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Slide Seminar
BREAST PATHOLOGY [SS-12]
The many faces of basal-like cancers

September 4th, 14.00-16.00 Auditorium VIII
Chairpersons: Isabel Amendoeira (Portugal) and ZsuzsannaVarga (Switzerland)
Case 1
Presented by: Ales Ryska, Hradec Kralove, Czech Republic

A 49-year-old female with non-palpable breast tumor in the upper outer quadrant of her right breast diagnosed on screening mammography. The tumor had 12 mm in largest diameter and showed an unsharp margin. Attempts for fine needle aspiration cytology and core cut biopsy were both non-diagnostic. Therefore, breast conserving surgery with removal of the specimen 40x30x30 mm was performed, material was send for pathological examination. The tumor was solid, whitish, uncircumscribed, localized close to the nearest resection margin (<1 mm). After the final diagnosis was made, partial mastectomy and axillary lymph nodes dissection followed by radiation therapy and 6 cycles of systemic adjuvant chemotherapy was done. Ten years after initial diagnosis, the patient is disease free and well.
Virtual slide HEp63CD10p53CK18
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Case 2
Presented by: Erika Resetkova , Houston, United States

A 29-year-old woman with palpable mass located in the posterior aspect of the right breast and small pea-sized peripheral nodules. US-guided core needle biopsy of the larger posterior mass was performed. On a subsequent excisional specimen, grossly two lobulated masses (1.3 and 0.8 cm in greatest dimension) were identified. Tumor was negative for breast prognostic/predictive markers. Sentinel lymph nodes were also negative. The patient is disease free ten years after initial diagnosis.
Slide 1H&E, low power magnification, 4xH&E, high power magnification (20x)
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Case 3
Presented by: Saudade André, Lisboa, Portugal

Woman, post-menopausal, 56 years, presented with a palpable lump with 5cm and with skin retraction, in the right breast. No personal or familial antecedents of breast pathology were documented. A biopsy was performed.
Slide 1
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Case 4
Presented by: Gábor Cserni, Kecskemét & Szeged, Hungary

• 47-year-old female with palpable nodule in the right breast, more likely to be benign on the basis of physical examination and mammography.

• R3 U4 (Slightly irregular,14x11 mm)

• US-guided FNAC: C5 - could be correlated with imaging • Breast conserving surgery and sentinel lymph node biopsy - the slide is from the excision specimen.
Slide 1PAS-ABPAS-AB x400CK5 x400
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Case 5
Presented by: Isabel Amendoeira, Porto, Portugal

77 year-old woman presenting with a well defined nodule on the central portion of the right breast, BI-RADS 5. A core-needle biopsy was performed followed by a mastectomy with sentinel node biopsy.

Macroscopy: a 27mm circumscribed tumour, whitish and compact with some microcysts, 30mm from the nipple.

Histology: the tumour has an expansive growing pattern mainly surrounded by fibrous tissue and it is composed by solid and glandular/pseudoglandular components. The cells are small, myoepithelial and epithelial cells, polarized around two types of spaces - glandular or pseudolumina. The true glandular spaces are surrounded by luminal cells and contain neutral mucin (PAS positive); the pseudolumina are stromal spaces filled by cylinders of hyaline material, surrounded by basal/myoepithelial cells; these spaces stain for Alcian Blue and collagen IV. The cells in the solid areas and around the cylinders stain for p63, smooth-muscle actin as well as for high-molecular-weight keratins. Cells around the lumina stain for low-molecular-weight keratin (for example keratin 7), as well as for CD117. On the cystic component, squamous metaplasia can be observed. Focally mainly in the solid areas the cells are bigger with evident nucleoli and the mitotic index is higher. Necrotic foci can be observed.

The tumour is negative for ER, PR and HER2.

The two sentinel nodes removed were negative.

The patient had no additional treatment and at one year of follow-up is alive with no evidence of disease.
Slide 1CD117CK7P63 .jpg
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Case 6
Presented by: Zsuzsanna Varga, Zurich, Switzerland

A 26 years-old patient presented with a circumscribed mass lesion of the breast. The lesion was approximately 15 mm on ultrasonography and on mammography. Surgical excision of the lesion was performed without preoperative core- or vacuum biopsy clarification of the lesion.

Stains: HE, S100, Coll IV, Calponin, ER
HE low-powerHEHEHE high powerS100Collagen type IVCalponin
p63ER
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