Breast malignant, males, children - Carcinoma with choriocarcinomatous features

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Breast malignant, males, children

Carcinoma subtypes

With choriocarcinomatous features

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 4 October 2012, last major update October 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.
PubMed Search: breast choriocarcinomatous
Broken links/comments: click here or email CopyrightPathOut@gmail.com, subject=breastmalignantductalNOSchoriocarcinomatous

General
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● Rare tumor (< 50 cases reported) with choriocarcinomatous differentiation, first described in 1981 (Am J Surg Pathol 1981;5:773, Arch Pathol Lab Med 2011;135:1097)
● Histologic origin of syncytiotrophoblastic cells is unclear - most plausible theory is metaplastic process
● Part of WHO classification
● Often elevated serum beta-hCG (although nonspecific)

Case reports
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● Two cases (Ann Diagn Pathol 2004;8:74)
● Choriocarcinomatous and neuroendocrine features (Sao Paulo Med J 2001;119:154)

Clinical features
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● Rapidly growing palpable mass indistinguishable from conventional breast carcinoma
● Usually characterized by locally advanced disease and poor prognosis

Treatment
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● Usually surgical resection; chemotherapeutic regimen unclear since tumor is rare

Gross description
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● Tumor size ranges from 1-10 cm
● Cut surface may be hemorrhagic
● Skin ulceration may be present and correlates with size and advanced stage

Micro description
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● Markedly pleomorphic multinucleated choriocarcinomatous cells with abundant eosinophilic cytoplasm and occasional cytoplasmic vacuoles
● Associated with ductal carcinoma in situ, invasive ductal carcinoma, and frank metaplastic carcinoma with distinctive heterologous components or sarcomatoid areas

Micro images
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Multinucleated giant cells with atypical nuclei that are hCG+

Metaplastic carcinoma with areas of choriocarcinomatous differentiation

Metastatic choriocarcinoma to breast, for comparison

Cytology description
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● Abundant multinucleated giant cells with highly pleomorphic tumor cells in a hemorrhagic necrotic background (Acta Cytol 2008;52:99)

Positive stains
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● Giant cells: human placental lactogen, beta-hCG (Breast J 2002;8:244)

Negative stains
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● Giant cells: ER/PR (usually)

Differential diagnosis
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● Metastatic choriocarcinoma to breast: clinically history; no usual type breast carcinoma, no DCIS (AJR Am J Roentgenol 2005;184:S53)

End of Breast malignant, males, children > Carcinoma subtypes > With choriocarcinomatous features

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