Histologic Types Of Breast Carcinoma Research Articles

Descriptive Study and Surgical Management Among Infiltrating Lobular Carcinoma Patients Admitted to King Abdulaziz Medical City From 2000 to 2017: A Retrospective Cross-Sectional Study.

Invasive lobular carcinoma (ILC) is the second most common histologic type of breast carcinoma. The etiology of ILC is unknown; however, many contributing risk factors have been suggested. Treatment of ILC can be divided into local and systemic. Our objectives were toassess the clinical presentations, risk factors, radiological findings, pathological types, and surgical options for patients with ILC treated at the national guard hospital. Identify the factors associated with metastasis and recurrence. Retrospective cross-sectional descriptive study at a tertiary care center in Riyadh.All adultpatients aged 16 years and above, from different nationalities, and both genders, were diagnosed with ILC from 2000 to 2017 and followed up at KAMC. The sampling technique was a non-probability consecutive technique.Among 1066 patients identified, 91 patients were diagnosed with ILC over seventeen years study period. The median age at the primary diagnosis was 50. On the clinical examination, 63 (71%) cases were found to have palpable masses which was the most suspicious finding. On radiology, the most encountered finding was speculated masses which were seen in 76 (84%). Regarding the pathology, unilateral breast cancer was seen in 82 while bilateral breast cancer was found only in eight. For the biopsy, a core needle biopsy was the most commonly used in 83 (91%) patients. The most documented surgery for ILC patients was a modified radical mastectomy. Metastasis in different organs was identified with the musculoskeletal system being the commonest site. Different significant variables were compared between patients with or without metastasis. Skin changes, post-operative invasion, estrogen, progesterone, and HER2 receptors were significantly associated with metastasis. Patients with metastasis were less likely to have conservative surgery. Regarding the Recurrence and five years survival, out of 62 cases, 10 had recurrence within five years, which was more prevalent in patients who had fine needle aspiration, excisional biopsy, and nulliparous patients. To our knowledge, this is the first study to exclusively describeILC in Saudi Arabia. The results of this current study are highly important, as these results provide baseline data of ILC in the capital city of Saudi Arabia.

Yassir Alaa Muhammed Hassan Shubbar CORRELATION BETWEEN DIFFERENT CLINICOPATHOLOGICAL PARAMETERS AND MOLECULAR SUBTYPES OF FEMALE BREAST CARCINOMA IN SOUTH REGION OF IRAQ.

The aim: To correlate variable clincopathological parameters with molecular subtypes of the breast carcinoma, which affect the prognosis and management of breast malignancy. Materials and methods: In this study a total of 511 female patients with breast carcinoma were included, ranging from 32 to 85 years of age, with 35.8% premenopausal and 64.1% being post-menopausal. The sample slides were stained immunohistochemically for estrogen receptors (ER), progesterone receptors (PR), ki67 and HER2, the tumors were graded histologically using the Nottingham criteria system. Results: Most tumors (72.8%) ranged between 2 and 5 cm in size; the most common histological type of breast carcinoma (49.7%) was invasive ductal carcinoma of no special type, with grade 2 presented in 51.8% cases; most frequent stage at time of presentation was stage 3A, found in 39.9%; the most frequent molecular subtype was ER and/or PR+, Her2- with low proliferation rate ki67<14% subtype in 48.5%, and those group were more likely (statistically significant) to be older, have stage 3 breast cancer, present with tumor size between 2 and 5 cm and tend to be well differentiated histological grade (grade1), mostly with lymph node positive, and most likely have tumor type of invasive ductal carcinoma of no special type. Conclusions: the most common histological type of breast carcinoma in Iraq south was invasive ductal carcinoma of no special type and most cases showed (ER and/or PR+, HER 2-, low ki67) as the most common molecular subtype.

