Breast – Malignant, Males, Children

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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: 23 September 2009

Last major update: September 2009

Definition

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● Similar morphologically to lung tumor

● Diagnosis requires exclusion of other primaries or presence of DCIS

Epidemiology

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● Rare, usually ages 43-70 years

Case reports

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● 61 year old woman with E-cadherin negative tumor (AJCP 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

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● Prognosis may not be as poor as previously thought (AJSP 2000;24:1231)

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

Gross description

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● Mean 3 cm, range 1-5 cm

Microscopic description

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● 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

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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

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

Cytology images

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

Positive stains

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● CK7, E-cadherin (100%, AJSP 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

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● CK20, HER2

Molecular / cytogenetics

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

Differential diagnosis

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● 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

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

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

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