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Presented by Pedram Argani, M.D. and prepared by Marc Halushka M.D., Ph.D.
Case 6: A seventy-six year-old female with a sub-areolar breast mass.
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1. Question
Week 174: Case 6
A seventy-six year-old female with a sub-areolar breast mass./images/Halushka/conf3104/case6image1.jpg
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/images/Halushka/conf3104/case6image5.jpgCorrect
Answer: In-situ papillary carcinoma
Histology: This is an unusual lesion in that the tumor cells, while monotonous, have a dimorphic appearance. Some of the nuclei have abundant clear cytoplasm, and appear to undermine other cells with less cytoplasm and darker nuclei. The proliferation is supported by fibrovascular cores, making it a papillary lesion. Between fibrovascular cores, there is rigid cribriform growth with both morphologies, indicating that this is in fact an in situ carcinoma and not a florid hyperplasia. Dimorphic cytology has been reported within in situ papillary carcinomas of the breast.
Discussion: Papillomas should feature both epithelial cells and myoepithelial cells, and lack the cytologic monotony seen in the current lesion. Adenomyoepithelioma is essentially a variant of papilloma with prominent myoepithelial cells; myoepithelial cells are not present in the current lesion. A ductal adenoma is essentially a sclerotic papilloma with superimposed sclerosing adenosis, which was not present in the current lesion.
Incorrect
Answer: In-situ papillary carcinoma
Histology: This is an unusual lesion in that the tumor cells, while monotonous, have a dimorphic appearance. Some of the nuclei have abundant clear cytoplasm, and appear to undermine other cells with less cytoplasm and darker nuclei. The proliferation is supported by fibrovascular cores, making it a papillary lesion. Between fibrovascular cores, there is rigid cribriform growth with both morphologies, indicating that this is in fact an in situ carcinoma and not a florid hyperplasia. Dimorphic cytology has been reported within in situ papillary carcinomas of the breast.
Discussion: Papillomas should feature both epithelial cells and myoepithelial cells, and lack the cytologic monotony seen in the current lesion. Adenomyoepithelioma is essentially a variant of papilloma with prominent myoepithelial cells; myoepithelial cells are not present in the current lesion. A ductal adenoma is essentially a sclerotic papilloma with superimposed sclerosing adenosis, which was not present in the current lesion.
