Invasive carcinoma breast

Invasive carcinoma of breast
Updated: 12/11/2018
© Jun Wang, MD, PhD

General features
  • More common in upper outer quadrant
  • Classified according to architecture and cytological grade
  • Most common type: Ductal carcinoma, followed by lobular carcinoma
  • Arises from terminal duct lobular unit
  • Always need ancillary test (ER, PR, Her2)
Clinical presentations
  • Mass
  • Nipple abnormalities
  • Mammographic detection of microcalcifications, soft-tissue densities, or both
Key morphological features
  • Mass with infiltrating border
  • Hemorrhage and/or necrosis
  • NO myoepithelial cells (can be stained by CD10 and p63)
  • Invasive ductal carcinoma
With better tubule formation: irregular tubules lined by atypical cells
With poor tubule formation: less tubular structure
Positive for E-cadherin
  • Invasive lobular carcinoma
Commonly bilateral and multifocal
Relatively monotonous tumor cells
Single files, no tubular formation
May have intracellular mucin, signet ringcells
Negative for E-cadherin due to CDH1 mutation
Mucin pool with clusters of tumor cells
Fibrovascular core covered by atypical cells
Finger like projection without fibrovascular core
Commonly with metastasis
Associated with BRCA1 mutation
Younger age
Sheets of markedly pleomorphic cells with syncytial appearance
Prominent lymphoplasmacytic infiltrate in the background
Negative for ER, PR, Her2
Positive for p53
Very well tubular formation
Less prominent cytological atypia
Angulated tubular structure lined by almost normal appearing cells
  • Cribriform carcinoma
  • Invasive carcinoma, type cannot be determined
Marker
  • Ductal carcinoma, medullary carcinoma: Positive for E-cadherin
  • Lobular carcinoma: Negative for E-cadherin
Inflammatory carcinoma
  • Clinical term, not pathological term
  • Enlarged, erythematous and edematous breast, appearance of acute inflammation
  • Peau d’orange: Lymphedema and thickening of skin of breast, orange peel appearing
  • Probably due to dermal plugging of lymphatic vessels by tumor
  • Aggressive
  • Stage T4d in TNM classification
  • Treatment: neoadjuvant chemotherapy, surgery
Treatment
  • Surgery
  • Chemotherapy
  • Radiation therapy: risk factor for Angiosarcoma

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