Abstract
BackgroundCentrally necrotizing carcinoma of the breast (CNC) represents a newly-identified subset of breast cancer. The clinical and pathological characteristics of this breast cancer subtype are not yet completely understood.MethodsWe assessed the clinicopathological characteristics of 73 cases of CNC and 30 control cases of high-grade infiltrating ductal carcinoma (IDC) with focal necrosis based on light microscopy and immunohistochemical staining for estrogen receptor, progesterone receptor, Cerb-B2/HER2, Ki-67, epidermal growth factor receptor, cytokeratin 5/6, smooth muscle actin, S-100 protein, p63 and CD10.ResultsAll the tumors showed extensive central necrotic or acellular zones with different degrees of fibrotic or hyaline material surrounded by ring-like or ribbon-like residual tumour tissue which were usually high-grade IDCs. The central necrotic zone accounted for at least 30% of the cross-sectional area of the tumor. Thirty-six cases (49.3%) showed a component of ductal carcinoma in situ. The tumorous stroma around the central necrotic zone was accompanied by myxoid matrix formation in 28 cases (40%). Lymphocytic infiltration was present in 53 cases (72.6%). Granulomatous reactions were detected at the periphery of the tumors in 49 cases (67.1%). Immunohistochemistry showed greater expression of basal-like markers (72.2%, 52 cases) than myoepithelial markers (60.6%, 43 cases), both of which were significantly higher than in controls (26.7%, 8 cases) (P < 0.001). According to molecular typing, most CNCs were basal-like subtype (37 cases, 50.7%). Follow-up data were available for 28 patients. Disease progression occurred in 11 patients. The combined rate of recurrence, distant metastasis or death was significantly higher in CNC patients compared with controls (P < 0.05).ConclusionsCNC was associated with distinctive clinicopathologic features mostly characterized as basal-like type. Its high proliferative activity, highly-aggressive biological behavior, and high rates of recurrence and metastasis, suggest that CNC should be classified as a new type of breast carcinoma.
Highlights
Necrotizing carcinoma of the breast (CNC) represents a newly-identified subset of breast cancer
According to the diagnostic criteria of Tsuda and Jimenez et al [2,4], Centrally necrotizing carcinoma of the breast (CNC) met the following conditions: (i) tumor composed of extensive central necrosis with varying degrees of fibrotic, hyalinized matrix or scar tissue; (ii) necrotic or acellular zones accounted for ≥30% of the cross-sectional area of the tumor; (iii) viable tumor tissue was mostly high-grade infiltrating ductal carcinoma (IDC)
Mammary gland molybdenum targets were available in 30 patients, six of whom showed Breast Imaging Reporting and Data System (BI-RADS) category 4 and 26 of whom showed BI-RADS 5
Summary
Necrotizing carcinoma of the breast (CNC) represents a newly-identified subset of breast cancer. The clinical and pathological characteristics of this breast cancer subtype are not yet completely understood. Necrotizing carcinoma of the breast (CNC) represents a newly-identified subset of breast cancer, usually included in “infiltrating ductal carcinoma, not otherwise specified”. It has been described as a “fibrotic focus in invasive ductal carcinoma of the breast” [1], and as “high-grade invasive ductal carcinomas with large central acellular zones” [2,3], since its first description by Jimenez et al in 2001 [4]. We retrospectively analyzed the clinicopathological features, immunophenotype, and biological behavior of 73 cases of CNC definitively diagnosed in our pathology department, and conducted a literature review.
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