The Most Usual Types of Invasive Breast Carcinoma


Chapter 5


The Most Common Types of Invasive Breast Carcinoma



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Fig. 5.1



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Fig. 5.3



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Fig. 5.4


Tubular carcinoma is usually a slow-growing, stellate tumor with stromal desmoplasia (Fig. 5.1). The typical mammographic appearance is a small stellate density with a central tumor mass (“white star”) (Fig. 5.2).


Diagnostic Criteria


More than 90% of the tumor has tubular structures, which are



–  angulated and irregular (Fig. 5.3)


–  composed of only one thin layer of epithelial cells, which means


–  absence of myoepithelium (Fig. 5.4, arrow).



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Fig. 5.2



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Fig. 5.5



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Fig. 5.6


Tubular carcinoma is usually small and of limited extent, but it may be multifocal. Structures of ductal carcinoma in situ (DCIS) grade I are regularly present in the tumor. Tubular carcinoma is regularly diploid (Fig. 5.5), estrogen-receptor positive (Fig. 5.6), and has an excellent prognosis.


Differental Diagnosis



1.  Radial scar (see also Chapter 6):



–  not palpable


–  typical mammographic picture of a “black star”


–  presence of myoepithelium



2.  Microglandular adenosis:


–  regular, round glands (absence of lobulocentricity and myoepithelium)



3.  Invasive ductal carcinoma not otherwise specified (NOS):



–  contains less than 90% tubular structures


Mucinous carcinoma is a mucin-producing, slow-growing, tumor with a favorable prognosis. Mammographically, it usually appears as a circular – oval, ill-defined, low-density tumor mass (Fig. 5.7).



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Fig. 5.7



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Fig. 5.8



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Fig. 5.9



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Fig. 5.10



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Fig. 5.11



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Fig. 5.12


Diagnostic Criteria



–  Macroscopically well-circumscribed and gelatinous tumor (Fig. 5.8), and


–  at least 90% of the tumor is composed of mucin, containing small groups of well-differentiated tumor cells. (Figs. 5.9 and 5.10).


A tumor fulfilling these criteria has an excellent prognosis. However, mucinous carcinoma often exhibits obvious intratumoral heterogeneity (see Chapter 10, case 1), which may have prognostic implications.


Differential Diagnosis



1.  Mucin-containing lobules, dilated ducts, mucocele (Fig. 5.11), and mucinous DCIS (Fig. 5.12).


2.  Ductal carcinoma with mucinous component:



–  poorly circumscribed, often stellate


–  more cellular


–  often less well-differentiated tumor cells


Ductal carcinomas with a mucinous component do not share the favorable prognosis of purely mucinous carcinomas.



3.  Invasive micropapillary carcinoma (see Chapter 6).


Medullary carcinoma is usually a rapidly growing, round or oval, well-circumscribed tumor appearing in younger patients. Mammographically or ultrasonographically (Fig. 5.13), a circumscribed, solid, round or oval density is observed.


Macroscopically and histologically the tumor is well-circumscribed, relatively soft, and often lobulated (Fig. 5.14).



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Fig. 5.13

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Jul 31, 2016 | Posted by in ONCOLOGY | Comments Off on The Most Usual Types of Invasive Breast Carcinoma
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