Breast

Other carcinoma subtypes, WHO classified

Cribriform carcinoma - invasive



Last author update: 19 October 2022
Last staff update: 19 October 2022

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PubMed search: Cribriform carcinoma breast

Arundhathi Shankaralingappa, M.B.B.S., M.D.
Sunitha Shankaralingappa, M.B.B.S., M.D., D.M.
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Cite this page: Shankaralingappa A, Shankaralingappa S. Cribriform carcinoma - invasive. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastmalignantcribriform.html. Accessed December 3rd, 2022.
Definition / general
  • Low grade invasive breast carcinoma microscopically characterized by a predominant cribriform pattern
  • By WHO classification, a specific subtype of invasive breast carcinoma
  • Variants:
    • Pure: cribriform architecture is > 90% of the tumor
    • Mixed: tumor composed of 10 - 90% of another morphological type (other than tubular carcinoma)
Essential features
  • Invasive breast carcinoma with > 90% of tumor composed of cribriform islands of malignant epithelial cells
  • Low grade nuclei and sparse mitosis (grade 1)
  • ER+ and HER2-
Terminology
  • Invasive cribriform carcinoma (ICC)
ICD coding
  • ICD-O: 8201/3 - cribriform carcinoma, NOS
  • ICD-10: C50.9 - malignant neoplasm of breast of unspecified site
  • ICD-11: 2C60 & XH1YZ3 - carcinoma of breast, specialized type & cribriform carcinoma, NOS
Epidemiology
Sites
  • Breast
  • Axilla - accessory breast tissue
Pathophysiology
  • Luminal A molecular pathway / subtype of breast cancer (Cell Genom 2021:1;100067)
  • Expresses hormone receptors and lacks HER2 overexpression
Etiology
  • Unclear
Clinical features
Diagnosis
  • Breast imaging including mammogram and ultrasound of breast
  • Cytologic or histologic examination of involved tissue
Radiology description
  • Mammogram: density, asymmetry, spiculated mass, microcalcifications
  • Ultrasound: mass
  • MRI: enhancing focus or mass
Radiology images

Images hosted on other servers:

Mammogram: 2.5 cm tumor, fuzzy border

Prognostic factors
  • Pure ICC: excellent; usually less lymph node metastasis and lower stage
  • Mixed ICC: prognosis poorer than pure but better than invasive ductal carcinoma of no special type (IDC, NST)
  • Lymph node / distant metastasis is rare (BMC Cancer 2021;21:168)
  • ICC: more favorable prognosis than invasive breast carcinoma with less cribriform pattern and low grade IDC (J Clin Exp Pathol 2013;6:445)
Case reports
Treatment
  • Primary surgical excision
  • Postsurgical local radiation therapy (typically in the setting breast conserving therapy only for this special subtype of breast carcinoma)
  • Endocrine therapy
Gross description
Microscopic (histologic) description
  • Irregular cribriform growth pattern > 90% of cells
  • Nuclear grade I pure ICC: > 90% cribriform pattern
  • Mixed: 10 - 90% other morphological type, other than tubular carcinoma
  • Low grade: Nottingham grade 1 tumors
  • Invasive islands or nests of malignant cells with round or angulated contours and well defined cribriform spaces formed by arches of epithelial cells; this gives a sieve-like appearance
  • Tumor cells: small, mild / moderate pleomorphism, no nuclear atypia
  • No / sparse mitotic activity
  • Desmoplastic stroma
  • Mucin positive secretion, microcalcifications in lumen
  • Osteoclastic giant cells may be seen
  • Myoepithelial cells absent
  • Associated with cribriform ductal carcinoma in situ (DCIS)
    Microscopic (histologic) images

    Contributed by Sunitha Shankaralingappa, M.B.B.S, M.D., D.M.
    Invasive cribriform carcinoma

    Epithelial cells in cribriform pattern

    Pure ICC

    Pure ICC

    Low grade, cribriform pattern, mucin

    Low grade, cribriform pattern, mucin

    Low grade nuclei

    Low grade nuclei

    Cribriform carcinoma with cribriform DCIS

    Cribriform carcinoma with cribriform DCIS


    Cribriform DCIS with invasive component

    Cribriform DCIS with invasive component

    Cribriform DCIS

    Cribriform DCIS

    IHC- ER strongly positive

    IHC: ER strongly positive

    IHC- PR strongly positive

    IHC: PR strongly positive

    IHC- HER2 negative

    IHC: HER2 negative

    Virtual slides

    Images hosted on other servers:

    Cribriform (> 90%), grade I, desmoplastic stroma

    Cytology description
    • Cytologic features and limitations
      • 3D clusters and cohesive sheets of bland ductal cells, cribriform pattern (Acta Cytol 2001;45:593)
      • Naked bipolar nuclei and myoepithelial cells are absent
      • Definitive diagnosis on cytology is rare; core needle biopsy is preferred
    Cytology images

    Images hosted on other servers:

    Large sheets, cribriform architecture

    Positive stains
    Negative stains
    • HER2
    • Myoepithelial markers: distinguish ICC from cribriform DCIS
    Electron microscopy description
    Sample pathology report
    • Breast, right, modified radical mastectomy
      • Invasive cribriform carcinoma, grade 1, measuring 1.5 cm
      • Immunohistochemical biomarker results: estrogen receptor positive (90%, strong intensity), progesterone receptor positive (50%, moderate intensity), HER2 negative (score 0).
    Differential diagnosis
    Board review style question #1

    A 62 year old woman underwent core needle biopsy for a lump, 1.2 cm in diameter, detected on mammogram. The histopathology pattern is shown above. Which statement is true regarding this tumor?

    1. Has a greater chance of distant metastasis
    2. Lesion is high grade
    3. Strong and diffuse positivity for ER
    4. Strongly positive (3+) for HER2 by IHC
    Board review style answer #1
    C. Strong and diffuse positivity for ER. This biopsy shows cribriform carcinoma. This type of breast carcinoma is seen in elderly, postmenopausal women and most often detected on mammogram. It is strongly positive for ER and usually positive for PR, while HER2 negative. It is a low grade tumor with Nottingham grade I, with a good prognosis and lower frequency of lymph node and distant metastasis.

    Comment Here

    Reference: Cribriform carcinoma
    Board review style question #2
    Which of the following is one of the diagnostic criteria for invasive cribriform carcinoma of the breast?

    1. < 50% component of tubular carcinoma
    2. ER, PR, HER2 negative
    3. At least 90% of tumor composed of cribriform islands with low grade nuclei
    4. Presence of myoepithelial cells on IHC
    Board review style answer #2
    C. Nuclear grade I in at least 90% of cells. Invasive cribriform carcinoma (ICC) is an infiltrating breast carcinoma with predominantly cribriform pattern. It is pure when > 90% of tumor is of cribriform pattern. It is termed mixed ICC when the other invasive component constitutes 10 - 90%. It is a low grade tumor with grade I nuclei and sparse mitotic activity. It is differentiated from cribriform DCIS by absence of myoepithelium. ICC is a luminal A molecular subtype of breast carcinoma and expresses hormone receptors and lacks HER2 overexpression.

    Comment Here

    Reference: Cribriform carcinoma
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