Breast malignant, males, children

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Breast malignant, males, children

In situ carcinoma

Neuroendocrine DCIS

Reviewer: Dina Kandil, M.D. (see Reviewers page)
Revised: 8 November 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● DCIS in which 50% or more cells express neuroendocrine markers (Histopathology 2008;53:288)
● Regarded by some as DCIS with neuroendocrine features rather than a distinct type

Terminology
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● First described in 1985 (Histopathology 1985;9:21)
● Also called endocrine DCIS, intraductal or solid papillary carcinoma (Am J Surg Pathol 1995;19:1237)

Epidemiology
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● 7% of DCIS cases
● Mean age 70 years, usually > age 60 years (Zhonghua Bing Li Xue Za Zhi 2006;35:594)

Clinical
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● May have associated invasive component, either mucinous (colloid) or with neuroendocrine features (Am J Surg Pathol 1996;20:921)
● Presents as breast mass or nipple discharge (Am J Surg Pathol 1996;20:921)
● Associated with intraductal papilloma and pagetoid involvement by tumor cells
● Neuroendocrine markers are expressed in 67% of solid intraductal papillary carcinomas (Virchows Arch 2007;450:539)
● Almost all DCIS with spindle cells have neuroendocrine differentiation (Histopathology 2004;45:343)

Case reports
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● 68 year old woman with 1.5 cm breast nodule (Am Surg 2000;66:1163)
● 72 year old woman with breast mass (Case of the Week #45)

Micro description
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● Solid lobular growth, neuroendocrine-like festoons and rosettes and prominent fibrovascular septa
● Cells are polygonal, oval or spindled with abundant granular eosinophilic cytoplasm and bland ovoid nuclei
● Accumulation of basophilic intracellular mucin
● Often pagetoid spread and well developed vascular network
● Variable stromal sclerosis or signet ring cells
● Usually no necrosis

Micro images
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Case of the Week #45


Synaptophysin


Solid proliferation

Cribriform pattern

Small cells with dense, deeply stained amphophilic cytoplasm and uniform round nuclei

Focal Grimelius+ cells

Cytology description
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● Plasmacytoid tumor cells and arborizing papillary fronds (Cancer 2000;90:286)

Cytology images
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Various images

Virtual slides
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Two cases

Positive stains
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● Chromogranin, synaptophysin, neuron-specific enolase
● ER, PR (Histopathology 2004;45:343)
● Low Ki-67

Negative stains
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● p53, HER2

EM description
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● Dense core neurosecretory granules, larger mucigen granules

Differential diagnosis
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● Florid epithelial hyperplasia and papilloma; lacks the monomorphic cell population associated with DCIS, negative for neuroendocrine markers

End of Breast malignant, males, children > In situ carcinoma > Neuroendocrine DCIS

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