It is ok to call metaplastic carcinoma with squamous differentiation. I favor the diagnosis of invasive ductal carcinoma with basal-like phenotype. Of cause your dx should depend on the usual way the surgens know. Medullary carcinoma is really rare you make the dx based on the strict criteria.
Bottomly all these three are the same. They may represent the same process in the different sides. Basically they are triple negative (ER/PR/Her2), positive for ck5/6 (infact CK5 better), ck14, ck17, and EGFR. If the tumor show more squamous differentiation, spidle shaped cells. Metaplastic carcinoma with squamous differentiation is a good call. Otherwise it should call IDC with basal-like phenotype. Medullary carcinoma and basal-like carcinoma share almost all the mophologic (pushing edges, high grade cytology, and lymphocyte infiltrate, et al) and IHC features. Medullary ca may have more lymphocyte infiltrate, which indicates good prognosis. Some people now think medullary ca may be not present. I work in a large GYN/Breast center and we basically never diagnose medullary ca in the past few years. Patients and clinical physican always think that the prognosis of medullary ca is good. It may be not true. This is why we do not like the term-medullary ca.
Just for your reference, Thank, cqz
Sone papers related to basal-like ca
Med Mol Morphol. 2008 Jun;41(2):117-20. Epub 2008 Jul 1Basal-like carcinoma of the breast: further evidence of the possibility that most metaplastic carcinomas may be actually basal-like carcinomas.
-
Breast Cancer Res. 2007;9(1):R4
Basal-like grade III invasive ductal carcinoma of the breast: patterns of metastasis and long-term survival.
-
Breast Cancer Res. 2006;8(5):R58.
Gene expression signatures of morphologically normal breast tissue identify basal-like tumors.
-
Finak G,
Sadekova S,
Pepin F,
Hallett M,
Meterissian S,
Halwani F,
Khetani K,
Souleimanova M,
Zabolotny B,
Omeroglu A,
Park M.
Proc Natl Acad Sci U S A. 2001 Sep 11;98(19):10869-74.
Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.
Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Eystein Lønning P, Børresen-Dale AL.
Clin Cancer Res. 2004 Aug 15;10(16):5367-74.
Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma.
-
Nielsen TO,
Hsu FD,
Jensen K,
Cheang M,
Karaca G,
Hu Z,
Hernandez-Boussard T,
Livasy C,
Cowan D,
Dressler L,
Akslen LA,
Ragaz J,
Gown AM,
Gilks CB,
van de Rijn M,
Perou CM.
It is ok to call metaplastic carcinoma with squamous differentiation. I favor the diagnosis of invasive ductal carcinoma with basal-like phenotype. Of cause your dx should depend on the usual way the surgens know. Medullary carcinoma is really rare you make the dx based on the strict criteria.
Bottomly all these three are the same. They may represent the same process in the different sides. Basically they are triple negative (ER/PR/Her2), positive for ck5/6 (infact CK5 better), ck14, ck17, and EGFR. If the tumor show more squamous differentiation, spidle shaped cells. Metaplastic carcinoma with squamous differentiation is a good call. Otherwise it should call IDC with basal-like phenotype. Medullary carcinoma and basal-like carcinoma share almost all the mophologic (pushing edges, high grade cytology, and lymphocyte infiltrate, et al) and IHC features. Medullary ca may have more lymphocyte infiltrate, which indicates good prognosis. Some people now think medullary ca may be not present. I work in a large GYN/Breast center and we basically never diagnose medullary ca in the past few years. Patients and clinical physican always think that the prognosis of medullary ca is good. It may be not true. This is why we do not like the term-medullary ca.
Just for your reference, Thank, cqz
Sone papers related to basal-like ca
Med Mol Morphol. 2008 Jun;41(2):117-20. Epub 2008 Jul 1Basal-like carcinoma of the breast: further evidence of the possibility that most metaplastic carcinomas may be actually basal-like carcinomas.
Breast Cancer Res. 2007;9(1):R4
Basal-like grade III invasive ductal carcinoma of the breast: patterns of metastasis and long-term survival.
Breast Cancer Res. 2006;8(5):R58.
Gene expression signatures of morphologically normal breast tissue identify basal-like tumors.
Finak G,
Sadekova S,
Pepin F,
Hallett M,
Meterissian S,
Halwani F,
Khetani K,
Souleimanova M,
Zabolotny B,
Omeroglu A,
Park M.
Proc Natl Acad Sci U S A. 2001 Sep 11;98(19):10869-74.
Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications.
Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Eystein Lønning P, Børresen-Dale AL.
Clin Cancer Res. 2004 Aug 15;10(16):5367-74.
Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma.
Nielsen TO,
Hsu FD,
Jensen K,
Cheang M,
Karaca G,
Hu Z,
Hernandez-Boussard T,
Livasy C,
Cowan D,
Dressler L,
Akslen LA,
Ragaz J,
Gown AM,
Gilks CB,
van de Rijn M,
Perou CM.
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