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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
This is a breast mass that is strongly immunoreactive for p63.
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1. Question
Week (619): Case 2
This is a breast mass that is strongly immunoreactive for p63.
Correct
Answer: Malignant phyllodes tumor
Histology: This is a high grade malignant neoplasm featuring marked cytologic atypia and abundant mitotic activity. Much of the neoplasm consists of sheets of these malignant cells, without any associated epithelium. One can focally appreciate an underlying lower grade intracanalicular component which merges with the high grade malignant component. This component is highlighted on immunostains for cytokeratin, which highlight ghosts of necrotic protrusions of the intracanalicular pattern. These features allow a confident diagnosis of a malignant phyllodes tumor.
Discussion: Metaplastic carcinoma is suggested by the immunoreactivity for p63; however, it is now recognized that a subset of malignant phyllodes tumor express p63 and p40 (Am J Surg Pathol 2014; 38:1689-1696). The presence of a lower grade phyllodes component excludes the default diagnosis of sarcoma, not otherwise specified. Fibroadenoma could also have intracanalicular pattern; however, the malignant cytology of the current case excludes that diagnosis.
Incorrect
Answer: Malignant phyllodes tumor
Histology: This is a high grade malignant neoplasm featuring marked cytologic atypia and abundant mitotic activity. Much of the neoplasm consists of sheets of these malignant cells, without any associated epithelium. One can focally appreciate an underlying lower grade intracanalicular component which merges with the high grade malignant component. This component is highlighted on immunostains for cytokeratin, which highlight ghosts of necrotic protrusions of the intracanalicular pattern. These features allow a confident diagnosis of a malignant phyllodes tumor.
Discussion: Metaplastic carcinoma is suggested by the immunoreactivity for p63; however, it is now recognized that a subset of malignant phyllodes tumor express p63 and p40 (Am J Surg Pathol 2014; 38:1689-1696). The presence of a lower grade phyllodes component excludes the default diagnosis of sarcoma, not otherwise specified. Fibroadenoma could also have intracanalicular pattern; however, the malignant cytology of the current case excludes that diagnosis.
