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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 2: This is a 64 year old female with a breast tumor.
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Question 1 of 1
1. Question
Week 545: Case 2
This is a 64 year old female with a breast tumor.images/vincent/5656_1_low res.jpg
images/vincent/5656_2_low res.jpg
images/vincent/5656_cdx2_low res.jpg
images/vincent/5656_gcdfp_low res.jpgCorrect
Answer: Carcinoid tumor, metastatic
Histology: Infiltrating between the normal lobules of the breast are nests of uniform epithelioid cells with finely granular cytoplasm and fine chromatin with a salt and pepper pattern. The cells label diffusely for neuroendocrine markers chromogranin and synaptophysin. These cells are non-immunoreactive for estrogen or progesterone receptor, and also do not label for GCDFP. They label for CDX2. The findings suggest intestinal origin.
Discussion: Primary invasion ductal carcinoma or lobular carcinoma of the breast with this low of a nuclear grade should label diffusely for estrogen receptor. The absence of labeling for estrogen receptor in a low grade lesion such of this suggests non-mammary origin. Primary mammary carcinoid tumors merge with ductal carcinoma showing extensive neuroendocrine differentiation. These lesions are generally of low nuclear grade and label for estrogen receptor. The prognostic impact of neuroendocrine differentiation in breast cancer, with the exception of small cell carcinoma, is unproven.
Incorrect
Answer: Carcinoid tumor, metastatic
Histology: Infiltrating between the normal lobules of the breast are nests of uniform epithelioid cells with finely granular cytoplasm and fine chromatin with a salt and pepper pattern. The cells label diffusely for neuroendocrine markers chromogranin and synaptophysin. These cells are non-immunoreactive for estrogen or progesterone receptor, and also do not label for GCDFP. They label for CDX2. The findings suggest intestinal origin.
Discussion: Primary invasion ductal carcinoma or lobular carcinoma of the breast with this low of a nuclear grade should label diffusely for estrogen receptor. The absence of labeling for estrogen receptor in a low grade lesion such of this suggests non-mammary origin. Primary mammary carcinoid tumors merge with ductal carcinoma showing extensive neuroendocrine differentiation. These lesions are generally of low nuclear grade and label for estrogen receptor. The prognostic impact of neuroendocrine differentiation in breast cancer, with the exception of small cell carcinoma, is unproven.
