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Breast malignant, males, children

Breast cancer

Pregnancy related carcinoma

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 19 December 2012, last major update February 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Clinical description

● Estimated incidence of 1 case per 3,000 pregnancies
● Increasing incidence due to delay of childbearing (Obstet Gynecol 2009;114:568)
● Associated with higher stage and larger primary tumors than non-pregnancy associated tumors (Obstet Gynecol 2008;112:71)
● Similar features as breast carcinoma in other young women, and clinical course may not be as aggressive as initially reported (Cancer 2003;98:1055)
● Mammogram is less sensitive during pregnancy due to increased parenchymal density; ultrasound is best technique for evaluation of breast masses during pregnancy or lactation
● Diagnosis may be delayed (Cancer 2009;115:1174)
● Tumors usually contain rare fetal cells (Breast Cancer Res 2008;10:R14)

Treatment and prognosis

● Sentinel lymph node mapping can be performed safely (Breast J 2008;14:250, Ann Surg Oncol 2007;14:218)
● Wait until second trimester to use chemotherapy (Cancer 2006;106:237, Eur J Surg Oncol 2009;35:215), which should be anthracycline based
● Delay until after delivery use of anti-folate (methotrexate) and anti-estrogen drugs (tamoxifen, Expert Opin Pharmacother 2009;10:2259), radiotherapy and Herceptin / trastuzumab (associated with anhydramnios, Ann Oncol 2008;19:607)

Micro description/grading

● 80% high grade
● Cancerization of lobules in 79%

Micro images

Extensive cancerization of lobules

Lactation associated colloid carcinoma is MUC2+

Figures 1 and 2

Positive stains

● MUC2 (if during lactation)
● Variable HER2 (Virchows Arch 2003;443:44)

Negative stains

● Usually ER, PR, although these markers may underestimate tumor hormone dependence (Anticancer Res 2008;28:2447)

Molecular images

FISH shows cells from male fetuses within tumor

Additional references

Arch Pathol Lab Med 2000;124:1053, National Cancer Institute (US)

End of Breast malignant, males, children > Breast cancer > Pregnancy related carcinoma

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