Invasive breast carcinoma - IARC

Glycogen–rich, clear cell
carcinoma (GRCC)
Definition
A carcinoma in which more than 90%
of the neoplastic cells have abundant
clear cytoplasm containing glycogen.
ICD-O code 8315/3
Synonyms
Clear cell carcinoma 8310/3
Glycogen-rich carcinoma 8315/3
Epidemiology
The frequency is from 1-3% of breast carcinomas
{880,1264}, with an age range
of 41-78 years, median 57 years {2870}.
Clinical features
These tumours show similar presentation
features to ductal NOS carcinoma.
Macroscopy
The clear cell glycogen-rich carcinoma
does not differ grossly from that of usual
invasive or intraductal carcinoma {1165}.
The neoplasm ranges from 1 to 8 cm in
size {2422,2754,2870}.
Histopathology
A strict definition for clear cell glycogenrich
is necessary for two re a s o n s .
C a rcinomas in the breast with a clear cell
appearance are uncommon and are due
to an artefact produced by extraction of
intracytoplasmic substances during tissue
processing. However, as the substances
that are extracted diff e r, they may
be of diff e rent biological significance. In
addition, intracytoplasmic glycogen has
been observed without significant clear
cell in 58% of breast carcinoma {880}.
The lesions usually have the structural
f e a t u res of intraductal and infiltrating
ductal neoplasms but rarely those of lobular,
medullary or tubular types have
been noted. GRCCs has either circumscribed
or infiltrative borders {880,165,
2754,2870}.
The in situ component, either in the
p u re form or in association with most
invasive cases has a compact solid,
comedo or papillary growth pattern .
The invasive tumour is generally composed
of solid nests, rarely of tubular or
p a p i l l a ry structures.
The tumour cells tend to have sharply
defined borders and polygonal contours.
The clear or finely granular cytoplasm
contains PAS positive diastase labile
glycogen. The nuclei are hyperc h ro m a t i c ,
with clumped chromatin and pro m i n e n t
n u c l e o l i .
Differential diagnosis
To differentiate this tumour from other
clear cell tumours, including lipid rich
carcinoma, histiocytoid carcinoma, adenomyoepithelioma,
clear cell hidradenoma
and metastatic clear cell carcinoma
( p a rticularly of renal origin), enzyme
c y t o c h e m i s t ry and immunohistochemistry
are useful {702,1165,1549,2754}.
Immunoprofile
Hormone receptor status is similar to
ductal NOS {880}.
Prognosis and predictive factors
Most reports suggest that GRCC is more
aggressive than typical ductal carcinoma
{2313,2754}. The incidence of axillary
lymph node invasion is significantly higher
than in the other non-GRCC forms
{1264}. The histologic grade is intermediate
to high with a paucity of grade I
tumours {1165}.
Although follow up studies confirm that
disease free and overall survival is significantly
worse in GRCC, due to the low
incidence, there are no multiparametric
analyses to compare GRCC stage by
stage with the other histological types of
breast carcinoma.
Sebaceous carcinoma
Definition
A primary breast carcinoma of the skin
adnexal type with sebaceous diff e re n t i a-
tion. There should be no evidence of derivation
from cuteneous adnexal sebaceous
glands.
ICD-O code 8410/3
Epidemiology
Only 4 examples of this rare mammary
tumour have been observed {2876}. The
women, three of whom were white, were
aged 45-62 years {2876,3006}.
Clinical features
All the patients presented with a palpable
mass.
Macroscopy
The tumours range in size from 7.5-20
cm. The margins are sharply delineated,
and the cut surface is solid and bright
y e l l o w.
A
Fig. 1.62 Glycogen-rich carcinoma. A Cells with abundant clear cytoplasm and relatively uniform round nuclei grow in a solid pattern supported by branching
vessels. B Note transition from typical ductal epithelial cells to clear cells in a duct adjacent to the invasive carcinoma.
B
46 Tumours of the breast