Breast – Malignant, Males, Children - Cribriform carcinoma

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Breast-malignant, males, children

Cribriform carcinoma - invasive

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

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

Revised: 13 September 2009

Last major update: September 2009

Definition

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● Invasive tumor with cribriform pattern similar to cribriform DCIS

● May have minor (<50%) component of tubular carcinoma

Clinical

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● Rare (1-3% of breast carcinomas), related to tubular carcinoma (Histopathology 1983;7:525)

● Nodal metastases in 14%

● Mixed patterns have intermediate prognosis between invasive cribriform and invasive ductal carcinomas

Case reports

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● 64 year old man with tumor microcalcifications (Breast Cancer 2005;12:145)

● Perineural invasion (Hum Path 1992;23:202)

● Internal mammary node metastasis (Tumori 2006;92:241)

Treatment and prognosis

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● Excellent prognosis, even with nodal metastases, if restrict diagnosis to pure pattern (Histopathology 1983;7:525, Eur J Gynaecol Oncol 1996;17:228)

Microscopic description

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● Low grade, cribriform appearance (well defined spaces formed by arches of cells) similar to cribriform DCIS but with larger cells, more cytoplasm and more vesicular nuclei

● Tumor cells are small, often have apical snouts, mild/moderate nuclear pleomorphism

● Also stromal invasion by islands of cells, often angulated

● May have predominantly solid appearance

● Associated with cribriform DCIS

● Often mixed with tubular carcinoma

● No/rare mitotic figures, no mucin production

● Note: pure pattern is defined as 90%+ cribriform; also considered “classic” even if minor component of tubular carcinoma

Micro images

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Various images Perineural invasion

Luminal Low grade nuclei Extensive secondary lumen formation

microcalcifications with angular clusters of tumor cells

Nodules may have solid appearance

ER+

Cytology description

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● Cohesive sheets and three dimensional cribriform clusters of bland ductal cells in a blood-stained background; variable osteoclast-like giant cells (Acta Cytol 2001;45:593, Acta Cytol 1992;36:48)

Positive stains

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● ER, PR (usually)

Electron microscopy

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● Numerous mitochondria; luminal surfaces have abundant microvilli (Ultrastruct Pathol 1994;18:519)

Differential diagnosis

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● Adenoid cystic carcinoma - second cell population, intracystic basement membrane material and secretory material

● Carcinoid tumor - intracytoplasmic granules, positive for neuroendocrine markers

● Collagenous spherulosis - intense eosinophilic secretions, circumscribed, not invasive (Am J Surg Pathol 1995;19:1366)

● Cribriform DCIS - non infiltrative, clusters are more regularly distributed, myoepithelial layer is present

Additional references

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● Hum Path 1990;21:333, Stanford University

End of Breast – Malignant, Males, Children > Cribriform carcinoma - invasive

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