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Presented by George Netto, M.D. and prepared by Julie M. Wu, M.D.
Case 4: A 45 year old woman with a suspicious density on mammographic exam. An open biopsy was obtained.
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1. Question
Week 315: Case 4
A 45 year old woman with a suspicious density on mammographic exam. An open biopsy was obtained.images/jmw062507/4.1.jpg
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images/jmw062507/4.4.jpgCorrect
Answer: Mucinous/Collagenous spherulosis
Histology: Collagenous/Mucinous spherulosis (CS) are rare benign breast lesions with an estimated incidence of less than 1% in breast surgical pathology specimens. CS are characterized by the presence of eosinophilic to basophilic spherules occupying lumina that are surrounded by myoepithelial and epithelial cells without cytologic atypia. Calcifications may be associated with CS. The “cribriform” appearance raises the differential diagnosis of ADH or cribriform DCIS. At times, the differential diagnosis may also include invasive lesions such as adenoid cystic carcinoma (ACC) and infiltrating cribriform carcinoma. Like ACC, the spherules are composed of basement membrane material. Lack of an infiltrating pattern and a solid component help differentiate CS from ACC. In a recent study from the MD Anderson Cancer Ctr, CS was associated with benign lesions of the breast in the majority of cases (41/59). Associated LCIS was present in 15/59 specimens and ADH was encountered in 3/59. However, there is no evidence to date to indicate that collagenous spherulosis is a precancerous lesion.
Discussion: see above
Reference(s):
– Resetkova E, Albarracin C, Sneige N. Collagenous spherulosis of breast: morphologic study of 59 cases and review of the literature. Am. J. Surg. Pathol. 2006 ;30(1):20-7.Incorrect
Answer: Mucinous/Collagenous spherulosis
Histology: Collagenous/Mucinous spherulosis (CS) are rare benign breast lesions with an estimated incidence of less than 1% in breast surgical pathology specimens. CS are characterized by the presence of eosinophilic to basophilic spherules occupying lumina that are surrounded by myoepithelial and epithelial cells without cytologic atypia. Calcifications may be associated with CS. The “cribriform” appearance raises the differential diagnosis of ADH or cribriform DCIS. At times, the differential diagnosis may also include invasive lesions such as adenoid cystic carcinoma (ACC) and infiltrating cribriform carcinoma. Like ACC, the spherules are composed of basement membrane material. Lack of an infiltrating pattern and a solid component help differentiate CS from ACC. In a recent study from the MD Anderson Cancer Ctr, CS was associated with benign lesions of the breast in the majority of cases (41/59). Associated LCIS was present in 15/59 specimens and ADH was encountered in 3/59. However, there is no evidence to date to indicate that collagenous spherulosis is a precancerous lesion.
Discussion: see above
Reference(s):
– Resetkova E, Albarracin C, Sneige N. Collagenous spherulosis of breast: morphologic study of 59 cases and review of the literature. Am. J. Surg. Pathol. 2006 ;30(1):20-7.
