Medullary breast carcinoma: Prognostic implications of p53 expression

Dendale, R.; Vincent‐Salomon, Anne; Mouret-Fourme, E.; Savignoni, Alexia; Médioni, Jacques; Campana, F.; Vilcoq, J.R.; Rochefordière, Anne de la; Soussi, Thierry; Asselain, Bernard; Crémoux, Patricia de

doi:10.5301/jbm.2008.1279

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…The current study was the first one to use competing risk models (CIF and SH models) to analyze the prognostic value of clinical variables to the BCSS of MCB and IDC. Our results showed IDC had a worse BCSS than MCB, which was consistent with previous studies 4, [13][14][15] . Larger tumor size, a greater number of positive regional nodes and unmarried status were found to promote the progression of Continued both MCB and IDC.…”

Section: Discussionsupporting

confidence: 93%

Competing Risk Analyses of Medullary Carcinoma of Breast in Comparison to Infiltrating Ductal Carcinoma

Dai

Shi

Wang

et al. 2020

Sci Rep

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the aim of current study was to use competing risk model to assess whether medullary carcinoma of the breast (MCB) has a better prognosis than invasive ductal carcinomas of breast cancer (IDC), and to build a competing risk nomogram for predicting the risk of death of MCB. We involved 3,580 MCB patients and 319,566 IDC patients from Surveillance, Epidemiology, and End Results (SEER) database. IDC was found to have a worse BCSS than MCB (Hazard ratio (HR) > 1, p < 0.001). The 5-year cumulative incidences of death (CID) was higher in IDC than MCB (p < 0.001). Larger tumor size, increasing number of positive lymph nodes and unmarried status were found to worsen the BcSS of McB (HR > 1, p < 0.001). We found no association between ER, PR, radiotherapy or chemotherapy and McB prognosis (p > 0.05). After a penalized variable selection process, the SH model-based nomogram showed moderate accuracy of prediction by internal validation of discrimination and calibration with 1,000 bootstraps. In summary, MCB patients had a better prognosis than IDC patients. Interestingly, unmarried status in addition to expected risk factors such as larger tumor size and increasing number of positive lymph nodes were found to worsen the BcSS of McB. We also established a competing risk nomogram as an easy-to-use tool for prognostic estimation of MCB patients. Medullary carcinoma of the breast (MCB) is a rare histology type of invasive breast cancer, accounting for 3-5% of all breast cancers. The histopathologic features of MCB include lymphoplasmacytic infiltration, noninvasive microscopic circumscription, syncytial growth pattern >75%, and grade 2 or 3 nuclei 1. Immunohistochemical results showed that MCB presented with more absence of estrogen (ER), progesterone (PR), and human epidermal growth factor receptor 2 (HER2) 2. Compared with invasive ductal carcinomas of breast cancer (IDC), MCB also exhibited with more BRCA1/2 mutations, greater T stage and tumor size 3. Despite the aggressive features, the prognosis of MCB was conflicting. Studies found MCB showed a better survival than IDC 1,3-6 , while other researches showed MCB (IDC) had a similar outcomes with IDC 7-9. However, since MCB is a rare type of breast cancer, most of these studies were involved with limited samples. Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute is a national collaboration program of Unite State, covering nearly 26% American population's cancer incidence and survival data, which could provide relatively large sample size for survival study. There were two SEER-based studies associated with MCB prognosis 7,10. One study 7 only focused on short-term survival status. The inadequate follow-up time might lead to skewed results. The other study 10 evaluated the prognostic factors of long-term MCB overall survival (OS) by Cox proportional hazards model. However, OS might unable to accurately describe long-term survival of disease such MCB, as the deaths could be caused by other competing risk events. In this case, the cum...

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Section: Discussionsupporting

confidence: 93%

Competing Risk Analyses of Medullary Carcinoma of Breast in Comparison to Infiltrating Ductal Carcinoma

Dai

Shi

Wang

et al. 2020

Sci Rep

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“…The reported incidence of medullary carcinoma is < 5%. 6,7,8 The typical medullary breast carcinoma requires five criteria for diagnosis, these are: predominantly (>75%) syncytial growth pattern of tumour, moderate to marked diffuse mononuclear stromal infiltrate, absence of microglandular features and intraductal component, grade II-III nuclear pleomorphism and microscopically completely circumscribed tumour growth. 3,5,9 In the present study, we found both typical and atypical type of medullary breast carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Medullary Carcinoma of Breast: Clinicopathological Study

