Breast malignant, males, children - Histiocytoid variant of lobular carcinoma

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Breast malignant, males, children

Carcinoma subtypes

Histiocytoid variant of lobular carcinoma

Reviewer: Monika Roychowdhury, M.D., (see Reviewers page)
Revised: 15 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Diffuse growth of tumor cells with abundant granular, foamy (vacuolated) cytoplasm and small bland nuclei
● First described by Hood et al (Cancer 1973;31:793)

Terminology
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● Also called myoblastomatoid variant of lobular carcinoma

Clinical features
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● Metastases may appear before diagnosis of primary tumor
● May metastasize to eyelid
● May be a variant of apocrine carcinoma (Am J Surg Pathol 1995;19:553)

Case reports
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● 68 year old man with 2.5 cm mass (Ann Diagn Pathol 2011;15:190)
● 93 year old woman with erythematous breast (Arch Pathol Lab Med 2003;127:1626)
● Histiocytoid metastases at autopsy (Arch Pathol Lab Med 1986;110:759)
● Triple negative case (Breast J 2010;16:84)

Micro description
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● Diffuse growth of tumor cells with abundant granular, foamy (vacuolated) cytoplasm and small bland nuclei
● Resembles histiocytes or granular cell tumor

Micro images
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Tumor cells have abundant cytoplasm and vesicular nuclei, resembling histiocytes

Fig A: LCIS (arrows) and large cells in single file with focal targetoid growth, inset and
Fig B: finely granular pale pink cytoplasm; inset: intracytoplasmic lumina
Fig C: tumor infiltration of fat mimics fat necrosis, inset: GCDFP-15+
Fig D: E-Cadherin in LCIS and invasive tumor

Figures 1-2: H&E and stains

Cytology description
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● Loosely cohesive tumor cells with abundant foamy to granular cytoplasm and bland nuclei (Pathol Int 2005;55:353)

Positive stains
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● GCDFP-15, mucicarmine, keratin, EMA
● Also PAS, ER, PR

Negative stains
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● E-cadherin, Oil red O (fresh tissue), CD68
● Lysozyme, S100, HER2

Differential diagnosis
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● Granular cell tumor: PAS+ cytoplasmic granules
● Histiocytoma: no atypia, histiocytes are CD68+, keratin-
● Lipid rich carcinoma: infiltrating ductal carcinoma with lipid in tumor cytoplasm, no mucin, very rare
● Xanthelasma: lipid filled cells, often in eyelid
● Xanthoma: no atypia

Additional references
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● Pathol Int 1998;48:549, Histopathology 1989;14:515, J Clin Pathol 2011;64:654, Stanford University

End of Breast malignant, males, children > Carcinoma subtypes > Histiocytoid variant of lobular carcinoma

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