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Presented by Risa Mann, M.D. and prepared by Angelique W. Levi, M.D.
Case 2: 50 year-old female with a breast mass
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1. Question
Week 17: Case 2
50 year-old female with a breast mass
Correct
Answer: Invasive micropapillary carcinoma of the breast
Histology: The tumor consists of multiple small clusters of epithelial cells which are somewhat papillary in appearance. The cells appear to sit in spaces and there is a surrounding lymphoid infiltrate. Although not present in this case, some cases are associated with an intraductal papillary carcinoma. This tumor can occur at virtually any age with the median age of about 54 years.
Discussion: This is an extremely uncommon variant of invasive duct carcinoma of the breast. In addition to the distinctive appearance of this tumor in the primary site, when this tumor metastasizes to lymph nodes it also shows a similar invasive micropapillary pattern. Usually the spaces are empty but occasionally mucinous material may also be demonstrated. This tumor can be distinguished from mucinous carcinoma because the latter usually has abundant extracellular mucin which is usually absent in this invasive micropapillary carcinoma. The immunohistochemical staining pattern of this tumor would be different from papillary thyroid cancer which would stain for thyroglobulin. The presence of intraductal carcinoma would help to rule out metastatic papillary ovarian carcinoma or papillary tumor from another site. This tumor can occur at virtually any age with the median age of about 54 years. Although there are limited series describing the clinical course and natural history of this tumor, a recent study has shown that this tumor has an extremely high incidence of lymph node metastasis. The tumor, in addition to the high incidence of lymph node involvement also apparently has a high early recurrence rate.
Incorrect
Answer: Invasive micropapillary carcinoma of the breast
Histology: The tumor consists of multiple small clusters of epithelial cells which are somewhat papillary in appearance. The cells appear to sit in spaces and there is a surrounding lymphoid infiltrate. Although not present in this case, some cases are associated with an intraductal papillary carcinoma. This tumor can occur at virtually any age with the median age of about 54 years.
Discussion: This is an extremely uncommon variant of invasive duct carcinoma of the breast. In addition to the distinctive appearance of this tumor in the primary site, when this tumor metastasizes to lymph nodes it also shows a similar invasive micropapillary pattern. Usually the spaces are empty but occasionally mucinous material may also be demonstrated. This tumor can be distinguished from mucinous carcinoma because the latter usually has abundant extracellular mucin which is usually absent in this invasive micropapillary carcinoma. The immunohistochemical staining pattern of this tumor would be different from papillary thyroid cancer which would stain for thyroglobulin. The presence of intraductal carcinoma would help to rule out metastatic papillary ovarian carcinoma or papillary tumor from another site. This tumor can occur at virtually any age with the median age of about 54 years. Although there are limited series describing the clinical course and natural history of this tumor, a recent study has shown that this tumor has an extremely high incidence of lymph node metastasis. The tumor, in addition to the high incidence of lymph node involvement also apparently has a high early recurrence rate.
