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Archives of Pathology & Laboratory... Dec 2019Metaplastic carcinoma is a rare, triple-negative carcinoma of the breast that exhibits transformation of part or all of its glandular carcinomatous component into a... (Review)
Review
CONTEXT—
Metaplastic carcinoma is a rare, triple-negative carcinoma of the breast that exhibits transformation of part or all of its glandular carcinomatous component into a nonglandular, or metaplastic, component. The World Health Organization currently recognizes 5 variants of metaplastic carcinoma based on their histologic appearance.
OBJECTIVE—
To review the histologic classifications, differential diagnosis, prognosis, and recent laboratory studies of metaplastic breast carcinoma.
DATA SOURCES.—
We reviewed recently published studies that collectively examine metaplastic carcinomas, including results from our own research.
CONCLUSIONS.—
Metaplastic breast carcinoma has a broad spectrum of histologic patterns, often leading to a broad differential diagnosis. Diagnosis can typically be rendered by a combination of morphology and immunohistochemical staining for high-molecular-weight cytokeratins and p63. Recent studies elucidate new genes and pathways involved in the pathogenesis of metaplastic carcinoma, including the downregulation of and pathway gene mutations, and provide a novel MMTV-Cre; knockout disease-relevant mouse model to test new therapies.
Topics: Animals; Biomarkers, Tumor; Female; Humans; Metaplasia; Triple Negative Breast Neoplasms
PubMed: 31765246
DOI: 10.5858/arpa.2019-0396-RA -
Seminars in Cancer Biology Jul 2021Many breast lesions are associated with microcalcifications that are detectable by mammography. In most cases, radiologists are able to distinguish calcifications... (Review)
Review
Many breast lesions are associated with microcalcifications that are detectable by mammography. In most cases, radiologists are able to distinguish calcifications usually associated with benign diseases from those associated with malignancy. In addition to their value in the early detection of breast carcinoma and accurate radiological diagnosis, the presence of microcalcifications often affects the extent of surgical intervention. Certain types of microcalcifications are associated with negative genetic and molecular characteristics of the tumor and unfavorable prognosis. Microcalcifications localized in the larger ducts (duct-centric, casting-type microcalcifications) represent an independent negative prognostic marker compared to lesions containing other types of microcalcifications and to non-calcified lesions. In this review, we summarize the theoretical and methodological background for understanding the clinical impact and discuss the diagnostic and prognostic value of microcalcifications detected in the breast by mammography.
Topics: Breast Neoplasms; Calcinosis; Female; Humans; Mammography; Prognosis
PubMed: 31733292
DOI: 10.1016/j.semcancer.2019.10.024 -
International Journal of Molecular... Jul 2021Metaplastic breast carcinoma (MBC) is a heterogeneous group of infrequent triple negative (TN) invasive carcinomas with poor prognosis. MBCs have a different clinical... (Review)
Review
Metaplastic breast carcinoma (MBC) is a heterogeneous group of infrequent triple negative (TN) invasive carcinomas with poor prognosis. MBCs have a different clinical behavior from other types of triple negative breast cancer (TNBC), being more resistant to standard chemotherapy. MBCs are an example of tumors with activation of epithelial-mesenchymal transition (EMT). The mechanisms involved in EMT could be responsible for the increase in the infiltrative and metastatic capacity of MBCs and resistance to treatments. In addition, a relationship between EMT and the immune response has been seen in these tumors. In this sense, MBC differ from other TN tumors showing a lower number of tumor-infiltrating lymphocytes (TILS) and a higher percentage of tumor cells expressing programmed death-ligand 1 (PD-L1). A better understanding of the relationship between the immune system and EMT could provide new therapeutic approaches in MBC.
Topics: B7-H1 Antigen; Biomarkers, Tumor; Breast Neoplasms; Cadherins; Carcinoma; Epithelial-Mesenchymal Transition; Female; Humans; Lymphocytes, Tumor-Infiltrating; MicroRNAs; Triple Negative Breast Neoplasms
PubMed: 34299016
DOI: 10.3390/ijms22147398 -
BMJ Case Reports Dec 2017We present a case of carcinoma en cuirasse as a presentation of advanced lobular breast carcinoma. On further investigation, she was found to have metastasis to her...