BCL2 expression in ductal carcinoma of breast and its association with other clinicopathologic variables

Breast cancer has now become the most common cancer among Indian females exceeding cervical cancer. Age adjusted incidence rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Trends of breast cancer now in India are increasing incidence at younger age group, late stage of presentation, aggressive cancers in the young. Bcl 2-a protooncogene identified in 1984. The protein is found mainly in the periphery of mitochondria, on the perinuclear membrane, and in the endoplasmic reticulum. In our study bcl2 expression in different histologic types of breast carcinoma and correlates we read about its expression with other clinico pathologic variables such as tumour size, histological grade, lymph node status, hormone receptor status and Nottingham prognostic index. :In this study 23.3% (7 out of 30) of the cases showed positivity for bcl2 expression of which all cases were strongly positive. Bcl2 expression was found in 45.5% grade I well differentiated ductal carcinoma,14.3% of Grade II Moderately differentiated ductal carcinomas, all cases of mucinous carcinoma of breast(p-&amp;#60;0.025) Bcl2 and ER/PR status found to have a statistically significant direct correlation with p value&amp;#60;0.004. Hence Bcl2 antagonism in these ER+ tumors might increase the effectiveness of these predominately proapoptotic treatment even more than it does from combination with endocrine therapies. Further development of bcl2 inhibitors has been explored and small molecule inhibitors such as ABT-737 AND ABT-199 have been recently introduced. Emerging evidence also suggests the usefulness of this type of theraphy in breast cancer.

Treatment Options and Follow-Up among Iraqi Patients with Breast Carcinoma

Breast cancer ranks the first among the Iraqi population and the leading cause of cancer related female mortality. In addition to the barriers that impede early detection of that cancer other major challenges include the capacity for effective multimodality treatment. Aim: To review and follow up a sample of Iraqi female patients diagnosed with breast cancer in a main referral center; recording their clinico-pathological characteristics, the offered treatment options and the rate of recurrence. Material and Methods: This retrospective study analyzed the clinical and pathological characteristics of 230 Iraqi female patients histologically diagnosed with breast carcinoma who had reliable valid data related to their demographic, clinical and tumor pathological status. The studied parameters included the age of the patient, marital status, parity, age at first delivery, occupation, history of lactation and hormonal intake, family history of breast and any other cancer, histological type, tumor grade and clinical stage. Hormone receptors (Estrogen and Progesterone) and HER2 over expression contents of the primary tumors were evaluated immunohistochemically. The offered treatment options included surgery, chemotherapy, radiotherapy, hormonal and biological targeted therapy. The rate of recurrence was evaluated after a follow-up period of three years. Results: Only 3.5% of the patients were under the age of 30 years while 39.1% were aged 50 years and over. About 84% were married, 11.3% were nulliparous, 24.9% had their first delivery before the age of 20 years and 56.9% were housewives. History of lactation was reported in 60.4%, whereas history of breast cancer was registered in 17.4%. The most common histological type of breast carcinoma was the infiltrative ductal (86.5%), well differentiated carcinomas were diagnosed in only 5.2%. The rates of positive ER, PR and HER2 tumor contents were 68.3%, 65.7% and 29.6% respectively. Overall 8.3%, 4.3%, 39.6% and 7.8% of the patients were diagnosed at stages I, II, III and IV respectively. Surgery was the primary treatment modality prescribed to the vast majority (96.1%) of the patients; 88.2% of those underwent modified radical mastectomy and only 3.6% had breast conservative surgery. Whereas 91.7% received chemotherapy, radiotherapy, hormonal and biological therapy were applied on 65.7%, 63.5% and 27.4% respectively. Recurrence of breast carcinoma three years following treatment was displayed among 9.7%; displaying significant direct association with the clinical stages of the disease (p&lt;.05). Conclusions: Breast cancer is still diagnosed at relatively advanced stages at the time of first presentation in Iraq; requesting radical mastectomy. Early detection represents the principal approach to control breast cancer in the near future. Regular long-term follow up through multidisciplinary tumor boards is mandatory to monitor response to therapy and recurrence.

