P63, CD34, and SMA Staining Patterns at a Case of Mixed Type Tubular Carcinoma of the Breast
Hacer Ece Arslan Ozcan.
Abstract Tubular carcinoma (TC) is a rare variant of invasive ductal adenocarcinoma in the breast and it could be mixed type. Tubular, micropapillary, and mucinous carcinoma are grouped at same molecular subtype, as luminal. Radial scar/complex sclerosing lesion (RS/CSL) is important at diagnostic differentiation, because of to being a benign lesion. However, it could be coexistence with in situ, invasive adenocarcinoma or other atypical lesions. The differential diagnosis is based on terminoductal lobular unit organization, distribution and shape of acini or tubules, complicity of basal membrane and myoepithelial cells (MECs). Progression from benign to invasive carcinoma is found meaningful with loss of p63 synthetized from MECs. On the other hand, differences of periductal, periacinar and peritubular stromal CD34(+) fibrocytes and smooth muscle actin (SMA)(+) myofibroblasts are analyzed to determine malignancy. Especially, loss of CD34(+) fibrocytes are over expanded for breast carcinoma in a lot of reports. The case was 60-year-old female and her lesion was localized in the left breast. It was 3 cm diameter and properties of mixed type TC with hematoxylin and eosin (H and E) stain. However, differential diagnosis of RS/CSL was necessity. Lesion was conformed TC by H and E staining in terms of diameter, tubular or aciner distribution and shaped, epithelial properties, loss of polarization, direct connection of stroma-tubular structures, fibroelastotic stroma, and intraneural invasion. In addition, a lot of in situ, and atypical papillary areas, these are ductal carcinoma in situ (DCIS), flat epithelial atypia (FEA)-columnar cell lesions (CCLs), sclerosing atypical intraductal papilloma, were present. Histomorphology was supported largely by immunohistochemical analyses. MECs were absent by p63, and CD34 fibrocytes were lost surrounding the atypical tubules. In pre-invasive group lesions, p63(+) MECs were incompleted, and periductal stromal CD34(+) fibrocytes were decreased to comparing near the benign lesions. Adenosis and apocrine metaplasia were other lesions. MECs were completed by p63. CD34(+) fibrocytes were diffuse and strong stained surrounding these lesions. This lesion was localized in the breast and it has benign, in situ, pre-invasive, and invasive areas. The case was interpreted as mixed type TC, that was coexistent with micropapillary type DCIS, diffuse CCLs-FEA, and focal sclerosing atypical intraductal papilloma. As a consequence, stromal CD34(+) fibrocytes were decreased and lost with to increasing malignant properties, so it is an important helper for to determining pre-invasive lesions, such as FEA, in mixed lesions. Differences of SMA(+) myofibroblast were could not discriminator for benign, in situ, and invasive areas or zonal properties of stroma under the light microscopy.
Hacer Ece Arslan Ozcan. P63, CD34, and SMA Staining Patterns at a Case of Mixed Type Tubular Carcinoma of the Breast. www.scopemed.org/?mno=246282 [Access: June 28, 2017]. doi:10.5455/jihp.20170325081105