Breast – Malignant, Males, Children - Pleomorphic lobular carcinoma in situ

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Breast-malignant, males, children

Central acellular carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 7 September 2009

Last major update: September 2009

Definition

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● Not in WHO breast classification

● Aggressive behavior despite small size and minimal nodal involvement

Terminology

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● Also called invasive ductal carcinoma with large central acellular zone, ring carcinoma, central necrotizing carcinoma

Clinical

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● Mean age 58 years, mean tumor size only 2.5 cm, but 28% had positive axillary nodes (central necrotizing carcinoma)

● 62% developed recurrence at median 16 months, 60% died at median 22 months from diagnosis (AJSP 2001;25:331)

● Lacks malignant features by mammography and ultrasound (Breast 2005;14:419)

● Metastases to lung and brain more common than usual (AJSP 2000;24:197)

● Considered a type of basal-like carcinoma (Breast Cancer 2009 Aug 6 [Epub ahead of print])

Treatment and prognosis

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● Poorer prognosis than matched patients with poorly differentiated tumors containing less extensive necrosis

Microscopic description / grading

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● Well-circumscribed, solitary nodule with extensive central necrosis or collagen / hyaline deposition, constituting a majority of tumor volume, surrounded by a narrow rim of viable high-grade tumor cells (ring like hypercellular zone) with pushing border and minimal tubule formation

● Relatively sharp margin but infiltrative growth accompanied by eosinophilic intercellular matrix

● Abrupt transition between peripheral cellular and central acellular zones without alteration of cancer cell adhesion (Pathol Int 2009;59:390)

Micro images

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Tumor with well circumscribed Smooth muscle actin

borders and central necrosis

Positive stains

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● S100, CK14, smooth muscle actin, p63 (myoepithelial phenotype likely due to aberrant differentiation, not a reflection of tumor histogenesis, Hum Path 1999;30:1134)

● Ki-67, p53 (Pathol Int 2008;58:26)

Negative stains

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● ER/PR (94%), HER2

Differential diagnosis

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● Matrix producing carcinoma - expansive growth with basophilic and myxoid matrix, gradual transition from cellular to acellular areas with gradual loss of tumor cell adhesion (Pathol Int 2009;59:390)

End of Breast – Malignant, Males, Children > Central acellular carcinoma

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