Histopathological subtypes of breast cancer and its correlation with various prognostic factors

The role of the pathologist in the evaluation of breast cancer now transcends that of determining the correct morphologic diagnosis, including the grading and staging of the cancer. Lumpectomy or modified radical mastectomy is the most commonly used tools for disease management. The objective of this study is to identify the clinical, macroscopic and microscopic examination of breast cancer which evaluates details like age, laterality, tumor size, stage, grade, lympho-vascular invasion and lymph node status. The study comprised a total of 212 breast cancer patients of which 209 were females. The mean age was 51.16 years. Majority of female patients were within age group 41 to 50 years. Left breast was more commonly involved than right breast. Invasive ductal carcinoma was the most common observed histological type of breast carcinoma. Grade II tumors were most frequent followed by Grade III and Grade I. Maximum 125 cases (59%) were 2-5 cm size. Mean size was 4.8 cm. There was increased incidence of Lymphovascular invasion as grade increased. Maximum number of lymphnode involvement was seen in grade II followed by grade III cases. Present study provides significance of various prognostic factors in breast cancer.

Institutional Spectrum of Rare Histological Types of Breast Carcinoma

Institutional Spectrum of Rare Histological Types of Breast Carcinoma

Secretory carcinoma of the breast: clinicopathologic profile of 14 cases emphasising distant metastatic potential.

Secretory carcinoma of the breast (SCB) is a rare histological type of breast carcinoma with a generally indolent clinical behaviour. We aim to elucidate the clinical, pathological and molecular findings of SCB cases and identify characteristics associated with aggressive clinical courses. Fourteen patients with SCB were identified, including 12 women and two men, with a median age of 56years (range=8-81years). Clinical data, histological diagnosis, molecular findings and follow-up were reviewed. Eight patients presented with palpable masses and four patients with radiographic abnormalities. All cases were unilateral. Surgical procedures included excisional biopsies and ipsilateral mastectomies. In 10 cases, oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) results were obtained, with six cases positive for ER and three positive for PR. All cases lacked HER2 overexpression. Sentinel lymph node biopsy was performed in 10 cases, and two patients had axillary lymph node metastasis. Follow-up ranged from 21 to 212months (median=70months). Two patients developed distant metastasis of SCB. Molecular analysis of these aggressive tumours revealed amplification of the 16p13.3 locus, a TERT promotor mutation and loss of 9p21.3 locus. Review of the literature for SCB cases with distant metastasis was performed. Although SCBs are generally associated with a favourable prognosis, our study and review demonstrate that a subset of SCBs may develop distant metastases. Further studies are warranted to identify markers predictive of more aggressive clinical behaviour in this rare breast cancer subtype.

Spectrum of the Breast Lesions With Increased 18F-FDG Uptake on PET/CT.

Interpretation of 18F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging.

Breast Cancer Reporting in Lagos, Nigeria: Implications for Training and Education in Africa.

PurposeTo assess the completeness and accuracy of breast cancer pathologic reporting in Nigeria.Materials and MethodsThe histologic parameters provided in breast cancer pathology reports at a large teaching hospital in Nigeria were assessed. The corresponding slides were reviewed after the United Kingdom Royal College of Pathologists guidelines, and results were compared.ResultsOut of 115 breast cancer cases, histologic type of breast carcinoma was concordant with the review type in 53.1% of cases and discordant in 46.9%. Grading was stated in 89.62% of cases, of which 50.5% were correctly graded, 35.8% were under-graded, and 8.5% were over-graded. Poor fixation and omission of the mitotic count were the main reasons for discordant grades. A comment on lymph node status was included in 40% of cases, and lymphovascular invasion was not commented on in 97.4% of cases. Only 26% of the tumors had hormone receptors and/or HER2 tested.ConclusionSome essential histologic parameters were absent from the histologic reports, and where present, a proportion were inaccurate. Attention to specimen fixation and method of grading and familiarity with uncommon breast cancer types are required; all can be facilitated by education and training. The use of a template/proforma is recommended to ensure cancer data set parameters are included in the pathology reports.

