Breast Cancer - Arab Medical Association Against Cancer

Pathology and methods of analysis 86Adenoid Cystic CarcinomaIn this histologic subtype, a cribriform pattern is seen with rounded hyaline spacesenclosed in between cellular masses. It associated two cell components oneexpressing cytokeratin the other actin. Perineural invasion is a peculiar feature tothis pattern of growth. Generally, this type of neoplasm exhibits a slow rate ofgrowth and a favorable prognostic outcome.Lipid Rich CarcinomaThis histologic variant has a particularly unfavorable prognosis. Large tumor cellsexhibit lipid material, best demonstrated in frozen tissue materialJuvenile (Secretory) CarcinomaIt occurs primarily in children and adolescents. This neoplastic variant is highlydifferentiated exhibiting excessive PAS positive secretory products.Inflammatory CarcinomaThis type of breast carcinoma has been given a variety of terms such as mastitiscarcinoma, carcinoma mastitoides, or acute mammary carcinoma. It is consideredas the most malignant type of breast carcinomas, and of high proliferative activity(PEV 3). It represents 1% to 2% of breast carcinoma in Western literature,however, in Egypt, North Africa and Tunisia such mammary carcinoma is notuncommon. Characteristically, the skin of the breast is reddened, warm, edematousand thickened. During early stage, an underlying breast mass may not be palpable,and this may cause an erroneous diagnosis of inflammatory non-neoplastic process.Histologically, the skin dermis is filled with many lymphatic tumor cell emboli.Blocking of lymphatics causes skin edema.Clinical Versus Pathologic DefinitionThe criteria for clinical diagnosis of inflammatory carcinoma include diffuseerythemaedema extending to greater than two thirds of the breast, “peau d’orange”,tenderness, engorgement, and diffuse breast involvement. The pathologic diagnosisrequires the presence of tumor emboli in the dermal lymphatics, in addition to thepresence of invasive carcinoma with spontaneous necrotic foci. In majority ofcases, the clinical picture and the pathologic picture of dermal lymphaticinvolvement coincide. However, all patients with the clinical disease havedemonstrable dermal lymphatic involvement, and there are also cases with dermallymphatic involvement but without the clinical inflammatory features. It was foundthat clinically occult inflammatory carcinoma i.e. patients without clinical signs ofinflammatory carcinoma but with tumor emboli in the dermal lymphatics followed