5/23/2015 1 Small Glandular Proliferative Lesions of the Breast Yunn-Yi Chen, MD, PhD Professor Director of Immunohistochemistry Laboratory Director of Breast Pathology Services UCSF Small Glandular Lesions of Breast Complex sclerosing lesion Benign lobules in fat Microglandular adenosis Sclerosing adenosis Radial scar Tubular carcinoma Invasive ductal ca Biopsy-related changes LG adenosquamous ca Adenoid cystic ca, tubular Distribution-- Lobulocentric vs diffuse pattern; organized vs haphazard Stromal appearance Glandular architecture, cytologic features Luminal content IHC markers Myoepithelial cell (MEC) markers: p63, SMM, Calponin, (SMA, CK5/6) ER S100 Cytokeratins: CK5/6, others Approach for Small Glandular Lesions Benign Breast Lobules in Fat: “Respect” the Fat
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5/23/2015
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Small Glandular ProliferativeLesions of the Breast
Yunn-Yi Chen, MD, PhDProfessor
Director of Immunohistochemistry LaboratoryDirector of Breast Pathology Services
UCSF
Small Glandular Lesions of Breast
Complex sclerosing lesion Benign lobules in fat Micro glandular adenosis
Sclerosing adenosis
Radial scar
Tubular carcinoma
Invasive ductal ca
Biopsy-related changes LG adenosquamous ca Adenoid cy stic ca, tubular
� Distribution--� Lobulocentric vs diffuse pattern; organized vs hapha zard
Approach for Small Glandular LesionsBenign Breast Lobules in Fat: “Respect” the Fat
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Radial Sclerosing Lesion: “Respect” the Fat Invasive Ductal Carcinoma: Invade the Fat
Sclerosing Adenosis (SA)
� Lobulocentric
� Stroma: collagenous, myxoid
� Glands and epithelial cells:� Glands compressed/central, open/peripheral; basemen t
membrane� Luminal epithelial and myoepithelial cells (MEC)� Epithelial cells: flat to cuboidal, bland
� Lumen: Calcifications
� IHC: Positive MEC markers
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Sclerosing Adenosis
� Incidental or mammographic calcifications
� Mimic invasion
� Nodular adenosis
� Involved by lobular neoplasia or DCIS
� Apocrine cytology
� Perineural invasion
Nodular Adenosis
� Florid sclerosing adenosis, nodular contour
� Mammographic mass or palpable lesion
� Also “adenosis tumor” (connotation of neoplasm)
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Biopsy for Mammographic Mass with Calcifications
Nodular adenosis
Sclerosing Adenosis and Nodular Adenosisp63
CK5/6SMM
Lobular Neoplasia Involving SA
� Mimic invasive carcinoma
� Lobulocentric
� MEC markers
Apocrine Adenosis
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Apocrine Adenosis Apocrine Adenosis
� SA with apocrine cytology� Eosinophic granular or foamy cytoplasm
� Mimic carcinoma� Lobulocentric, MEC markers
� Atypical apocrine adenosis
Invasive Apocrine CA Mimicking Apocrine Adenosis
SMM
Atypical Apocrine Adenosis--3x nuclear enlargement with prominent pleomorphic n ucleoli
(O’Malley FP and Bane AL. Adv Anat Pathol 2004)
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Apocrine Adenosis
� SA with apocrine cytology� Eosinophic granular or foamy cytoplasm
� Mimic carcinoma
� Atypical apocrine adenosis� 3x nuclear enlargement, prominent pleomorphic nucle oli� Long-term breast cancer risk: not well-defined� On CNB: recommend excision to exclude DCIS� On excision: regular follow-up
(Carter D et al: Mod Pathol 1991; Seidman J et al: Cancer 1996; Fuehrer N et al: Arch Pathol Lab Med 2 012)
DCIS with Apocrine Features
p63
Sclerosing Adenosis with Perineural “Invasion”
CNB for a Palpable Lesion
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p63SMM
Sclerosing Lesion with Perineural “Invasion”
Peri- and Intraneural “Invasion” in Benign Breast Lesions
� Ackerman: 1 st description in 1957
� Taylor and Norris (AFIP): series of 20 patients in 1967
� Incidence: ~2%
� Also reported in benign lesions of other anatomic sites
� In breast: SA, radial scar, sclerosing papilloma
� Pathogenesis unclear : post-traumatic, involvement by the proliferative process
Radial Scar
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Radial Scar (RS)
� Tumor-like or pseudoinfiltrative lesion
� Stellate appearance� Mimic malignancy on imaging and pathology
� Central fibroelastotic core with entrapped distorted tubules, surrounded by radiating ducts and lobules
� Avoid over-diagnosis� When in doubt about the presence of invasion, diagn ose as
non-invasive
(Hilson JB et al: Am J Surg Pathol 2009 and 2010)
Radial Sclerosing Lesions
� Organized
� Stroma: Fibroelastotic
� Glands and epithelial cells:� Distorted, compressed, angulated� Luminal epithelial and myoepithelial cells (MEC)� Epithelial cells: flat to cuboidal, bland
� Lumen: Calcifications
� IHC: Positive MEC markers� Reduced or focally absent for MEC expression
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Tubular Carcinoma--Diffuse/infiltrative growth
Tubular Carcinoma--Desmoplastic or elastotic stroma
Tubular Carcinoma with FEA
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� Infiltrative
� Desmoplastic cellular stroma, ± elastosis
� Open round, oval, or angulated tubules
� Cytology� Single layer, non-stratified, cuboidal to columnar cells,
prominent cytoplasmic apical snouts� Minimal pleomorphism, basally located round to oval nuclei� Mitosis rare