Breast – Malignant, Males, Children

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Breast-malignant, males, children

Morphologic variants of DCIS

Solid papillary DCIS

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

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

Revised: 19 August 2009

Last major update: August 2009

Definition

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● Associated with invasive colloid/mucinous or neuroendocrine carcinomas (AJSP 1995;19:1237, Pathol Int 2007;57:421)

● Indolent behavior if no invasion

● With invasion, patients often die of disease (AJSP 2006;30:501)

Terminology

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● Also called neuroendocrine DCIS

Epidemiology

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● Uncommon (2% of breast cancer)

● Age 60+ years

Case reports

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● Solid and cystic papillary carcinoma (Ann Diagn Pathol 2004;8:126)

Microscopic description / grading

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● Circumscribed, large cellular nodules separated by bands of dense fibrosis

● Resembles usual duct hyperplasia involving a papilloma

● Papillary architecture with solid growth, cellular streaming and low grade nuclear features

● Cytoplasm is often eosinophilic and granular

● May have pseudorosettes with palisading around small vascular spaces

● Often mitotic figures

● May have intracytoplasmic mucin with signet ring cells

Micro images

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Solid tumor with Solid variant with spindling

focal fibrovascular stroma

Inconspicuous fronds Tumor cells in cords and festoons, with

centrally (AFIP) well defined fibrovascular septa and vascular cores

H&E, chromogranin and

GCDFP15 (Fig d-f)

Virtual slides

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Two cases

Cytology

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● Malignant features include hypercellularity, highly discohesive clusters, numerous isolated cells and severe overcrowding; benign features include small and bland nuclei, low nuclear-cytoplasmic ratio and inconspicuous nucleoli (Diagn Cytopathol 2007;35:417)

Positive stains

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● Chromogranin or synaptophysin in 50%, ER, p63 or smooth muscle actin at epithelial-stromal interface in 27% (Histopathology 2007;51:657)

Negative stains

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● Usually negative for myoepithelial markers (Histopathology 2007;51:657), including CK5/6, but entrapped benign and myoepithelial cells may be positive (Hum Path 2006;37:787)

● 34betaE12 (Virchows Arch 2007;450:539)

Differential diagnosis

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● Ductal hyperplasia involving a papilloma - no atypia, strong CK5/6+

● LCIS - no fibrovascular septa, no papillary features

● Solid variant of adenoid cystic carcinoma - biphasic with small inconspicuous intercalated ducts mixed with myoepithelium and small collagenous spherules

● Metastatic carcinoid - clinical history of primary, may not be papillary, usually ER negative

End of Breast – Malignant, Males, Children > Solid papillary DCIS

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