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Presented by Dr. Pedram Argani and prepared by Dr. Katelynn Davis
This is a 90 year old female with a breast mass.
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1. Question
This is a 90 year old female with a breast mass.
Correct
Answer: B
Histologic Description: This lesion is composed of solid nests of neoplastic epithelial cells. Cells are relatively low nuclear grade. Some of the solid nests have fibrovascular cores in their center, indicating a papillary neoplasm. At the edge of the lesion, the nests of epithelial cells merge with the fat in a non-lobular pattern, which suggesst invasive carcinoma arising in a papillary DCIS. This type of invasive carcinoma typically occurs in older patients, and often is not associated with desmoplastic stromal reaction. Immunostains for myoepithelial markers confirm that the lesion is diffusely positive for estrogen receptor, and that the invasive component lacks myoepithelial markers.
Differential Diagnosis: Papillary ductal carcinoma in situ would not be associated with the irregular nests that permeate the stroma in this case, and would have intact myoepithelium. Ductal carcinoma in situ or lobular carcinoma in situ involving adenosis typically shows rounded nests at its periphery, which is a clue that there is not invasion. In contrast, the nests at the periphery of this lesion are more infiltrative and irregular. Adenosis would demonstrate intact myoepithelium throughout, unlike the current case. Lobular carcinoma in situ would be more discohesive than the current lesion.
Incorrect
Answer: B
Histologic Description: This lesion is composed of solid nests of neoplastic epithelial cells. Cells are relatively low nuclear grade. Some of the solid nests have fibrovascular cores in their center, indicating a papillary neoplasm. At the edge of the lesion, the nests of epithelial cells merge with the fat in a non-lobular pattern, which suggesst invasive carcinoma arising in a papillary DCIS. This type of invasive carcinoma typically occurs in older patients, and often is not associated with desmoplastic stromal reaction. Immunostains for myoepithelial markers confirm that the lesion is diffusely positive for estrogen receptor, and that the invasive component lacks myoepithelial markers.
Differential Diagnosis: Papillary ductal carcinoma in situ would not be associated with the irregular nests that permeate the stroma in this case, and would have intact myoepithelium. Ductal carcinoma in situ or lobular carcinoma in situ involving adenosis typically shows rounded nests at its periphery, which is a clue that there is not invasion. In contrast, the nests at the periphery of this lesion are more infiltrative and irregular. Adenosis would demonstrate intact myoepithelium throughout, unlike the current case. Lobular carcinoma in situ would be more discohesive than the current lesion.
