Breast – Malignant, Males, Children - Histiocytoid variant of lobular carcinoma

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Breast-malignant, males, children

Histiocytoid variant of lobular carcinoma

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

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

Revised: 26 September 2009

Last major update: September 2009

Definition

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● Diffuse growth of tumor cells with abundant granular, foamy (vacuolated) cytoplasm and small bland nuclei

Terminology

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● Also called myoblastomatoid variant of lobular carcinoma

Clinical

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● Metastases may appear before diagnosis of primary tumor

● May metastasize to eyelid

● May be a variant of apocrine carcinoma (AJSP 1995;19:553)

Case reports

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● 93 year old woman with erythematous breast (Archives 2003;127:1626)

● Histiocytoid metastases at autopsy (Archives 1986;110:759)

Microscopic description / grading

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● Diffuse growth of tumor cells with abundant granular, foamy (vacuolated) cytoplasm and small bland nuclei

● Resembles histiocytes or granular cell tumor

Micro images

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Tumor cells have abundant cytoplasm and vesicular nuclei, resembling histiocytes

Fig A: LCIS (arrows) and large cells in single file with focal targetoid growth; inset and

Fig B: finely granular pale pink cytoplasm

Fig B inset: intracytoplasmic lumina

Fig C: tumor infiltration of fat mimics fat necrosis; inset: GCDFP-15+

Fig D: E-Cadherin in LCIS and invasive tumor

Cytology description

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● Loosely cohesive tumor cells with abundant foamy to granular cytoplasm and bland nuclei (Pathol Int 2005;55:353)

Positive stains

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● GCDFP-15, mucicarmine, keratin, EMA

● Also PAS, ER, PR

Negative stains

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● E-cadherin, Oil red O (fresh tissue), CD68, lysozyme

● S100, HER2

Differential diagnosis

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● Lipid rich carcinoma - infiltrating ductal carcinoma with lipid in tumor cytoplasm, no mucin; very rare

● Granular cell tumor - PAS+ cytoplasmic granules

● Xanthoma - no atypia

● Xanthelasma - lipid filled cells, often in eyelid

● Histiocytoma – no atypia, histiocytes are CD68+, keratin-

Additional references

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● Pathol Int 1998;48:549, Histopathology 1989;14:515, Stanford University

End of Breast – Malignant, Males, Children > Histiocytoid variant of lobular carcinoma

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