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Presented by Pedram Argani, M.D. and prepared by Hillary Ross, M.D.
Case 1: This is a 35 year old female with a family history of breast cancer who presents with a breast mass.
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1. Question
Week 466: Case 1
This is a 35 year old female with a family history of breast cancer who presents with a breast mass.images/1alex/01242011case1image1.jpg
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images/1alex/01242011case1image3.jpgCorrect
Answer: Basal-like breast carcinoma
Histology: This is a poorly differentiated carcinoma which features primitive basaloid type cells with frequent mitoses and abundant necrosis. At the edge of the lesion there is an in situ component which colonizes lobules. The neoplastic cells have fairly fine chromatin, but nucleoli are present and nuclear molding is not prominent. The neoplastic cells were negative for ER/PR/Her2, and expressed cytokeratin 5/6.
Discussion: Malignant lymphoma would lack the in situ carcinoma component, and would feature dyscohesive cells with thick irregular nuclear membranes. Metastatic carcinoma is always a consideration; however, the presence of an in situ component argues against this possibility. Small cell carcinoma would feature cells with markedly hyperchromatic chromatin, and would demonstrate nuclear molding and immunoreactivity for neuroendocrine markers but not cytokeratin 5/6.
Basal like breast carcinoma is frequently associated with BRCA1 mutations. There is a predilection to lung and brain metastasis, but not to lymph node metastasis. Basal like breast carcinomas frequently show retinoblastoma gene inactivation, so they frequently over express p16
Reference(s):
– American Journal Surgical Pathology 2009; 33:163-175.Incorrect
Answer: Basal-like breast carcinoma
Histology: This is a poorly differentiated carcinoma which features primitive basaloid type cells with frequent mitoses and abundant necrosis. At the edge of the lesion there is an in situ component which colonizes lobules. The neoplastic cells have fairly fine chromatin, but nucleoli are present and nuclear molding is not prominent. The neoplastic cells were negative for ER/PR/Her2, and expressed cytokeratin 5/6.
Discussion: Malignant lymphoma would lack the in situ carcinoma component, and would feature dyscohesive cells with thick irregular nuclear membranes. Metastatic carcinoma is always a consideration; however, the presence of an in situ component argues against this possibility. Small cell carcinoma would feature cells with markedly hyperchromatic chromatin, and would demonstrate nuclear molding and immunoreactivity for neuroendocrine markers but not cytokeratin 5/6.
Basal like breast carcinoma is frequently associated with BRCA1 mutations. There is a predilection to lung and brain metastasis, but not to lymph node metastasis. Basal like breast carcinomas frequently show retinoblastoma gene inactivation, so they frequently over express p16
Reference(s):
– American Journal Surgical Pathology 2009; 33:163-175.