We present a case of carcinoma en cuirasse as a presentation of advanced lobular breast carcinoma. On further investigation, she was found to have metastasis to her liver and bone. We report this case to highlight the phenomenon of cutaneous metastasis. It is important to consider this diagnosis as an initial manifestation of breast cancer, but rarely, it can also be associated with other adenocarcinomas, for example, carcinoma of lung, kidney or gastrointestinal tract.
Topics: Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Lobular; Female; Humans; Liver Neoplasms; Skin Neoplasms
PubMed: 29197843
DOI: 10.1136/bcr-2017-222121 -
Modern Pathology : An Official Journal... Jan 2021Lobular neoplasia (LN) is an atypical proliferation of small, dyscohesive epithelial cells within the terminal duct lobular unit (TDLU), with or without pagetoid... (Review)
Review
Lobular neoplasia (LN) is an atypical proliferation of small, dyscohesive epithelial cells within the terminal duct lobular unit (TDLU), with or without pagetoid extension and encompasses both lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). LN is a non-obligate precursor of invasive breast carcinoma and the diagnosis of LN confers an increased risk of invasive carcinoma development, compared to the general population. Diagnostic challenges arise in the accurate classification of LCIS into classic, pleomorphic and florid subtypes, in distinguishing between LCIS and ductal carcinoma in situ (DCIS) and in the appropriate use and interpretation of E-cadherin immunohistochemistry. Due to the paucity of robust data on the natural history of LCIS, and hence its clinical significance, the management is often pragmatic rather than entirely evidence-based and requires a multidisciplinary approach. In this review, we discuss the clinicopathologic and molecular features of LCIS and address the key challenges that arise in the diagnosis and management of LCIS.
Topics: Biopsy, Large-Core Needle; Breast Carcinoma In Situ; Breast Neoplasms; Cadherins; Carcinoma, Intraductal, Noninfiltrating; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Mammary Glands, Human; Precancerous Conditions
PubMed: 33024303
DOI: 10.1038/s41379-020-00689-3 -
The Oncologist Jan 2016: Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management.... (Review)
Review
UNLABELLED
: Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management. Early stage tumors are usually treated with the same strategy used for the other types of invasive breast cancer. Anthracycline- and taxane-based regimens represent the most frequently administered chemotherapy in neoadjuvant and adjuvant setting, as well as for metastatic disease, although combinations of platinum compounds and etoposide have been widely used, in particular for small-cell histology and tumors with a high proliferation index. For metastatic disease, a multimodality therapeutic strategy can be considered on an individual basis, with chemotherapy, endocrine therapy, peptide receptor radionuclide therapy, radiation therapy, surgery, or a combination of the above. In the near future, a better knowledge of the biology of these tumors will hopefully provide new therapeutic targets for personalized treatment. In this review, we discuss the current evidence and the future perspectives on diagnosis and treatment of neuroendocrine carcinoma of the breast.
IMPLICATIONS FOR PRACTICE
Neuroendocrine carcinoma of the breast (NECB) is a distinct entity of breast cancer. Clinical features and morphology are not helpful to distinguish NECB from other subtypes of breast cancer; therefore, immunohistochemistry markers for neuroendocrine differentiation, mainly chromogranin and synaptophysin, should be routinely used to confirm the diagnosis, especially in cases of mucinous or solid papillary carcinoma in which the suspicion of NECB may be relevant. Adjuvant treatment should be offered according to the same recommendations given for the other types of invasive breast cancer. An accurate diagnosis of NECB is also important in the metastatic setting, in which a multimodality approach including specific therapies such as peptide receptor radionuclide therapy can be considered.
