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Presented by Pedram Argani, M.D. and prepared by Mohammed Lilo, M.D.
Case 3: This is a 56 year old female with a breast mass.
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Week 585: Case 3
This is a 56 year old female with a breast mass.images/lilo/Arg-3-A.jpg
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images/lilo/Arg-3-E.jpgCorrect
Answer: Small cell carcinoma of the breast
Histology: The breast is involved by a diffuse proliferation of malignant small round blue cells. The cells demonstrate nuclear molding, have a high mitotic rate, and are associated with extensive apoptosis and necrosis. The cells demonstrate immunoreactivity for cytokeratin Cam5.2 in a dot-like fashion, and label for synaptophysin, chromogranin and CD56. These features established the diagnosis of small cell carcinoma. This small cell carcinoma is closely associated with a high grade ductal carcinoma in situ, which supports the interpretation of this small cell carcinoma as primary to the breast in the absence of other sites of disease.
Discussion: Solid invasive lobular carcinoma may also appear as small round cell tumor; however, it should not demonstrate immunoreactivity for CD56 and would show loss of E-cadherin immunoreactivity. Basal-like breast carcinoma would label for high molecular weight cytokeratin, and should not label for neuroendocrine markers. Metastatic small cell carcinoma is a consideration, but the association of the current lesion with a precursor and the absence of disease elsewhere help exclude this possibility.
Incorrect
Answer: Small cell carcinoma of the breast
Histology: The breast is involved by a diffuse proliferation of malignant small round blue cells. The cells demonstrate nuclear molding, have a high mitotic rate, and are associated with extensive apoptosis and necrosis. The cells demonstrate immunoreactivity for cytokeratin Cam5.2 in a dot-like fashion, and label for synaptophysin, chromogranin and CD56. These features established the diagnosis of small cell carcinoma. This small cell carcinoma is closely associated with a high grade ductal carcinoma in situ, which supports the interpretation of this small cell carcinoma as primary to the breast in the absence of other sites of disease.
Discussion: Solid invasive lobular carcinoma may also appear as small round cell tumor; however, it should not demonstrate immunoreactivity for CD56 and would show loss of E-cadherin immunoreactivity. Basal-like breast carcinoma would label for high molecular weight cytokeratin, and should not label for neuroendocrine markers. Metastatic small cell carcinoma is a consideration, but the association of the current lesion with a precursor and the absence of disease elsewhere help exclude this possibility.