Comparison of Oncotype DX Recurrence Score by Histologic Types of Breast Carcinoma.

Oncotype DX (ODX) is a widely used commercial assay that estimates the risk of distant recurrence and may predict the benefit of chemotherapy in a subset of breast cancers. Some studies have shown the ability to predict Oncotype DX recurrence score (ODXRS), based on routinely reported pathologic features; however, there are limited data correlating specific histologic type of breast cancer to ODXRS. To compare ODXRS to specific histologic types of breast cancer. One hundred eighty-four cases were sent for ODXRS testing and the results were compared with histologic type and grade. The highest average ODXRS was seen in invasive ductal carcinoma with micropapillary features (29) followed by invasive ductal carcinoma not otherwise specified (mean = 19.4, SD = 11.6), invasive mucinous carcinoma (mean = 17.2, SD = 5.9), invasive lobular carcinoma (mean = 15.7, SD = 7.2), mixed ductal and lobular carcinoma (mean = 14.1, SD = 7.7), tubular carcinoma (10.0), and mixed ductal and mucinous carcinoma (mean = 8.0, SD = 4.2). Most tumors that had a high ODXRS were grade 3 invasive ductal carcinoma, representing 13 of a total of 20 cases (65%). Interestingly, 3 of the 4 cases of pure invasive mucinous carcinoma had an intermediate ODXRS. Although the numbers are small, our findings raise further awareness of the significance between histologic type and grade, and RS in breast cancer. In some special histologic types of breast cancer, particularly those considered to follow either an excellent or poor clinical course by histology alone, it is unclear whether the ODXRS results are as meaningful as in carcinomas of no special type. Further investigation with higher numbers and outcome data is needed.

Expression of DDR1 and DVL1 in invasive ductal and lobular breast carcinoma does not correlate with histological type, grade and hormone receptor status.

Invasive ductal (IDC) and lobular (ILC) carcinomas are the common histological types of breast carcinoma which are difficult to distinguish when poorly differentiated. Discoidin domain receptor (DDR1) and Drosophila dishevelled protein (DVL1) were recently suggested to differentiate IDC from ILC. To assess the expression of DDR1 and DVL1 and their association with histological type, grading and hormonal status of IDC and ILC. This cross sectional study was conducted on IDC and ILC breast tumours. Tumours were immunohistochemically stained for (DDR1) and (DVL1) as well as estrogen receptor (ER), progesterone receptor (PR) and C-erbB2 receptor. Demographic data including age and ethnicity were obtained from patient records. A total of 51 cases (30 IDCs and 21 ILCs) were assessed. DDR1 and DVL1 expression was not significantly associated with histological type (p=0.57 and p=0.66 respectively). There was no association between DDR1 and DVL1 expression and tumour grade (p=0.32 and p=1.00 respectively), ER (p=0.62 and 0.50 respectively), PR (p=0.38 and p=0.63 respectively) and C-erbB2 expression (p=0.19 and p=0.33 respectively) in IDC. There was no association between DDR1 and DVL1 expression and tumour grade (p=0.52 and p=0.33 respectively), ER (p=0.06 and p=0.76 respectively), PR (p=0.61 and p=0.43 respectively) and C-erbB2 expression (p=0.58 and p=0.76 respectively) in ILC. This study revealed that DDR1 and DVL1 are present in both IDC and ILC regardless of the tumour differentiation. More studies are needed to assess the potential of these two proteins in distinguishing IDC from ILC in breast tumours.

