MEDULLARY CARCINOMA
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Medullary carcinoma represents 5 to 7% of invasive breast carcinomas
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It is considered as variant of ductal carcinoma
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Mean age of presentation is 45 -54 years. Patients are relatively younger than ductal carcinoma NOS
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Mammographically – well circumscribed nodule
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Gross features
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Tumor is soft and fleshy like marrow, hence the term medullary (Medulla is Latin word for marrow)
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Smaller size of 2 to 3 cms
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Well circumscribed with distinct margins often resembling benign lesion clinically and mammographically
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Haemorrhage and necrosis are rarely present
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Microscopic features
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Five classical diagnostic features of Medullary carcinoma are
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Syncytial growth pattern (sheet like) in greater than 75% of tumor area
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Moderate to marked lymphoplasmacytic infiltrate in the stroma. Predominantly T lymphocytic infiltrate is present
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Tumor cells with high nuclear grade and indistinct cell borders
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Noninvasive microscopic circumscription – pushing smooth borders instead of infltrating margins
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High mitotic rate
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- Microphotographs
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Immunohistochemistry
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Tumor cells are P53 positive and HER2/neu negative tumors
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90% of tumors are ER negative. Only 10% are ER and PR positive
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Treatment and Prognosis
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Good prognosis
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Treatment is modified radical mastectomy
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The only prognostic factor is axillary lymph nodal status.
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References :
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Robbins and Cotrans: Pathologic basis of diseases.8th edition
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Fattaneh A Tavassoli, Vincenzo Eusebi. Tumors of mammary gland. AFIP Atlas of tumor pathology. Series 4
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Robin Reid, Fiona Roberts, Elaine Mac Duff. Pathology Illustrated. 7th Edition 2011