Breast – Malignant, Males, Children - Pregnancy related carcinoma

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Breast-malignant, males, children

Pregnancy related carcinoma

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

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

Revised: 8 September 2009

Last major update: September 2009

Clinical

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● Estimated incidence of 1 case per 3,000 pregnancies

● Increasing incidence due to delay of childbearing (Obstet Gynecol 2009;114:568)

● Associated with higher stage and larger primary tumors than non-pregnancy associated tumors (Obstet Gynecol 2008;112:71)

● Similar features as breast carcinoma in other young women, and clinical course may not be as aggressive as initially reported (Cancer 2003;98:1055)

● Diagnosis may be delayed (Cancer 2009;115:1174)

● Tumors usually contain rare fetal cells (Breast Cancer Res 2008;10:R14)

Treatment and prognosis

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● Sentinel lymph node mapping can be performed safely (Breast J 2008;14:250, Ann Surg Oncol 2007;14:218)

● Wait until second trimester to use chemotherapy (Cancer 2006;106:237, Eur J Surg Oncol 2009;35:215), which should be anthracycline based

● Delay until after delivery use of anti-folate (methotrexate) and anti-estrogen drugs (tamoxifen) (Expert Opin Pharmacother 2009 Aug 10 [Epub ahead of print]), radiotherapy and Herceptin / trastuzumab (associated with anhydramnios, Ann Oncol 2008;19:607)

Microscopic description / grading

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● 80% high grade

● Cancerization of lobules in 79%

Micro images

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Extensive cancerization of lobules

Lactation associated colloid carcinoma is MUC2+

Invasive ductal carcinoma with adjacent Syncytial sheets of tumor cells

lobules showing pregnancy-related change with high nuclear grade

Positive stains

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● MUC2 (if during lactation)

● Variable HER2 (Virchows Arch 2003;443:44)

Negative stains

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● Usually ER, PR, although these markers may underestimate tumor hormone dependence (Anticancer Res 2008;28:2447)

Molecular images

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FISH shows cells from male fetuses within tumor

Additional references

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● Archives 2000;124:1053, National Cancer Institute (US), US Guidelines

End of Breast – Malignant, Males, Children > Pregnancy related carcinoma

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