Spontaneous Mammary Carcinomas in Female Dogs: Association between the Immunohistochemical Degree of Aggressiveness of Tumors, Intensity of DNA Damage and Residues of Pyrethroids

Diagnosis and biological behavior of breast cancer of female dog represent one of the biggest challenges facing the Veterinarian in recent years. Due to its exponential growth and the degree of aggressiveness, the exact cause of this tumor is probably multifactorial and it is believed that may suffer influence from environmental factors. Among the suspected environmental contaminants are the pyrethroids. Aiming to investigate the participation of pyrethroids in tumorigenesis in female dogs, a study was conducted using 50 female dogs, 22 were positive for simple breast carcinoma (Group I), 18 with a diagnosis of complex breast carcinoma (Group II) and 10 negative (Group III) for breast cancer. In order to detect DNA damage, the Comet assay was performed on mammary samples of these animals, which also had samples submitted to the technique of High Performance Liquid Chromatography (HPLC), which aimed to quantify the concentration of pyrethroids. The results of HPLC of each animal were compared with those obtained by the Comet assay analysis of variance and the means were compared by the test groups “Student T” at the significance level of p ￡ 0.05. Despite presenting correlation between the amount of DNA damage and tumor aggressiveness, no statistical differences were found in the DNA damage of different histologic types of breast carcinoma. As for pyrethroids, even these were detected in 22% of tumor tissues and peritumoral fat, there was no difference in DNA damage between cells exposed and not exposed to environmental contaminant.

Epstein-Barr Virus Infection and Sporadic Breast Cancer Risk: A Meta-Analysis

BackgroundA large number of epidemiological studies have evaluated the association between Epstein-Barr virus infection and breast carcinoma risk but results have been inconsistent.MethodologyResearch using the polymerase chain reaction technique for detecting the Epstein-Barr virus was selected; 24 studies and 1535 cases were reviewed. Information on the study populations, sample types, publication calendar period and histological types of breast carcinoma were collected. An unconditional logistic regression model was used to analyze potential parameters related to the Epstein-Barr virus prevalence. A Kappa test was used to evaluate the consistency in detecting different Epstein-Barr virus DNA regions. Nine studies that included control groups and 1045 breast cancer cases were adopted in this meta-analysis.ConclusionsWe found that 29.32% of the patients with breast carcinoma were infected with the Epstein-Barr virus. The prevalence of Epstein-Barr was highest in Asia (35.25%) and lowest in the USA (18.27%). Statistical analysis revealed a trend that showed lobular breast carcinoma might have the strongest association with Epstein-Barr virus infection. This meta-analysis showed a significant increase in breast malignancy risk in patients testing positive for the Epstein-Barr virus (OR = 6.29, 95% CI = 2.13–18.59). This result suggests that an Epstein-Barr virus infection is statistically associated with increased breast carcinoma risk.

Distinct Clinical and Prognostic Features of Invasive Lobular Breast Cancer

When in the early 1940s pathologists started to subcategorize breast carcinomas based on their histology the key development of subdividing breast cancer into different diseases began [9]. About 60 years later distinguishing various breast cancer subtypes has become a major focus of research at the level of genomic structure and gene expression [2,15,32]. Invasive lobular carcinoma is the second most frequent histological type of breast carcinoma, found in about 5– 15% of patients [1,24,25]. Based on estimations of the World health organization 100.000 – 150.000 new cases per year of invasive lobular carcinoma are diagnosed worldwide. The analyses of large patient series have uncovered distinct clinical features for infiltrating lobular (ILC) and infiltrating ductal (IDC) breast carcinoma. In addition, the most recent studies with long term follow-up suggest that ILC and IDC also differ in their pattern of disease free survival (DFS) and overall survival (OS). Here we review newer findings and discuss possible implications of this knowledge for clinical practice and research in breast cancer.

