Lipid-rich carcinoma of the breast: A report of two cases and a literature review

Abstract

Lipid-rich carcinoma of the breast is extremely rare with no standard guidelines for treatment with poor patient prognosis. In the present study, the clinical features, imaging results, pathology, immunohistochemistry, treatment and prognoses of two patients with lipid-rich carcinoma of the breast were analyzed. Two patients were admitted to the Yantai Yuhuangding Hospital Affiliated to the Medical College of Qingdao University (Yantai, Shandong, China) for examination of a palpable mass in the breast. Enlarged lymph nodes were found in the axilla of each patient. The results of mammography and echography imaging suggested the presence of malignancy. A modified radical mastectomy was performed in each patient, and pathological examination revealed atypical large vacuolated cells arranged in clusters and confirmed lipid-rich carcinoma and lymph node metastases. The tumor tissue of patient one was immunohistochemically positive for estrogen receptor (ER), p53, p120 and E-cadherin, and negative for progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2), with a Ki-67 labeling index of 50%. The tumor tissue of patient two was immunohistochemically positive for p53, and negative for ER, PR, HER-2 and cytokeratin 5/6, with a Ki-67 labeling index of 30%. Post-surgery, patient one was administered chemotherapy for six cycles, radiotherapy and endocrine therapy in the form of anastrozole. Patient two was administered three cycles of chemotherapy without radiotherapy. Subsequent to being followed up for 25 months and 13 months, respectively, there was no evidence of recurrence or distant metastasis in patient one or two, respectively.

Lipid-rich carcinoma of the breast that is strongly positive for estrogen receptor: a case report and literature review

“…Thus, chemotherapy including paclitaxel or platinum agents may have the potential to improve the prognosis of recurrent LRC. On the other hand, because all LRCs except for two previously reported cases 13 , 14 have been ER negative, the effect of endocrine therapy on LRC has not been established. In the present case, endocrine therapy is expected to be effective because the tumor was strongly ER positive.…”

“…LRC cases reported in the English literature are summarized in Table 1 . 2 , 3 , 6 , 7 – 14 Guan et al 3 investigated the clinicopathological features of 17 patients with LRC and reported that none were ER positive, whereas one (5.9%) was PgR positive; however, all patients were HER2 positive. Shi et al 2 studied 49 cases of LRC and reported that none were ER positive, five (10.2%) were PgR positive, and 35 (71.4%) were HER2 positive.…”

“… 6 , 15 In addition, >30% of Ki-67-positive tumor cells were detected in 27 (55.1%) cases in the study by Shi et al 2 Moreover, LRC was ER negative in 12 of the 14 case reports. 5 , 8 – 14 Thus, all LRCs except for two cases 13 , 14 have been reported to be ER negative, and there has been a tendency for LRC to be HER2 positive and contain highly proliferative cells. Hence, the aggressiveness of LRC may be attributed to these biological features.…”

Invasive Lobular Carcinoma With Extensive Clear Cells: A Pitfall in Diagnosis

“…Lipid may be demonstrated by Oil Red O or Sudan stains on fresh tissue. 2 Apocrine carcinomas may have a clear cytoplasm. They may contain diastase-resistant PASpositive granules and are often GCDFP positive.…”

“…The differential diagnosis includes glycogen-rich clear cell carcinoma (GRCC), lipid-rich clear cell carcinoma, secretory carcinoma, myoepithelial carcinoma, apocrine carcinoma, metastatic renal cell carcinoma, perivascular epithelioid cell neoplasm (PEComa), clear cell sarcoma/malignant melanoma of soft parts, and other cutaneous clear cell neoplasms. [1][2][3][4][5][6][7][8][9][10] We report an interesting case of invasive lobular carcinoma with extensive clear cell morphology and discuss the differential diagnosis of clear cell neoplasms in the breast.…”