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Presented by Pedram Argani, M.D. and prepared by Shien Micchelli, M.D.
Case 1: This is a 53 year old HIV+ female with a breast mass.
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Question 1 of 1
1. Question
Week 291: Case 1
This is a 53 year old HIV+ female with a breast mass./images/11_20_06_1a.jpg
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/images/11_20_06_1d.jpgCorrect
Answer: Infiltrating ductal carcinoma, high grade
Histology: The tumor consists of nests of cells set within a desmoplastic stroma. The tumor cells have pleomorphic nuclei, fail to form tubules, and have high mitotic activity. Therefore, based upon nuclear grade, tubular formation, and mitotic index, this tumor would qualify as high grade using the modified Elston –Ellis Criteria.
Discussion: Malignant lymphoma would be composed of discohesive tumor cells which would not form nests. Well differentiated ductal carcinomas should feature well-formed glands, monotonous nuclei and minimal mitosis. Small Cell Carcinoma features nuclei which mould, and chromatin which is uniformly dark without prominent nucleoli.
The current tumor was negative for estrogen receptor, progesterone receptor and Her-2/neu overexpression (“triple-negative”). The tumor expressed cytokeratin 5/6, and was immunoreactive for EGFR; therefore, this tumor qualifies as a basal-like breast cancer. Basal-like carcinomas are one of the five subtypes of breast carcinomas that have been as elucidated by gene expression profiling. This subtype is associated with a poor prognosis.
Incorrect
Answer: Infiltrating ductal carcinoma, high grade
Histology: The tumor consists of nests of cells set within a desmoplastic stroma. The tumor cells have pleomorphic nuclei, fail to form tubules, and have high mitotic activity. Therefore, based upon nuclear grade, tubular formation, and mitotic index, this tumor would qualify as high grade using the modified Elston –Ellis Criteria.
Discussion: Malignant lymphoma would be composed of discohesive tumor cells which would not form nests. Well differentiated ductal carcinomas should feature well-formed glands, monotonous nuclei and minimal mitosis. Small Cell Carcinoma features nuclei which mould, and chromatin which is uniformly dark without prominent nucleoli.
The current tumor was negative for estrogen receptor, progesterone receptor and Her-2/neu overexpression (“triple-negative”). The tumor expressed cytokeratin 5/6, and was immunoreactive for EGFR; therefore, this tumor qualifies as a basal-like breast cancer. Basal-like carcinomas are one of the five subtypes of breast carcinomas that have been as elucidated by gene expression profiling. This subtype is associated with a poor prognosis.
