Case 1 - Click here for Text and References
Submitted by: Donald L. Weaver
Clinical Summary:
A 68 year old woman self-detected a right lower outer quadrant breast mass. The core biopsy demonstrated and exclusively spindle cell neoplasm. On excision, the 2.5 cm mass was solid and partially cystic.
Case 1 - Slide 1
Low-magnification overview of the lesion, periphery of the 2.5 cm solid and cystic mass.
High-magnification view of upper right portion of Figure 1. Note there are two populations of epithelial cells differentiated by their cytoplasm: eosinophilic or cleared. The back-to-back configuration of some glands and focal central cellular necrosis indicates transformation to carcinoma-in-situ or at least atypical ductal hyperplasia.
High-magnification p63 immunostain of upper left portion of Figure 1. The expanded spindle cell proliferation around and between the glands exhibits myoepithelial differentiation.
High-magnification p63 immunostain of upper right portion of Figure 1. This is the same region as shown in Figure 2. The polygonal cells with cleared cytoplasm exhibit myoepithelial differentiation.
Intermediate-magnification view of lower right portion of Figure 1. Note transition from glandular epithelial cells with dense cytoplasm to polygonal cells with cleared cytoplasm to spindled cells.
High-magnification view of lower right portion of Figure 1. Note the malignant characteristics of the spindle cells.
Representative section of the solid and cystic mass.
Intermediate magnification p63 immunostain of spindle cell proliferation in figure 7.
Case 2 - Click here for Text and References
Submitted by: Celina G. Kleer
Clinical Summary:
This is a a 32 year old woman with a 0.7 cm circumscribed lesion on mammography. Four years ago, she underwent a breast biopsy which revealed an intraductal papilloma. The patient has history of juvenile rheumatoid arthritis. She has no family history of breast cancer. An exicisional biopsy of the nodule was performed.
Case 2 - Slide 1
Case 3 - Click here for Text and References
Submitted by: Daniel Visscher
Clinical Summary:
A 48 year old woman who underwent excision of a 1.2cm stellate breast mass detected on imaging
Case 3 - Slide 1
Case 4 - Click here for Text and References
Submitted by: Erinn P. Downs-Kelly
Clinical Summary:
A 67 year old female was treated for left breast pT2 pN0 invasive ductal carcinoma, Bloom-Richardson grade II in 2007 with breast conservation including radiation therapy and systemic chemotherapy. Did well until presenting for her yearly follow-up in 2011 where she had noted a small area of bruising of the left breast that had seemed to get better but then reappeared. On physical exam, radiation changes were noted on the left along with a 5 mm area of patchy purplish discoloration. The images provided include the punch biopsy of the left breast.
Case 4 - Slide 1
Low power image with a suggestion of a vasoformative lesion with ectatic vessels within the upper dermis.
Medium power view where occasional stellate cells are noted within the dense collagen of the dermis. The ectatic vessels are lined by a single layer of cells, some of which appear hyperchromatic with a hobnail appearance.
High power image showing several atypical stellate shaped cells within the collagen that have a high nuclear to cytoplasmic ratio and prominent nucleoli.
An immunohistochemical stain for ERG highlights the recognizable endothelial cells lining the ectatic vessels and is also immunoreactive within the atypical stellate shaped stromal cells confirming that they are endothelial.
An immunohistochemical stain for MYC shows strong nuclear immunoreactivity within these atypical endothelial cells while the majority of the endothelial cells within the ectatic vessels are negative.
High power image of an immunohistochemical stain for ERG with immunoreactivity within the atypical stellate shaped stromal cells.
High power image of an immunohistochemical stain for MYC showing strong reactivity within the atypical endothelial cells.
Fluorescence in situ hybridization for assessment of MYC copy number. Several tumor cell nuclei are present within this field that have multiple copies of the MYC gene (red signal); the aqua signal represents the CEP8 probe which serves as a control for the copy number of chromosome 8.
Case 5 - Click here for Text and References
Submitted by: Fattaneh A. Tavassoli
Clinical Summary:
An 83-year-old woman presented with a right breast nodule. The slide is from the area of nodularity.
Case 5 - Slide 1