Central acellular carcinoma

Breast malignant, males, children
Carcinoma subtypes
Central acellular carcinoma

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 26 December 2016, last major update October 2012

Copyright: (c) 2001-2016, PathologyOutlines.com, Inc.

PubMed search: central acellular [title] carcinoma breast

Table of Contents

Cite this page: Central acellular carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantcentralacellular.html. Accessed July 14th, 2017.

Definition / general

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

Terminology

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

Clinical features

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)

Prognostic factors

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

Microscopic (histologic) description

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)

Microscopic (histologic) images

Images hosted on PathOut server:

Tumor with well circumscribed borders and central necrosis

Positive stains

S100, CK14, smooth muscle actin, p63 (myoepithelial phenotype likely due to aberrant differentiation, not a reflection of tumor histogenesis, Hum Pathol 1999;30:1134)
Ki67, p53 (Pathol Int 2008;58:26)
CK5 / 6 in surrounding ring of viable cells

Negative stains

ER / PR (94%), HER2

Differential diagnosis

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)