Tall Cell Carcinoma with Reversed Polarity: Case Report of a Rare Special Type of Breast Cancer and Review of the Literature

Abstract

Background: Tall cell carcinoma of the breast with reversed polarity (TCCRP) is a rare type of invasive breast cancer with overlapping features with papillary thyroid carcinoma and a characteristic molecular profile. Few cases have been reported in the literature since the first case was described in 2003. Case presentation: We present the case of a 41-year-old female with a symptomatic left breast lump. Image-guided core biopsy was diagnosed as triple-negative apocrine carcinoma. Surgical excision revealed an invasive carcinoma with solid papillary pattern, nuclei arranged away from the basement membrane (reversed polarity) and luminal eosinophilic colloid-like material. The tumour was GATA3-, CK5-, CK14- and CK7-positive and TTF1-negative. Specialist opinion and the identification of hotspot mutations in the IDH2 p.Arg172 gene via PCR confirmed the diagnosis of TCCRP. Conclusions: TCCRP is a relatively recently recognised papillary epithelial neoplasm with characteristic morphological features and molecular profile. Due to its rarity, TCCRP can be diagnostically challenging, and features can be mistaken for benign and malignant lesions. Accurate diagnosis is important in effective treatment of this indolent malignant triple-negative breast cancer, which carries an excellent prognosis.

Invasive papillary carcinoma of the breast: A case report

“…Based on the 5th edition of the WHO Classification of Breast Tumors, papillary neoplasms of the breast comprise a diverse group of diseases, encompassing benign papilloma, intraductal papillary carcinoma, as well as EPC, SPC and IPC (15). The rarest subtype of papillary neoplasms is IPC, characterized by a predominantly (>90%) papillary infiltrating component (24)(25)(26). Compared with other papillary neoplasms, IPC possesses distinct clinical and histological characteristics.…”

Invasive papillary carcinoma of the breast

“…It is worth noting that they may be accompanied by either apocrine metaplasia or apocrine secretion. Most breast cancers with papillary structures are typically characterized as estrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative, except for tall cell carcinoma with reversed polarity and mucinous cystadenocarcinoma ( 45 , 46 ). Typical IPC is characterized by high expression of ER and progesterone receptor (PR), no amplification of the HER2 gene, and a low Ki-67 proliferation index ( 30 , 47 ).…”