Breast malignant, males, children - Lipid rich carcinoma

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Breast malignant, males, children

Carcinoma subtypes

Lipid rich carcinoma

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 10 October 2012, last major update October 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● 90%+ cells have prominent intracytoplasmic neutral lipid

Clinical description
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● 1-2% of breast carcinomas
● Axillary metastases may resemble histiocytes

Treatment
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● Poor prognosis due to frequent (70%) nodal metastases at presentation

Case reports
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● 53 year old woman (Acta Chir Belg 2008;108:115)
● 55 year old man (Pathology 1995;27:280)
● 56 year old woman with focal chondroid metaplasia in tumor (Pathol Int 1998;48:912)
● 62 year old woman (Arch Pathol Lab Med 2003;127:e396)
● 78 year old woman with solid alveolar pattern in tumor (Breast Cancer 1998;5:171)

Gross description
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● Lobulated, variable circumscription, firm
● 1 to 15 cm

Micro description
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● Nests, cords and sheets of large polygonal cells with foamy or vacuolated cytoplasm containing lipid
● May resemble clear cells or lipoblasts
● Irregular nuclei with coarse chromatin, moderate atypia, prominent nucleoli
● Other patterns are large pleomorphic cells in alveolar pattern with hobnail appearance, oncocytic or apocrine-type change

Micro images
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Low power and high power

Fig 1: tumor with pushing borders and lymphoplasmacytic and eosinophilic infiltrate (arrow: high grade comedo DCIS)
Fig 2: tumor composed of sheets and cords of large polyhedral cells with ill-defined borders, fine granular, eosinophilic
cytoplasm and large nuclei with prominent nucleoli and coarse chromatin
Fig 3: also large clear cells with foamy or vacuolated cytoplasm
Fig 4: axillary nodal metastasis

Polygonal tumor cells with distinct cell borders and variable cytoplasmic clearing (AFIP)

Positive stains
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● Lipid stains (Sudan black, Oil red O on fresh tissue)
● HER2 (71%+, Tumori 2008;94:342, Ann Diagn Pathol 2011;15:225)

Negative stains
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● Glycogen (PAS)
● Mucin
● Usually ER, PR
● CK5/6, CK14, p63

Electron microscopic description
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● Numerous intracytoplasmic non-membrane bound lipid droplets, often within autophagocytic vacuoles
● No evidence of lipid synthesis by rough ER or Golgi complexes (Virchows Arch A Pathol Anat Histopathol 1988;413:381)

Electron microscopic images
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Luminal microvilli, lipid droplets and mitochondria

Differential diagnosis
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● Apocrine carcinoma: uniformly granular and eosinophilic cytoplasm, GCDFP15+, no lipid
● Glycogen-rich carcinoma: clear cytoplasm, secretions are glycogen (PAS+), not lipid
● Oncocytic carcinoma: granular and markedly eosinophilic cytoplasm, no lipid
● Secretory carcinoma: low grade, PASd+ secretions, no lipid
● Xanthogranulomatous mastitis (on core biopsy): not invasive, cells are CD68+, alpha-1-antitrypsin+ histiocytes (Pathol Int 2009;59:234)

Additional references
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● Stanford University

End of Breast malignant, males, children > Carcinoma subtypes > Lipid rich carcinoma

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