Breast – Malignant, Males, Children

Home Chapter Home Jobs Conferences Fellowships Books

Breast-malignant, males, children

Small cell 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 April 2010

Last major update: September 2009

Definition

=========================================================================

● Similar morphologically to lung tumor

● Diagnosis requires exclusion of other primaries or presence of DCIS

Epidemiology

=========================================================================

● Rare, usually ages 43-70 years

Case reports

=========================================================================

● 61 year old woman with E-cadherin negative tumor (Am J Clin Pathol 2004;121:117)

● Merging with solid variant of adenoid cystic carcinoma (Pathol Res Pract 2005;201:705)

● With multiple axillary nodal metastases (Archives 2000;124:296)

Treatment and prognosis

=========================================================================

● Prognosis may not be as poor as previously thought (Am J Surg Pathol 2000;24:1231)

● Treatment is surgery, possibly chemotherapy (Breast Cancer 2009;16:68)

Gross description

=========================================================================

● Mean 3 cm, range 1-5 cm

Microscopic description

=========================================================================

● Typical small cell carcinoma features of scant cytoplasm, small (diameter of three lymphocytes) nuclei with finely granular, evenly distributed chromatin, absent or inconspicuous nucleoli

● Frequent mitoses

● Frequent crush artifact or nuclear streaming

● Infiltrative borders, lymphatic tumor emboli, necrosis

● Associated with invasive poorly differentiated carcinoma and lobular carcinoma

● Small cell in situ carcinoma is common

● Also high grade DCIS

Micro images

=========================================================================

Classic features Cytology, H&E, stains

Chromogranin Neuron specific enolase

Lung:

Classic features Necrosis

H&E, CD117 Flow, H&E, stains (site unknown)

Cytology description

=========================================================================

● Resembles small cell carcinoma of lung (Breast Cancer 2007;14:414)

Cytology images

=========================================================================

Metastatic lung tumor to breast Clusters of neoplastic cells with nuclear molding

Positive stains

=========================================================================

● CK7, E-cadherin (100%, Am J Surg Pathol 2001;25:831)

● ER or PR (35-50%, Semin Oncol 2007;34:64)

● bcl2, TTF1 (20%)

● Variable neuroendocrine staining (neuron specific enolase, synaptophysin, chromogranin)

● May have basal-like phenotype due to expression of EGFR and basal type keratins (Int J Surg Pathol 2009 Jul 3 [Epub ahead of print]), or “triple negative” pattern (Med Mol Morphol 2009;42:58)

Negative stains

=========================================================================

● CK20

● HER2

Molecular / cytogenetics

=========================================================================

● Small study shows similar genetic changes as both invasive ductal carcinoma and lung small cell carcinoma (Hum Pathol 2001;32:753)

Differential diagnosis

=========================================================================

● Lobular carcinoma - single file or targetoid patterns, cells have low grade features with occasional intracytoplasmic vacuoles, no nuclear molding, E-cadherin negative

● Metastatic tumor from lung or elsewhere - Diagn Cytopathol 2009;37:208

Additional references

=========================================================================

● Stanford University, J Clin Pathol 2005;58:775

End of Breast – Malignant, Males, Children > Small cell carcinoma

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by Copyright, (c) 2001-2009, PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions.