Breast – Malignant, Males, Children

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Breast-malignant, males, children

Lipid rich carcinoma

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

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

Revised: 15 September 2009

Last major update: September 2009

Definition

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● 90%+ cells have prominent intracytoplasmic neutral lipid

Clinical

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● Rare; 1-2% of breast carcinomas

● Axillary metastases may resemble histiocytes

Treatment and prognosis

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● Poor prognosis due to frequent (70%) nodal metastases at presentation

Case reports

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● 53 year old woman (Acta Chir Belg 2008;108:115)

● 55 year old man (Pathology 1995;27:280)

● 56 year old woman with focal chondroid metaplasia in tumor (Pathol Int 1998;48:912)

● 62 year old woman (Archives 2003;127:e396)

● 78 year old woman with solid alveolar pattern in tumor (Breast Cancer 1998;5:171)

Gross description

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● Lobulated, variable circumscription, firm

● 1 to 15 cm

Microscopic description / grading

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● Nests, cords and sheets of large polygonal cells with foamy or vacuolated cytoplasm containing lipid

● May resemble clear cells or lipoblasts

● Irregular nuclei with coarse chromatin, moderate atypia, prominent nucleoli

● Other patterns are large pleomorphic cells in alveolar pattern with hobnail appearance, oncocytic or apocrine-type change

Micro images

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Low power High power

Fig 1: tumor with pushing borders and lymphoplasmacytic and eosinophilic infiltrate (arrow: high grade comedo DCIS)

Fig 2: tumor composed of sheets and cords of large polyhedral cells with ill-defined borders, fine granular, eosinophilic cytoplasm and large nuclei with prominent nucleoli and coarse chromatin

Fig 3: also large clear cells with foamy or vacuolated cytoplasm; Fig 4: axillary nodal metastasis

Polygonal tumor cells with distinct cell borders

and variable cytoplasmic clearing (AFIP)

Positive stains

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● Lipid stains (Sudan black, Oil red O on fresh tissue), HER2 (71%, Tumori 2008;94:342)

Negative stains

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● Glycogen (PAS), mucin

● Usually ER, PR

Electron microscopy

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● Numerous intracytoplasmic non-membrane bound lipid droplets, often within autophagocytic vacuoles

● No evidence of lipid synthesis by rough ER or Golgi complexes (Virchows Arch A Pathol Anat Histopathol 1988;413:381)

Electron microscopy images

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Luminal microvilli, lipid droplets and mitochondria

Differential diagnosis

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● Apocrine carcinoma - uniformly granular and eosinophilic cytoplasm, GCDFP-15+, no lipid

● Glycogen-rich carcinoma - clear cytoplasm, secretions are glycogen (PAS+), not lipid

● Oncocytic carcinoma - granular and markedly eosinophilic cytoplasm, no lipid

● Secretory carcinoma - low grade, PASd+ secretions, no lipid

● Xanthogranulomatous mastitis (on core biopsy) - not invasive, cells are CD68+, alpha-1-antitrypsin+ histiocytes (Pathol Int 2009;59:234)

Additional references

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● Stanford University

End of Breast – Malignant, Males, Children > Lipid rich carcinoma

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