Radiologic–Pathologic Conferences of the Nagoya University Hospital: Centrally Necrotizing Carcinoma of the Breast

Oda, Koji; Satake, Hiroko; Nishio, Akiko; Ichihara, Shu; Shimoyama, Yoshie; Imai, Tsuneo; Nagino, Masato

doi:10.2214/ajr.07.3004

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“…In our study, ultrasonography was performed in 26 patients, usually presented with well-defined, heterogeneous, hypoechoic lesions. Oda et al [ 7 ] reported a well-circumscribed tumor with cystic and solid parts and an abundant blood supply, similar to some in the present series, and noted that preoperative diagnosis was important for breast surgeons and radiologists because of the suspected risk of hemorrhage in these lesions. Hemanz et al [ 5 ] reported one case of CNC in which it was not possible to obtain a sample of viable tumor cells despite numerous biopsies, because of the minimal width of the viable tumor rim and the predominance of fibrosis and adiponecrosis in the central region.…”

Section: Discussionsupporting

confidence: 85%

“…It has been described as a “fibrotic focus in invasive ductal carcinoma of the breast” [ 1 ], and as “high-grade invasive ductal carcinomas with large central acellular zones” [ 2 , 3 ], since its first description by Jimenez et al in 2001 [ 4 ]. There have only been four reports of CNC to date; two case reports, and two other studies [ 4 - 7 ]. The clinical and pathological characteristics of this breast cancer subtype thus remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological study of centrally necrotizing carcinoma of the breast

Zhang

et al. 2015

BMC Cancer

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BackgroundCentrally necrotizing carcinoma of the breast (CNC) represents a newly-identified subset of breast cancer. The clinical and pathological characteristics of this breast cancer subtype are not yet completely understood.MethodsWe assessed the clinicopathological characteristics of 73 cases of CNC and 30 control cases of high-grade infiltrating ductal carcinoma (IDC) with focal necrosis based on light microscopy and immunohistochemical staining for estrogen receptor, progesterone receptor, Cerb-B2/HER2, Ki-67, epidermal growth factor receptor, cytokeratin 5/6, smooth muscle actin, S-100 protein, p63 and CD10.ResultsAll the tumors showed extensive central necrotic or acellular zones with different degrees of fibrotic or hyaline material surrounded by ring-like or ribbon-like residual tumour tissue which were usually high-grade IDCs. The central necrotic zone accounted for at least 30% of the cross-sectional area of the tumor. Thirty-six cases (49.3%) showed a component of ductal carcinoma in situ. The tumorous stroma around the central necrotic zone was accompanied by myxoid matrix formation in 28 cases (40%). Lymphocytic infiltration was present in 53 cases (72.6%). Granulomatous reactions were detected at the periphery of the tumors in 49 cases (67.1%). Immunohistochemistry showed greater expression of basal-like markers (72.2%, 52 cases) than myoepithelial markers (60.6%, 43 cases), both of which were significantly higher than in controls (26.7%, 8 cases) (P < 0.001). According to molecular typing, most CNCs were basal-like subtype (37 cases, 50.7%). Follow-up data were available for 28 patients. Disease progression occurred in 11 patients. The combined rate of recurrence, distant metastasis or death was significantly higher in CNC patients compared with controls (P < 0.05).ConclusionsCNC was associated with distinctive clinicopathologic features mostly characterized as basal-like type. Its high proliferative activity, highly-aggressive biological behavior, and high rates of recurrence and metastasis, suggest that CNC should be classified as a new type of breast carcinoma.

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Section: Discussionsupporting

confidence: 85%