Medullary carcinoma – breast – Histopathology.guru

MEDULLARY CARCINOMA OF BREAST

Medullary carcinoma represents 5 to 7% of invasive breast carcinoma
It is considered as variant of ductal carcinoma
Mean age of presentation is 45 -54 years. Patients are relatively younger than ductal carcinoma NOS
Mammographically – well circumscribed nodule
Gross features
- Tumor is soft and fleshy like marrow, hence the term medullary (Medulla is Latin word for marrow)
- Smaller size of 2 to 3 cms
- Well circumscribed with distinct margins often resembling benign lesion clinically and mammographically
- Haemorrhage and necrosis are rarely present

· Microscopic features
- Five classical diagnostic features of Medullary carcinoma are
  - Syncytial growth pattern (sheet like) in greater than 75% of tumor area
  - Moderate to marked lymphoplasmacytic infiltrate in the stroma. Predominantly T lymphocytic infiltrate is present
  - Tumor cells with high nuclear grade and indistinct cell borders
  - Noninvasive microscopic circumscription – pushing smooth borders instead of infltrating margins
  - High mitotic rate

Medullary carcinoma: Syncitial sheets of tumor cells with peripheral lymphocyte infiltrate (H&E,X50)

Medullary carcinoma: Syncitial sheets of tumor cells with peripheral lymphocyte infiltrate (H&E,X100)

Medullary carcinoma: Circumscribed tumor with tumor cells arranged in sheets and nests. Periphery of the tumor shows lymphocytic infiltrate (H&E,X50)

Medullary carcinoma: Tumor cells are arranged in cords. Interstitial stroma shows lymphocytic infiltrate (H&E,X100)

Medullary carcinoma: Sheets of tumor cells with hyperchromatic nuclei with nucleoli and indistinct cell borders. Interstitial stroma shows lymphocytic infiltrate (H&E,X100)

Medullary carcinoma: Sheets of tumro cells having pleomorphic round to oval vesicular nuclei with nucleoli and moderate amount of cytoplasm. Interstitial stroma shows lymphocytic infitrate (H&E,X400)

Medullary carcinoma: Tumor cells having hyperchromatic nuclei of varying sizes. Mononucleated and multinucleated tumor giant cells are present. Interstitial stroma shows lymphocytic infiltrate (H&E,X400)

Medullary carcinoma: Spindling of tumor cells having hyperchromatic nuclei of varying sizes and shapes. Interstitial stroma shows lymphocytic infiltrate (H&E,X100)

Medullary carcinoma: Tumor cells having round to oval nuclei with prominent nucleoli. Multinucleated tumor giant cells are present (H&E,X400)

Medullary carcinoma: Tumor cells arranged in syncytial pattern with peripheral lymphocytic infiltrate (H&E,X50)

Medullary carcinoma: Tumor cells arranged in syncytial pattern with peripheral lymphocytic infiltrate (H&E,X100)

Medullary carcinoma: Tumor cells showing pleomorphism with peripheral lymphocytic infiltrate (H&E,X100)

Medullary carcinoma: Tumor cells showing pleomorphism with peripheral lymphocytic infiltrate (H&E,X200)

Medullary carcinoma: Tumor cells showing pleomorphism with peripheral lymphocytic infiltrate (H&E,X400)

Immunohistochemistry
- Tumor cells are P53 positive and HER2/neu negative tumors
- 90% of tumors are ER negative. Only 10% are ER and PR positive

· Treatment and Prognosis
- Good prognosis
- Treatment is modified radical mastectomy
- The only prognostic factor is axillary lymph nodal status.

References :

1. Robbins and Cotrans: Pathologic basis of diseases.8th edition

2. Fattaneh A Tavassoli, Vincenzo Eusebi. Tumors of mammary gland. AFIP Atlas of tumor pathology. Series 4