British/ Arab School of Pathology, June 2008

Slide Seminars

44AF51, Lt breast biopsy

44AF51, Lt breast biopsy

Diagnosis: Intraduct papilloma with adjacent DCIS

49F40, Nipple discharge

Diagnosis: Intraduct papilloma with in situ malignant change

143F46, Rt breast lump

Diagnosis: Solid papillary carcinoma+ Invasive Ductal carcinoma

Solid papillary carcinoma/Immunohistochemistry

Cytokeratin 5/6 CD10

SM Actin

Case No. 152F 64y, Left Breast, Cystic Lump

Case No. 152F 64y, Left Breast, Cystic Lump

Case No. 152F 64y, Left Breast, Cystic Lump

Case No. 152F 64y, Left Breast, Cystic Lump

K5/6 SMA

Diagnosis: Intracystic papillary Carcinoma

Case 184

Case 184 (CK 5/6)

Case 184

SMA ERER

Diagnosis: Intraduct papilloma With usual type hyperplasia

Case 185

Case 185 (CK 5/6)

Case 185

SMA p63

Diagnosis: Benign intraduct papillomas

Core biopsy 54

Core biopsy 54

SMA CK5/6

Diagnosis: Intracystic Papillary Carcinoma (B5)

136FF67, Rt breast lump, 20mm

Diagnosis: Myoid hamartoma

SMA

33 (for 139) F85, Lt breast, Asymmetry M3, US 8mm solid/cystic lesion

Diagnosis: Atypical Apocrine Adenosis (B4)

Case No. 144F 71y, Lt breast Lump, 3cm

Case No. 144F 71y, Lt breast Lump, 3cm

Diagnosis: Malignant phyllodes tumour

145. F58, Lt breast lump

Tubular adenoma rich in myoepithelial cells

150. F53, Rt breast lump, Stopped breast feeding 1 year ago

Extensive sclerosing adenosis (Adenosis tumour)

Case No. 153F 58y, Rt breast Lump, Screen-detected lesion

Case No. 153F 58y, Rt breast Lump, Screen-detected lesion

Case No. 153F 58y, Rt breast Lump, Screen-detected lesion

Diagnosis: Adenomyoepithelioma

Adenomyoepithelioma/Myoepithelial markers

p63

Adenomyoepithelioma/Myoepithelial markers

CD10 SMA

165F 40y, Right Breast Lump

Ductal or Lobular?

165F 40y, Right Breast Lump

E-Cadherin

ER

In situ Invasive

HER2

165F 40y, Right Breast Lump

165F 40y, Right Breast Lump

E-Cadherin

HER2

Case No. 165F 40y, Right Breast Lump

Diagnosis: Pleomorphic in situ & Invasive Lobular Carcinoma+ DCIS

187. F53, Rt breast lump

Benign complex sclerosing lesion

Core 41F44y, Lt breast

microcalcification, ?fibrocystic. M3, U3

41

41

Microcalcification

41

Cysts lined by cuboidal epithelium and containing mucin

41. AB/ PAS

Diagnosis: Mucocele-like lesion (B3)

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

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

Mucocele-like lesions: B2 or B3? At the moment: Surgical excision seems to

be warranted, hence B3 may be more appropriate

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

Mucinous Carcinoma: WT1 positive

41. Mucocele- like lesion: WT1 positive

Supporting a link between mucinous carcinoma and mucocele-like lesions

Core biopsy 50

Core biopsy 50

ER

Diagnosis: Adenoid cystic carcinoma

Differential diagnosis1. Cribriform DCIS

ER: Uniformly positiveCells: monomorphic

2. Collagenous Spherulosis

Differential diagnosis: Using ER & CD10

Cribriform DCIS Adenoid cystic carcinoma

Collagenous spherulosis

ER

CD10

147F73, Rt breast lump

ER –PgR –HER2 –

Triple Negative (Basal Cell Type) Breast Carcinoma

ER PgR

HER2

CK5/6CK14

SMA

EGFR

EGFR Kinase Inhibitors:LapatinibGefitinib

176F73, Rt breast lump

176F73, Rt breast lump

176F73, Rt breast lump

AE1/AE3 CK5/6 CK5/6

SMA p63 ER

Diagnosis: Metaplastic carcinoma + DCIS

Case No. 157M 58y, Lt breast Lump

CD20CD3

M 58, Lt breast Lump

AE1/AE3

CK5/6

SMA

CD68

CD10

Diagnosis: Diabetic mastopathy

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.

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.

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

164. F72, ‘Eczema’, Rt nipple

Glandular Paget’s disease

182: M 95y, ‘Contents of a breast cyst’

CX3: M 95y, ‘Contents of a breast cyst’

Diagnosis: Mucinous Carcinoma, ?breast ?skin ?Colon

AB/PAS

M 95y, ‘Contents of a breast cyst’

CK7 CK20

ER PgR

M 95y, ‘Contents of a breast cyst’/ HER2/ IH

IHC ++

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

M 95y, ‘Contents of a breast cyst’

Final Diagnosis: Mucinous Carcinoma of breast, ER+, PgR+, HER2-

188. F 43, Rt breast lump

ER

S100

SMA

CD10

Microglandular adenosis

ER

S100

Diagnosis: Microglandular adenosis and matrix producing invasive carcinoma

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.

Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.

Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.

Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.

Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.

Ae1/AE3

Case No. 135F 61y, Lt breast haemorrhagic tumour, 11cm.

CD31 Factor VIII

Diagnosis: Angiosarcoma

Thank you