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Breast malignant, males, children

Carcinoma subtypes

Small cell carcinoma


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 29 October 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● Similar morphologically to lung tumor
● Diagnosis requires exclusion of other primaries or presence of DCIS
● Also known as oat cell carcinomas, high-grade neuroendocrine carcinoma, small cell undifferentiated carcinoma
● May arise as variant of metaplastic carcinoma or from multipotential stem cells capable of divergent differentiation (Surg Today 2008;38:734)
● Prognosis may not be as poor as previously thought (Am J Surg Pathol 2000;24:1231)

Epidemiology
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● Rare, usually ages 43-70 years

Case reports
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● 60 year old woman with multiple axillary nodal metastases (Arch Pathol Lab Med 2000;124:296)
● 61 year old woman with E-cadherin negative tumor (Am J Clin Pathol 2004;121:117)
● 64 year old woman (J Korean Surg Soc 2012;82:116)
● Merging with solid variant of adenoid cystic carcinoma (Pathol Res Pract 2005;201:705)

Treatment
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● Surgery, possibly chemotherapy (Breast Cancer 2009;16:68)

Gross description
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● Mean 3 cm, range 1-5 cm

Micro description
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● Typical small cell carcinoma features of scant cytoplasm, small (diameter of three lymphocytes) nuclei with finely granular, evenly distributed chromatin and absent or inconspicuous nucleoli
● Frequent mitoses
● Frequent crush artifact or nuclear streaming
● Infiltrative borders, lymphatic tumor emboli and necrosis
● Associated with invasive poorly differentiated carcinoma and lobular carcinoma
● Associated with small cell in situ carcinoma and high grade DCIS

Micro images
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Classic features


Immunostains

Lung:

Classic features  H&E, CD117    Flow, H&E and stains (site unknown)

Cytology description
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● Resembles small cell carcinoma of lung (Breast Cancer 2007;14:414)

Cytology images
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Clusters of monotonous neoplastic cells, some with nuclear molding

Positive stains
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● CK7, E-cadherin (100%, Am J Surg Pathol 2001;25:831)
● ER or PR (35-50%, Semin Oncol 2007;34:64)
● BCL2, TTF1 (20%)
● Variable neuroendocrine staining (neuron specific enolase, synaptophysin, chromogranin)
● May have basal-like phenotype due to expression of EGFR and basal type keratins (Int J Surg Pathol 2009;17:368), or “triple negative” pattern (Med Mol Morphol 2009;42:58)

Negative stains
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● CK20, HER2

Molecular description
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● Small study shows similar genetic changes as both invasive ductal carcinoma and lung small cell carcinoma (Hum Pathol 2001;32:753)

Differential diagnosis
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Invasive lobular carcinoma: single file or targetoid patterns, cells have low grade features with occasional intracytoplasmic vacuoles, no nuclear molding and are E-cadherin negative
Metastatic tumor from lung or elsewhere: see Diagn Cytopathol 2009;37:208

Additional references
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Stanford University, J Clin Pathol 2005;58:775

End of Breast malignant, males, children > Carcinoma subtypes > Small cell carcinoma


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