,2)
This is supported by recent evidence concerning staining for WT-1
(1) Hamele-Bena D et al. Am J Surg Pathol 1996; 20: 1081-1085 (2) Fisher CJ et al. Histopathology 1992; 21:69-71
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Mucinous Carcinoma: WT1 positive
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41. Mucocele- like lesion: WT1 positive
Supporting a link between mucinous carcinoma and mucocele-like lesions
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Core biopsy 50
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Core biopsy 50
ER
Diagnosis: Adenoid cystic carcinoma
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Differential diagnosis1. Cribriform DCIS
ER: Uniformly positiveCells: monomorphic
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2. Collagenous Spherulosis
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Differential diagnosis: Using ER & CD10
Cribriform DCIS Adenoid cystic carcinoma
Collagenous spherulosis
ER
CD10
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147F73, Rt breast lump
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ER –PgR –HER2 –
Triple Negative (Basal Cell Type) Breast Carcinoma
ER PgR
HER2
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CK5/6CK14
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SMA
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EGFR
EGFR Kinase Inhibitors:LapatinibGefitinib
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176F73, Rt breast lump
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176F73, Rt breast lump
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176F73, Rt breast lump
AE1/AE3 CK5/6 CK5/6
SMA p63 ER
Diagnosis: Metaplastic carcinoma + DCIS
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Case No. 157M 58y, Lt breast Lump
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CD20CD3
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M 58, Lt breast Lump
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AE1/AE3
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CK5/6
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SMA
CD68
CD10
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Diagnosis: Diabetic mastopathy
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Diabetic Mastopathy
Fibrotic breast lumps presenting in patients with long standing diabetes,
more than 10 years, particularly the insulin-dependent variety.
Patients are relatively young (average 42 years), but a range of 32-66 years
Other diabetic complications are usually present. It has also been described, less commonly, in
patients with: type 2 diabetes patients with auto-immune thyroid and connective
tissue diseases.
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Diabetic Mastopathy/ Histopathology
Lesions vary in size between 2-6 cm can be single or multiple and are bilateral in 50% of cases. Histology:
Dense keloid-like fibrosis heavy lobular and peri-vascular lymphocytic
infiltration. ‘Epithelioid fibroblasts’, sometimes
multinucleated, are present in the stroma. Cysts are characteristically absent.
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Diabetic Mastopathy
The disease is self-limiting, but can recur. Reported recurrence rates varies between 32-80% of
patients Hence follow up is recommended, and any new lumps
developing examined by FNA or a core biopsy The disease is not associated with an increased risk of
breast carcinoma or lymphoma, although sporadic cases of breast carcinoma developing in association with diabetic mastopathy have been described
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164. F72, ‘Eczema’, Rt nipple
Glandular Paget’s disease
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182: M 95y, ‘Contents of a breast cyst’
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CX3: M 95y, ‘Contents of a breast cyst’
Diagnosis: Mucinous Carcinoma, ?breast ?skin ?Colon
AB/PAS
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M 95y, ‘Contents of a breast cyst’
CK7 CK20
ER PgR
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M 95y, ‘Contents of a breast cyst’/ HER2/ IH
IHC ++
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M 95y, ‘Contents of a breast cyst’/ p63
P63 negativity is in favour of ‘non-skin’ originD.Evans et al. J Cutan Pathol 2007, 34; 474-480
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M 95y, ‘Contents of a breast cyst’
Final Diagnosis: Mucinous Carcinoma of breast, ER+, PgR+, HER2-
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188. F 43, Rt breast lump
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ER
S100
SMA
CD10
Microglandular adenosis
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ER
S100
Diagnosis: Microglandular adenosis and matrix producing invasive carcinoma
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm. Had Lt Breast Carcinoma, 5y ago
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
Ae1/AE3
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Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.
CD31 Factor VIII
Diagnosis: Angiosarcoma
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Thank you