Breast malignant, males, children - Central acellular carcinoma

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Breast malignant, males, children

Carcinoma subtypes

Central acellular carcinoma

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 1 October 2012, last major update October 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Not in WHO breast classification
● Aggressive behavior despite small size and minimal nodal involvement

Terminology
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● Also called invasive ductal carcinoma with large central acellular zone, ring carcinoma, central necrotizing carcinoma

Clinical description
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● Mean age 58 years, mean tumor size only 2.5 cm, but 28% had positive axillary nodes (central necrotizing carcinoma)
● 62% developed recurrence at median 16 months, 60% died at median 22 months from diagnosis (Am J Surg Pathol 2001;25:331)
● Lacks malignant features by mammography and ultrasound (Breast 2005;14:419)
● Metastases to lung and brain more common than usual (Am J Surg Pathol 2000;24:197)
● Considered a type of basal-like carcinoma (Histopathology 2010;57:193, Breast Cancer 2009;16:254)
● May be related to metaplastic carcinoma (Med Mol Morphol 2012;45:14)

Treatment and prognosis
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● Poorer prognosis than matched patients with poorly differentiated tumors containing less extensive necrosis

Microscopic description / grading
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● Well-circumscribed, solitary nodule with extensive central necrosis or collagen / hyaline deposition, constituting a majority of tumor volume, surrounded by a narrow rim of viable high-grade tumor cells (ring like hypercellular zone) with pushing border and minimal tubule formation
● Relatively sharp margin but infiltrative growth accompanied by eosinophilic intercellular matrix
● Abrupt transition between peripheral cellular and central acellular zones without alteration of cancer cell adhesion (Pathol Int 2009;59:390)

Micro images
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Tumor with well circumscribed borders and central necrosis

Positive stains
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● S100, CK14, smooth muscle actin, p63 (myoepithelial phenotype likely due to aberrant differentiation, not a reflection of tumor histogenesis, Hum Pathol 1999;30:1134)
● Ki-67, p53 (Pathol Int 2008;58:26)
● CK5/6 in surrounding ring of viable cells

Negative stains
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● ER/PR (94%), HER2

Differential diagnosis
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● Matrix producing carcinoma: expansive growth with basophilic and myxoid matrix, gradual transition from cellular to acellular areas with gradual loss of tumor cell adhesion (Pathol Int 2009;59:390)

End of Breast malignant, males, children > Carcinoma subtypes > Central acellular carcinoma

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