Quality Issues in Diagnostic Immunohistochemistry in Breast Pathology

Hoda, Raza S; Wen, Hannah Y.

doi:10.1159/000522538

Cited by 11 publications

(14 citation statements)

References 33 publications

(36 reference statements)

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“…12 At the other end of the spectrum, apocrine ductal carcinoma in situ with high nuclear grade shows marked nuclear pleomorphism and prominent nucleoli. 12 Despite that tumor cells with apocrine differentiation have large nuclei and prominent nucleoli and are classified as high-grade atypia corresponding to nuclear atypia score 3, carcinomas with apocrine differentiation tend to have a better prognosis than other triple-negative breast cancers. 2,13 In addition, although invasive pleomorphic lobular carcinoma, which often demonstrates apocrine features, has been considered more aggressive than invasive classical lobular carcinoma, there is a report that the pleomorphic variant is not significantly associated with progression-free survival or overall survival.…”

Section: Discussionmentioning

confidence: 99%

“…Apocrine ductal carcinoma in situ with low nuclear grade can sometimes be difficult to differentiate from apocrine metaplasia cytologically, but it shows complex architectural patterns such as expansive solid and papillary growth. 12 At the other end of the spectrum, apocrine ductal carcinoma in situ with high nuclear grade shows marked nuclear pleomorphism and prominent nucleoli. 12 Despite that tumor cells with apocrine differentiation have large nuclei and prominent nucleoli and are classified as high-grade atypia corresponding to nuclear atypia score 3, carcinomas with apocrine differentiation tend to have a better prognosis than other triple-negative breast cancers.…”

Section: Discussionmentioning

confidence: 99%

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A Case Report on Apocrine Encapsulated Papillary Carcinoma of the Breast with Frank Invasion: A Diagnostic Quandary

et al. 2022

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Encapsulated papillary carcinoma is a special type of breast cancer defined in the fifth edition of the World Health Organization breast tumor classification guidelines. Apocrine encapsulated papillary carcinoma is extremely rare, and only 10 cases have been described previously. We encountered a case of apocrine encapsulated papillary carcinoma with frank invasion. The patient was a 77-year-old woman with a painless mass in her right breast. Core needle biopsy revealed that the tumor cells had voluminous eosinophilic cytoplasm and enlarged nuclei with prominent nucleoli. We diagnosed this lesion as carcinoma with apocrine differentiation and suggested the possibility of an encapsulated papillary carcinoma. The patient underwent a right-sided mastectomy. Gross examination of the resected specimen revealed a multilobulated tumor. Microscopically, the tumor cells, which had voluminous eosinophilic cytoplasm and enlarged nuclei with prominent nucleoli, proliferated in papillary fashion with fibrous stalks in the cystic space. Myoepithelial cells were not observed around the cystic space. Frank invasion was also observed around the encapsulated papillary carcinoma. Immunohistochemistry analysis revealed that the tumor cells were negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 and positive for androgen receptor and gross cystic disease fluid protein 15. Based on these findings, we diagnosed this lesion as an apocrine encapsulated papillary carcinoma with frank invasion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case Report on Apocrine Encapsulated Papillary Carcinoma of the Breast with Frank Invasion: A Diagnostic Quandary

et al. 2022

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“…[ 18 ] However, a concurrent invasive carcinoma focus has been found in approximately 10% of the cases. [ 19 ] Drinka et al [ 15 ] have reported concurrent invasive carcinoma in 9 (11%) cases in their study including 79 cases with a PASH diagnosis. The diagnosis was invasive ductal carcinoma in eight, and invasive micropapillary carcinoma in one of these cases.…”

Section: Discussionmentioning

confidence: 99%

The relationship of PASH (pseudoangiomatous stromal hyperplasia)-like appearance in invasive breast carcinomas with PASH areas in non-tumoral breast parenchyma as well as on axillary lymph node involvement

Sigirci¹

2022

Sisli Etfal

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Objectives: The aim of this study were to determine the relationship of pseudoangiomatous stromal hyperplasia (PASH)-like appearance in invasive breast carcinomas (IBCs) with PASH foci in the non-tumoral breast parenchyma as well as axillary lymph node involvement. Methods: In this study, 200 consecutive cases with IBC were re-examined. Cases with and without PASH-like appearance in IBC were determined. Each case was assessed regarding the presence of accompanying PASH foci (CD34+, CD31-) in the non-tumoral areas in addition to other clinicopathological parameters. Results: PASH-like appearance within the IBC was present in 22 of the 200 cases (11%) and absent in 178 (89%). The presence of PASH foci in the non-tumoral breast parenchyma was significantly more common in IBC with PASH-like appearance compared to the group without such areas. However, there was no significant difference between the groups regarding other clinicopathological parameters (age, tumor size, nuclear and histological grade, Estrogen receptor/Progesterone receptor status, HER2 status, and Ki-67 proliferation index), lymphovascular invasion (LVI), and axillary lymph node involvement. There was no significant difference between the two groups regarding the histopathological findings observed in the non-tumoral areas. Conclusion: PASH-like appearance within IBC was found to be associated with higher rate of PASH foci in the non-tumoral breast parenchyma. However, such cases do not show a difference as regards LVI and axillary lymph node metastasis.

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“…IHC, alongside antibodies against the most ubiquitous BM components collagen IV and laminin, is now used more frequently in routine practice for BM identification [36]. However there are some limitations as cross reactivity, propensity to stain vasculature structure [37] and the expression of some of these markers in the malignant epithelial cells [9] can complicate interpretation.…”

Section: Bm Staining Techniques and Its Pitfallsmentioning

confidence: 99%

Defining invasion in breast cancer: the role of basement membrane

et al. 2022

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Basement membrane (BM) is an amorphous, sheet-like structure separating the epithelium from the stroma. BM is characterised by a complex structure comprising collagenous and non-collagenous proteoglycans and glycoproteins. In the breast, the thickness, density and composition of the BM around the ductal lobular system vary during differing development stages. In pathological conditions, the BM provides a physical barrier that separates proliferating intraductal epithelial cells from the surrounding stroma, and its absence or breach in malignant lesions is a hallmark of invasion and metastases. Currently, diagnostic services often use special stains and immunohistochemistry (IHC) to identify the BM in order to distinguish in situ from invasive lesions. However, distinguishing BM on stained sections, and differentiating the native BM from the reactive capsule or BM-like material surrounding some invasive malignant breast tumours is challenging. Although diagnostic use of the BM is being replaced by myoepithelial cell IHC markers, BM is considered by many to be a useful marker to distinguish in situ from invasive lesions in ambiguous cases. In this review, the structure, function and biological and clinical significance of the BM are discussed in relation to the various breast lesions with emphasis on how to distinguish the native BM from alternative pathological tissue mimicking its histology.

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Quality Issues in Diagnostic Immunohistochemistry in Breast Pathology

Cited by 11 publications

References 33 publications

A Case Report on Apocrine Encapsulated Papillary Carcinoma of the Breast with Frank Invasion: A Diagnostic Quandary

A Case Report on Apocrine Encapsulated Papillary Carcinoma of the Breast with Frank Invasion: A Diagnostic Quandary

The relationship of PASH (pseudoangiomatous stromal hyperplasia)-like appearance in invasive breast carcinomas with PASH areas in non-tumoral breast parenchyma as well as on axillary lymph node involvement

Defining invasion in breast cancer: the role of basement membrane

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