See also Common Cancers
It is recommended that special types of carcinoma are graded using the same criteria as no specicial type cancers.
See also Grading Breast Cancer
See also Prognosis
Invasive carcinomas of special type:
- Invasive Lobular Carcinoma - classical pattern
- Invasive Tubular Carcinoma
- Invasive Mucinous Carcinoma
- Invasive Cribriform Carcinoma
- Invasive Medullary-like Carcinoma
- Other Invasive Carcinomas
Invasive lobular carcinoma
- 10% of all invasive cancers
- 90% Grade 2
- See also Lobular carcinoma variants
Invasive lobular carcinoma - classical pattern
Invasive Tubular Carcinoma
Clinical basics:
- 2% of all invasive cancers
- Frequently impalpable
- More common in screening population
- Usually detected as small stellate leions on mammograms
- When identified, review of previous mammograms may reveal the lesion, and show how slow growing it can be
- A small percentage of cases, probably < 2% will have axillary node metastases, often subtle
- Excellent prognosis
Histological diagnosis:
- May be difficult to distinguish from a radial scar - usually have a more crowded, less scarred, centre
- Radiating 'legs' with hyperplastic ducts much less of a feature in tubular carcinomas
- Glandular structures usually less 'pinched' in tubular carcinomas
- No bounding myoepithelial layer around tubular carcinoma glands - confirm with CK 5/6 or other myoepithelial immunostain
- Beware the radial scar that also harbours a tubular carcinoma - not that uncommon
Tubular carcinoma - the scale bar (lower right) is 1mm. Pass the mouse over this image for a high power view (arrows point to calcs).
Tubular carcinoma of breast (Example 2)
Invasive mucinous carcinoma
- 1% of all cancers
- May be pure or mixed pattern
- Excellent prognosis if pure
- Majority Grade 1 or 2
Mucinous carcinoma of breast
See also Mucocele-like lesion
Invasive Cribriform Carcinoma
- 1% of all cancers
- Masses of small regular cells similar to tubular carcinoma
- Cribriform appearance required in 90% + of tumour
- Apical snouts common
- Often combined with other carcinomas - most frequenty tubular
- Prognosis probably better (stage for stage)
Cribriform carcinoma of breast
Low power view (x 10) of invasive cribriform carcinoma (example 2).
Arrow points to luminal calc.
High power view (x 40) of cribriform carcinoma (example 2).
Note predominance of grade 1 nuclei -See also Grading Breast Cancer
Invasive Medullary-like Carcinoma
- Includes "Medullary" and "Atypical Medullary Carcinomas"
- Very uncommon in practice
- Pushing margins at low power
- Grade 3 features with syncitial (fused) cells lacking distinct cell borders
- Widespread lymphoid infiltrate
- Surrounding in situ elements very uncommon
Medullary-like Carcinoma - previously classified as classical medullary carcinoma
Medullary-like Carcinoma - previously classified as medullary variant carcinoma.
Note focally infiltrative margin
Other Invasive Carcinomas
These include:
- Metaplastic carcinoma - See Case of the month August 2007
- Apocrine carcinoma - See Case of the month August 2006
- Invasive micropapillary carcinoma - See Case of the month October 2006
- Adenoid cystic carcinoma
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Arrow points to luminal calc.
Note predominance of grade 1 nuclei -See also Grading Breast Cancer
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