Topics: Breast Neoplasms; Carcinoma, Neuroendocrine; Cell Differentiation; Female; Humans; Neoadjuvant Therapy; Neoplasm Metastasis; Precision Medicine; Prognosis
PubMed: 26659223
DOI: 10.1634/theoncologist.2015-0309 -
Medical Oncology (Northwood, London,... Jul 2020Breast carcinoma with neuroendocrine differentiation, also known as neuroendocrine breast carcinoma (NEBC), includes a heterogeneous group of rare tumors, which account... (Review)
Review
Breast carcinoma with neuroendocrine differentiation, also known as neuroendocrine breast carcinoma (NEBC), includes a heterogeneous group of rare tumors, which account for 2-5% of all invasive breast carcinomas. Because of their low incidence, most of the current limited knowledge of these tumors derives from anecdotal case reports or small retrospective series. The diagnosis of NEBC is based on the presence of morphological features similar to gastrointestinal and lung NETs and neuroendocrine markers. NEBCs are usually hormone receptors positive and HER2 negative, but despite this luminal phenotype, most recent studies suggested that NEBC could be associated with worse prognosis compared to invasive breast cancer without neuroendocrine differentiation. Due to its rarity and lack of randomized data, there is little evidence to guide the choice of treatment, so NEBC is currently treated as any invasive breast carcinoma not-otherwise specified. Recently, attempts to molecularly characterize NEBC have been made, in order to provide new targets for a more personalized treatment of this uncommon entity.
Topics: Breast Neoplasms; Carcinoma, Neuroendocrine; Female; Humans; Neoplasm Grading; Rare Diseases; Receptors, Estrogen
PubMed: 32712767
DOI: 10.1007/s12032-020-01396-4 -
Surgical Pathology Clinics Sep 2021Breast cancer is a heterogenous disease with various histologic subtypes, molecular profiles, behaviors, and response to therapy. After the histologic assessment and... (Review)
Review
Breast cancer is a heterogenous disease with various histologic subtypes, molecular profiles, behaviors, and response to therapy. After the histologic assessment and diagnosis of an invasive breast carcinoma, the use of biomarkers, multigene expression assays and mutation profiling may be used. With improved molecular assays, the identification of somatic genetic alterations in key oncogenes and tumor suppressor genes are playing an increasingly important role in many areas of breast cancer care. This review summarizes the most clinically significant somatic alterations in breast tumors and how this information is used to facilitate diagnosis, provide potential treatment options, and identify mechanisms of resistance.
Topics: Biomarkers, Tumor; Breast Neoplasms; Female; Humans; Mutation; Oncogenes; Pathology, Molecular
PubMed: 34373096
DOI: 10.1016/j.path.2021.05.009 -
Archives of Pathology & Laboratory... Feb 2018Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and its higher-grade counterpart, dedifferentiated liposarcoma (DDL), are extraordinarily rare tumors... (Review)
Review
Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and its higher-grade counterpart, dedifferentiated liposarcoma (DDL), are extraordinarily rare tumors in the breast. The main differential diagnostic consideration of primary breast ALT/WDL is malignant phyllodes tumor with liposarcomatous differentiation, and the main differential diagnostic consideration of DDL in the breast is metaplastic breast carcinoma, particularly the spindle cell type, with heterologous sarcomatous differentiation. These differential diagnoses may be particularly challenging when evaluating limited core needle biopsy sampling. MDM2 and/or CDK4 protein overexpression and gene amplification are beneficial ancillary studies that can help establish the diagnosis of primary breast ALT/WDL and DDL, and effectively rule out the diagnoses of malignant phyllodes tumor and metaplastic breast carcinoma.
Topics: Breast Neoplasms; Female; Humans; Lipoma; Liposarcoma
PubMed: 29372852
DOI: 10.5858/arpa.2016-0380-RSR2 -
Chirurgia (Bucharest, Romania : 1990) Dec 2021Ductal carcinomata in situ (DCIS) are both biologically and morphologically a heterogeneous group of neoplastic intraductal proliferations of the breast tissue, they...
Ductal carcinomata in situ (DCIS) are both biologically and morphologically a heterogeneous group of neoplastic intraductal proliferations of the breast tissue, they represent an important precursor lesion for the development of invasive breast carcinoma and their diagnosis increases due to improved imaging. Nevertheless, the exact classification and differentiation from other lesions of the mammary gland tissue is often challenging for the pathologist. Therefore, this article highlights both the clinical and macroscopic presentation as well as the classification based on histomorphology and immunohistochemistry in addition to the most important differential diagnoses and the special types of DCIS.
Topics: Breast Neoplasms; Carcinoma in Situ; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Immunohistochemistry; Treatment Outcome
PubMed: 34967312
DOI: 10.21614/chirurgia.116.5.suppl.S59