2–14 Correlation Between Numeric Gadolinium-Enhanced Dynamic MRI Ratios and Prognostic Factors and Histologic Type of Breast Carcinoma

2–14 Correlation Between Numeric Gadolinium-Enhanced Dynamic MRI Ratios and Prognostic Factors and Histologic Type of Breast Carcinoma

Treatment of invasive lobular carcinoma with breast conserving therapy

11046 Background: Invasive lobular carcinoma (ILC) is the second most common histological type of breast carcinoma .There is still a persisting concern regarding the use of breast-conserving therapy(BCT) in patients with ILC.Difficulty to identify the exact size , location of ILC and multifocality and/or multicentricity are the reasons to suggest that patients with ILC might be poor candidates for BCT. The aim of our current study was to evaluate the possibilty of risk adapted BCT for patients with ILC with or without breast irradiation. Methods: 277 patients with ILC pure or mixed type between 1994 and 2006 were accrued for pospective risk adapted therapy. Contraindications for BCT are multicentricity , inability to obtain negative margins or poor cosmesis. Palpation, mammograpy,ultrasound were routinely done and preoperative MRI in cases with no sharp tumor image. Breast conserving surgery was standardised by performing a radial segmental resection. Inking margins,histological semiserial step sections and specimen radiography was done. Sharp dileneated ILC with a free margins of &gt;/= 1cm and no lymphvesel invasion(LVI) were treated by BCT without breast irradiation(Rx). Patients with ER + were treated with endocrine therapy.Mean follow-up time was 74 months. Results: Of the 277 ILC cases , 55(19,8%) were treated by mastectomy and five patients palliatively because of distant metastases. 217 ILC (79%) were treated with BCT (T1:108/48%;T2:45(21%);T3:67/31% ; NO:135/62%; ER+: 295/94%). 6 patients(2,8%) had local recurrence(LR). 161 ILC (T1 38%; T2 22%; T3 39%; N0 55%) were treated with BCT with Rx. Patients mean age was 57 years. 6(3,7%) of the patients had local recurrence (4 LR only, 2 LR and distant metastases). 56 ILC (T1 69%; T2 15% T3 22% ; NO 81%) were treated with BCT without Rx. Mean age 66 years. There were no LR , 2 patients had distant metastases. Conclusions: Using strict selecting criteria with a standardized breast conserving surgical procedure, thorough histological examination and using all breast imaging possibilities risk adapted BCT for ILC are not more likely to fail than BCT of other types of breast cancer. These results support the use of BCT for ILC patients. No significant financial relationships to disclose.

Secretory breast carcinoma with metastatic sentinel lymph node.

BackgroundSecretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases.Clinical presentationIn this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression.We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma.ConclusionAfter a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice.

Correlation Between Numeric Gadolinium-Enhanced Dynamic MRI Ratios and Prognostic Factors and Histologic Type of Breast Carcinoma

The purpose of this study was to assess the usefulness of numeric ratios from dynamic contrast-enhanced MRI in predicting histologic type of breast carcinoma and three histologic prognostic factors for invasive ductal carcinoma. A total of 104 patients with breast carcinoma were included in the study. Dynamic contrast-enhanced MR images were obtained every 30 seconds during the first 4.5 minutes after administration of contrast material, and peripheral contrast enhancement ratio and central contrast enhancement ratio were calculated in the early phase (1 minute after contract injection) and in the delayed phase (4 minutes after injection). Four contrast enhancement ratios were used for quantitative analysis of the following numeric ratios: early peripheral/early central, delayed peripheral/delayed central, delayed peripheral/early peripheral, and delayed central/early central. The four ratios were compared with histologic type. For invasive ductal carcinoma, the ratios were then compared with modified Scarff-Bloom-Richardson histologic grade, microvessel density, and fibrotic focus. Mucinous carcinoma had significantly higher mean early peripheral/early central and delayed central/early central ratios than other types of tumors (p< 0.0001). For invasive ductal carcinoma, the mean early peripheral/early central ratio was significantly lower for modified Scarff-Bloom-Richardson grade 1 tumors than for grades 2 and 3 tumors (p < 0.0001). Early peripheral/early central ratio had a significant correlation with the ratio of peripheral to central mean microvessel density (p < 0.0001). There was also a significant difference in early peripheral/early central ratio (p < 0.0001) between tumors with a fibrotic focus and those without a fibrotic focus. Numeric ratios obtained on gadolinium-enhanced dynamic MRI of the breast may be useful in predicting histologic type of breast carcinoma and three histologic prognostic factors for invasive ductal carcinoma: modified Scarff-Bloom-Richardson grade, microvessel density, and fibrotic focus.

