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

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Breast-malignant, males, children

Pleomorphic 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: 14 September 2009

Last major update: September 2009

Definition

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● Aggressive variant with high grade tumor cells

Epidemiology

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● Mean age 57 years, range 24-92

Clinical

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● Presents at more advanced stage than classic lobular carcinoma (J Surg Oncol 2008;98:314)

● Aggressive clinical course (AJSP 2000;24:1650)

Gross images

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Gross images: circumscribed tumor

Microscopic description

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● Multifocal nodular aggregates of dyscohesive, pleomorphic, high-grade tumor cells in dense fibrotic breast parenchyma

● Also single file and targetoid pattern of classic lobular carcinoma

● Often signet ring cells (29%), globoid plasmacytoid cells with eosinophilic or foamy or vacuolated cytoplasm, high nuclear grade and often multiple nucleoli

● Pleomorphic LCIS (45%) and classic LCIS (21%) often present

● 3-10 mitoses per 10 HPF

● Usually no microcalcifications, no duct formation present

Micro images

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Pleomorphic tumor cells

Signet ring type cells With pleomorphic LCIS

Other images: pleomorphic tumor cells; E-cadherin negative

Cytology description

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● More cellular than classic lobular, large tumor cells with single filing, tumor cells have cytoplasmic vacuoles and pleomorphic nuclei (Cancer 1997;81:29)

● May have apocrine features and resemble atypical mesothelial cells (Diagn Cytopathol 2008;36:657)

● Ductal lavage: similar features, although less striking; including epithelial cells in small clusters, single-file or isolated; also nuclear atypia, cytoplasmic vacuoles and signet ring features (Acta Cytol 2008;52:207)

Cytology images

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Single file arrangement of tumor Tumor cells have occasional pleomorphic

cells with cytoplasmic vacuoles nuclei and cytoplasmic vacuoles

Tumor cells exhibit marked cellularity Indented and budding nuclei

with pleomorphic nuclei and occasional

multinucleated tumor cells

Virtual slides

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With ductal NOS

Positive stains

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● GCDFP-15 (71%, due to apocrine nature), HER2 (2+ to 3+ in 81%), p53 (48%)

● Variable ER and PR

Negative stains

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● E-cadherin (Mod Path 2003;16:674), beta-catenin (membrane staining is absent, Appl Immunohistochem Mol Morphol 2007;15:260)

Molecular / cytogenetics

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● Resembles infiltrating lobular carcinoma more than infiltrative ductal carcinoma (J Pathol 2008;215:231)

● Frequent gains on 1q and 16p, losses on 11q and 16q, and genomic amplifications of 8q24, 11q13, 12q13, 17q12 and 20q13 (Future Oncol 2009;5:233)

Differential diagnosis

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● Chemotherapy or radiation treatment effect

Additional references

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● Hum Path 1992;23:1167, Hum Path 1992;23:655, Mod Path 1998;11:814

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

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