Jagtap¹,

Beniwal²,

Shah³

et al. 2016

jebmh

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To study the clinical and histopathological features of medullary breast carcinoma (MBC) in rural population in Western Maharashtra. MATERIALS AND METHODS This is a retrospective, analytic study which is done at a tertiary care hospital from March 2010 to April 2016 for a period of 6 years. RESULTS Total of 241 consecutive cases of breast malignancy surgically operated for mastectomy or modified radical mastectomy were studied. From these 241 cases, 11 were reported as medullary carcinoma (constitute 4.56%). From these 11 cases, 10 cases were of typical medullary breast while 1 case was of atypical medullary breast carcinoma was noted. Each case was studied for clinical, morphological, radiological and immunohistochemistry (IHC) findings. For typical medullary carcinoma, the age range in present study was 33 to 55 years with a mean age of 46.3 years. The common clinical presentation was painless lump in the breast with common location being upper outer quadrant. The size of the tumour ranged from 2.5 to 9 cm with a mean size of 5.6 cm. The axillary lymph nodes were involved in 4 (40%) cases. The ER, PR and HER-2 were found to be positive in 10%, 10% and 20% respectively. Triple negative cases were 70%. CONCLUSION The clinicopathological features of medullary breast carcinoma showed early disease stage, having high-grade histological features of tumour, more triple negativity for ER/PR/HER2 and low rate of nodal metastasis.

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“…Moreover, its poorly differentiated morphology represented a diagnostic challenge. The mutated p53 and overexpression of HER-2/neu were evaluated in studies, showing that the majority of MC had a positive nuclear expression of p53 [6,7], while there was no immunostaining of HER-2/neu [8].…”

Section: Introductionmentioning

confidence: 99%

Are all high-grade breast cancers with no steroid receptor hormone expression alike? The special case of the medullary phenotype

et al. 2005

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Background: Medullary carcinoma (MC) of the breast is associated with favorable prognosis compared with other histological types, despite high nuclear grade, fast proliferation and lack of steroid hormone receptor expression. We retrospectively evaluated the clinical relevance of selected immunohistochemical features of tumors in three cohorts of patients with typical medullary (MC), 'atypical' medullary (AMC) or ductal (DC) breast carcinoma. Patients and methods: Evaluation was performed on node-negative tumor specimens from 40 patients who had either MC (12 patients), AMC (nine patients) or DC (19 patients), treated in a single institution. All had no hormonal receptor, Ki-67 > _ 30%, G3, expansive pattern of growth and peritumoral lymphocytic infiltration. In addition, p27, p21 and HER2/neu overexpression, p53, cyclin E and E-cadherin expression, presence of apoptotic cells, stromal tenascin (TN), and type of immune cell infiltration (CD3-and CD68-positive cells) were assessed. Results: No difference in expression of HER2/neu, p21, p27, p53, number of apoptotic cells and CD68-positive cells was detected. Lower levels of stromal TN expression were found in MC compared with DC (P = 0.0007), but differences between MC and AMC were not significant (P = 0.27). A higher proportion of intratumoral CD3-positive cells was seen in MC than in AMC (P = 0.046). No differences were seen between MC and DC (P = 0.73). With a median follow-up of 67 months, three patients with DC had relapsed in distant sites, while one patient with AMC had a second primary. Two patients with MC had reappearance of DC in the breast. Conclusions: The three distinct disease types, selected by having similar high proliferation, had similar expression of cell cycle regulators. The lower expression of TN and massive infiltration of T lymphocytes might both indicate a special interaction between tumor cells and microenvironment, important features for conferring improved prognosis through negligible invasive and metastatic potential to MC. In our series, however, patients with a previous MC are not free from the risk of developing a subsequent DC. Finally, defining AMC as a distinct entity from DC is not justified.

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Medullary breast carcinoma: Prognostic implications of p53 expression

Cited by 10 publications

References 23 publications

Competing Risk Analyses of Medullary Carcinoma of Breast in Comparison to Infiltrating Ductal Carcinoma

Competing Risk Analyses of Medullary Carcinoma of Breast in Comparison to Infiltrating Ductal Carcinoma

Medullary Carcinoma of Breast: Clinicopathological Study

Are all high-grade breast cancers with no steroid receptor hormone expression alike? The special case of the medullary phenotype

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