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Presented by Dr. Pedram Argani and prepared by Dr. J. David Peske
This a 32 year old female with a breast mass.
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1. Question
Diagnosis:
Correct
Answer: B
Histologic Description: The core biopsy shows a diffuse infiltrate of small round cells with effaced chromatin that permeate between benign breast ducts. Mitotic activity is evident. There is no in situ component. The lesional cells label for CD34, which raises the possibility of a vascular lesion or pseudoangiomatous stromal hyperplasia in its cellular form. However, the lesional cells also label for CD43 and myeloperoxidase, consistent with granulocytic sarcoma.
Differential Diagnosis: Granulocytic sarcoma involving the breast is a known mimic of invasive lobular carcinoma, in this case the mimic would be the solid variant of invasive lobular carcinoma. The absence of immunoreactivity for cytokeratin and estrogen receptor excludes the diagnosis of invasive lobular carcinoma. Pseudoangiomatous stromal hyperplasia would label for CD34, but would not label for CD43 and myeloperoxidase. Pseudoangiomatous stromal hyperplasia is essentially a spindle cell lesion with only rare epithelioid forms. Invasive ductal carcinoma would label for cytokeratin and demonstrate greater pleomorphism.Incorrect
Answer: B
Histologic Description: The core biopsy shows a diffuse infiltrate of small round cells with effaced chromatin that permeate between benign breast ducts. Mitotic activity is evident. There is no in situ component. The lesional cells label for CD34, which raises the possibility of a vascular lesion or pseudoangiomatous stromal hyperplasia in its cellular form. However, the lesional cells also label for CD43 and myeloperoxidase, consistent with granulocytic sarcoma.
Differential Diagnosis: Granulocytic sarcoma involving the breast is a known mimic of invasive lobular carcinoma, in this case the mimic would be the solid variant of invasive lobular carcinoma. The absence of immunoreactivity for cytokeratin and estrogen receptor excludes the diagnosis of invasive lobular carcinoma. Pseudoangiomatous stromal hyperplasia would label for CD34, but would not label for CD43 and myeloperoxidase. Pseudoangiomatous stromal hyperplasia is essentially a spindle cell lesion with only rare epithelioid forms. Invasive ductal carcinoma would label for cytokeratin and demonstrate greater pleomorphism.