Transvaginal Sonographic Findings of Endometrial Metastases of Mammary Ductal Carcinoma

Metastases to the uterus are rare and account for less than 10% of all metastases to the female genital tract from extragenital cancers. 1 The endometrium is even less frequently affected by metastases. 1 The most common type of breast cancer that metastasizes to the uterus is infiltrating lobular carcinoma. 1 Other histologic types of breast carcinoma that may metastasize to the endometrium include infiltrating ductal carcinoma and signet ring breast carcinoma. 1-5 We report an unusual case in which a postmenopausal patient with infiltrating mammary ductal carcinoma receiving tamoxifen presented because of recent mild uterine bleeding. Transvaginal sonography depicted a symmetrically thickened endometrium and a small hydrometra. Tissue obtained at curettage confirmed metastatic carcinoma consistent with mammary ductal carcinoma.

Electron microscopic findings for diagnosis of breast lesions

The normal mammary gland can be roughly divided into the large duct close to the nipple and the terminal duct located within the lobulus. Both the large duct and the terminal duct are composed of epithelial cells and myoepithelial cells. The epithelial cells can be divided into light and dark cells using electron density. Heterochromatin is the predominant type of chromatin found in normal mammary glands. The cytoplasm of myoepithelial cells contains a number of fine filaments that possess dense patches. The myoepithelial cells of the large duct have a large process with a crablike appearance that protrudes from the cytoplasm. The myoepithelial cells of the terminal duct, by contrast, assume a relatively flat form and are approximately parallel to the epithelial-stromal junction. If the nuclei of the epithelial cells of normal mammary glands and benign breast lesions are compared with those of malignant breast lesions, the latter are primarily oval or circular in shape whereas the former often show marked notches. The predominant chromatin is heterochromatin in noncancer cells and euchromatin in cancer cells. The intracytoplasmic lumen (ICL) can be roughly divided into two types. The ICL is frequently seen in breast cancers, especially scirrhous carcinoma and lobular carcinoma. Invasive ductal carcinoma can be divided into three types: papillotubular carcinoma, solid-tubular carcinoma, and scirrhous carcinoma. Scirrhous carcinoma can be divided into two subtypes: scirrhous carcinoma in the broader sense of the term (characterized by scirrhous invasion of the stroma by papillotubular carcinoma or solid-tubular carcinoma), and scirrhous carcinoma in the narrower sense of the term (characterized by linear or cluster-like invasion of the stroma without forming ducts). Ultrastructural characteristics of scirrhous carcinoma in the narrow sense are bright cytoplasm (seen in most cells) and euchromatin (seen in all cells of this type of carcinoma). In cases of papillotubular carcinoma, solid-tubular carcinoma, and scirrhous carcinoma in the broad sense, euchromatin is predominant but sporadic cells with heterochromatin are also seen. Adenoid cystic carcinoma and carcinoid tumor of the breast are histological types of breast carcinoma that show characteristic features under an electron microscope. Ultrastructurally, the former shows a pseudocyst and true lumen whereas the latter presents numerous neuroendocrine granules within the cytoplasm. Breast carcinoma shows several ultrastructural characteristics that are useful in differential diagnosis. Therefore, it is advisable to take electron microscopic findings into account when evaluating or diagnosing breast lesions.