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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 1: 51-year-old female with a breast mass
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1. Question
Category: breastWeek 1: Case 1
This is a 51-year-old female with a breast mass.
Correct
Answer: Small cell carcinoma
Histology: This is a high grade malignant neoplasm composed of cells with high nucleus to cytoplasm ratio arranged in nests and sheets, involving the mammary stroma. These cells show predominant features of small cell carcinoma; that is, they have hyperchromatic nuclei which mold to each other and lack prominent nucleoli. These areas label for neuroendocrine markers like CD56, and demonstrate dot-like cytokeratin immunoreactivity. Very focally, one can appreciate an area in which the cells have more open, vesicular chromatin, typical of ductal carcinoma of the breast. This area lacks labeling for neuroendocrine markers.
Discussion: Basal-like carcinoma would label for high molecular cytokeratin and not for neuroendocrine markers, and typically would demonstrate a more nested architecture with peripheral palisading with central necrosis. Malignant lymphoma would be less cohesive, and would label for lymphoid markers but not cytokeratin. Desmoplastic small round cell tumor typically occurs in younger patients, and would demonstrate immunoreactivity for desmin in addition to cytokeratin.
The presence of a focal typical mammary component or ductal carcinoma in situ helps assure that a small cell carcinoma involving the breast is primary to this site.
Reference: American Journal of Surgical Pathology 2000; 24:1231-8.
Incorrect
Answer: Small cell carcinoma
Histology: This is a high grade malignant neoplasm composed of cells with high nucleus to cytoplasm ratio arranged in nests and sheets, involving the mammary stroma. These cells show predominant features of small cell carcinoma; that is, they have hyperchromatic nuclei which mold to each other and lack prominent nucleoli. These areas label for neuroendocrine markers like CD56, and demonstrate dot-like cytokeratin immunoreactivity. Very focally, one can appreciate an area in which the cells have more open, vesicular chromatin, typical of ductal carcinoma of the breast. This area lacks labeling for neuroendocrine markers.
Discussion: Basal-like carcinoma would label for high molecular cytokeratin and not for neuroendocrine markers, and typically would demonstrate a more nested architecture with peripheral palisading with central necrosis. Malignant lymphoma would be less cohesive, and would label for lymphoid markers but not cytokeratin. Desmoplastic small round cell tumor typically occurs in younger patients, and would demonstrate immunoreactivity for desmin in addition to cytokeratin.
The presence of a focal typical mammary component or ductal carcinoma in situ helps assure that a small cell carcinoma involving the breast is primary to this site.
Reference: American Journal of Surgical Pathology 2000; 24:1231-8.
