Haemodynamic Disorder M. O. Al-Sohaibani, MBBS, FCAP, FRCPath.
Slide Seminar Sami Shousha, MD, FRCPath Department of Histopathology, Charing Cross Hospital &...
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Transcript of Slide Seminar Sami Shousha, MD, FRCPath Department of Histopathology, Charing Cross Hospital &...
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Slide Seminar
Sami Shousha, MD, FRCPathDepartment of Histopathology,
Charing Cross Hospital & Imperial College, London
Amman, November 2013
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Case 237
• F63
• Screen detected tumour
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Core Biopsy
PgR
ER
No DCIS
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Core Biopsy
HER2 CK5
CK7 TTF1WT!
DIAGNOSIS: Invasive pleomorphic ductal carcinoma of the breast (B5b), please exclude lung primary
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AreasOf Inflammation
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LargeAbnormalNucleiWithVesiclesAnd inclusions
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MultinucleatedGiant cells
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+ AbundantAndAbnormal mitoses
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Final Diagnosis: Invasive pleomorphic ductal carcinoma, grade 3, triple negative
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Pleomorphic Ductal Carcinoma of the Breast
Characterised by 1, 2:
1. Marked nuclear pleomorphism (>6 fold variation of nuclear size), in more than 50% of tumour cells
2. Presence of multinucleated giant tumour cells
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Pleomorphic Ductal Carcinoma of the Breast
In a series of 37 cases 2 :• Age 23-78y• Size: 1.2-11.6cm• Positive Axillary Nodes in 52% 1, 2
• Focal spindle cell component in 38% 1, 2
• Necrosis in 76%• Well or Fairly circumscribed in 61%• Typical invasive ductal elements in 22%• Associated DCIS in 38%
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Pleomorphic Ductal Carcinoma of the Breast/ Immunohistochemistry
• ER & PgR negative in 94-100%% 1-3
• HER2 Negative in 40-84% 1-3
• p53 expression in 60-71% 1,3
• S100 positive in 40% 3
• p63 positive in 20% (spindle cell elements)3
• Ki67: High
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Pleomorphic Ductal Carcinoma of the Breast
• 5-year survival 2 :
– 38% if there are spindle cell elements
– 89% in the absence of spindle cell elements
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p53
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Ki67
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E-Cadherin
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EGFR
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S100
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CD68
Macrophage markers have been described in 2 cases4
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Follow up
• Patient Well with no evidence of recurrence or metastasis 14 months after surgery (Had no chemo or radiotherapy because of Huntington’s disease)
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Does Tumour morphology reflect unique patient’s personality?(Personalised Pathology!)
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References1. Silver SA, Tavassoli FA. Pleomorphic carcinoma of the breast:
clinicopathological analysis of 25 cases of an unusual high-grade phenotype of ductal carcinoma. Histopathology 2000, 36: 505-514
2. Nguyen CV et al. Pleomorhic ductal carcinoma of the breast: Predictors of decreased overall survival. Am J Surg Pathol 2010,34: 486-493
3. Zhao J et al. Clinicopathologic characteristics of pleomrphic carcinoma of the breast. Virchows Arch 2010: 456: 31-37
4. Cordoba A et al. Pleomorphic carcinoma of the breast with expression of macrophage markers: report of two cases. Pathol Int 2012: 62: 491-495
5. Sousa CM et al. The huntington disease protein accelerates breast tumour development and metastasis through ErbB2/HER2 signaling. EMBO Mol Med 2013,34: 309-325
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• F75 with breast cancer
• Section of Sentinel lymph node
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F75, Rt invasive ductal carcinoma,Sentinel node biopsy
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AE1/AE3
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p63
Diagnosis:
Benign Glandularinclusions
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WT1
WT1 negative: Not consistent with endosalpingiosis
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AE1/AE3 p63
Diagnosos: Benign glandular breast-like epithelial inclusions
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Benign epithelial inclusions in axillary lymph nodes
• Uncommon, but now increasingly seen in sentinel node biopsies, and can be mistaken for metastatic carcinoma.
• Four types have been described*;1. Glandular breast like inclusions:
• Myoepithelial cells are present around the glands. • Negative for WT1. • Can show all pathological changes that can be seen in the breast.
2. Glandular Mullerian like inclusions (nodal endosalpingiosis): • Myoepithelial cells absent. • Cells are ciliated and are WT1 positive.
3. Squamous inclusions: solid or cystic.
4. Mixed glandular and squamous inclusions*Fellgara G, Carcangiu ML, Rosai J. Benign epithelial inclusions in axillary lymph nodes: Report of 18 cases and review of the literature. Am J Surg Pathol 2011; 35: 1123-1133
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Benign epithelial inclusions in axillary lymph nodes
• Possible aetiology:
– Transported epithelium from the breast (possibly in some cases that had breast surgery)
– embryologic epithelial rests (as sometimes seen with no previous breast surgery)
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Conclusion
• Not all epithelial elements in lymph nodes are malignant
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Case 258: F46 Rt Breast Lump
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CD10
Diagnosis: Extensive atypical crbriform hyperplasia (Juvenile papillomatosis)
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Case 258
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With focal low grade in situ malignant change