Stromal keratin expression in phyllodes tumours of the breast: a comparison with other spindle cell breast lesions

Chia, Yifoong; Thike, Aye Aye; Cheok, Poh Yian; Chong, Luke Yong-Zheng; Tse, Gary; Tan, Puay Hoon

doi:10.1136/jclinpath-2011-200377

Cited by 66 publications

(43 citation statements)

References 36 publications

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“…The majority of PTs are negative for CKs and p63. 25 In a recent study of 32 PTs, it was found that p63, p40, and CKs can be focally positive in 57%, 29% and 21%, respectively, of malignant PT but not in benign or borderline PT. 26 These results suggest that these markers alone should not be used to differentiate metaplastic (sarcomatoid) carcinoma from malignant PT on core biopsy.…”

Section: Malignant Ptmentioning

confidence: 95%

Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates

Zhang

Kleer

2016

Archives of Pathology &Amp; Laboratory Medicine

209

204

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Context.-Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm with risks of local recurrence and uncommon metastases. The classification proposed by the World Health Organization for PTs into benign, borderline, and malignant is based on a combination of several histologic features. The differential diagnosis between PT and fibroadenoma and the histologic grading of PT remain challenging. In addition, the molecular pathogenesis of PT is largely unknown.Objective.-To provide an updated overview of pathologic features, diagnostic terminology, and molecular alterations of PT.Data Sources.-Current English literature related to PT of the breast.Conclusions.-Phyllodes tumor shows a wide spectrum of morphology. There are no clearly distinct boundaries between PT and fibroadenoma. Strict histologic assessment of a combination of histologic features with classification can help to achieve the correct diagnosis and provide useful clinical information. The genomic landscapes of PT generated from genomic sequencing provide insights into the molecular pathogenesis of PT and help to improve diagnostic accuracy and identify potential drug targets in malignant PT.

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Section: Malignant Ptmentioning

confidence: 95%

Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates

Zhang

Kleer

2016

Archives of Pathology &Amp; Laboratory Medicine

209

204

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“…Cytokeratin expression per se in a spindle cell lesion does not exclude other diagnoses. A recent study found focal expression of some cytokeratins in phyllodes tumours,17 although this is rarely a diagnostic problem as most phyllodes tumours show the typical fibroepithelial architecture. Also some sarcomas, such as leiomyosarcoma, can express cytokeratins.…”

Section: Spindle Cell Lesionsmentioning

confidence: 99%

Use of immunohistochemistry in the diagnosis of problematic breast lesions

Lee

2013

J Clin Pathol

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Most diagnoses in breast pathology can be made with H&E sections. Nevertheless immunohistochemistry plays a useful supplementary role. This article reviews the common uses of immunohistochemistry in diagnostic breast pathology. It is important to be aware of the limitations of individual antibodies. Such problems can often be overcome by using panels of antibodies. Quality control is also essential: internal and external controls should show appropriate staining. Immunohistochemistry must be interpreted in combination with the morphology seen on H&E sections. Myoepithelial markers, such as smooth muscle actin, smooth muscle myosin heavy chain and p63, are useful for distinguishing invasive carcinoma from sclerosing lesions and ductal carcinoma in situ (DCIS), and in the classification of papillary lesions. Basal cytokeratins can help distinguish epithelial hyperplasia of usual type (UEH) and clonal proliferations such as DCIS and lobular carcinoma in situ (LCIS). UEH usually shows patchy expression whereas DCIS and other clonal proliferations are typically negative. E-cadherin can usually separate DCIS and LCIS: DCIS typically shows membrane staining and most LCIS is negative. Cytokeratins can be used to detect small nodal metastases or subtle invasive carcinomas such as invasive lobular carcinomas. Immunohistochemistry plays a useful role in diagnosing spindle cell lesions such as a panel of cytokeratins to identify spindle cell carcinomas. Immunohistochemistry is helpful in recognising metastases to the breast. Different antibodies are useful for different tumours: WT1 for ovarian carcinoma; TTF1 for pulmonary adenocarcinoma; S100, melan-A and HMB45 for melanoma; and lymphoid markers for lymphoma.

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“…Contrary to other studies, they observed some expression of keratins MNF116, 34bE12, CK7, CK14, AE1/3, and Cam5.2 in the stromal cells of 11.9%, 22%, 28.4%, 1.8%, 8.3%, and 1.8% of PTs, respectively. 69 However, keratin positivity was focal and patchy and was found in only 1% to 5% of stromal cells in these cases, and the explanation for keratin expression is uncertain. In an earlier study, Dunne et al 70 applied a panel of keratins (AE1/AE3, 34bE12, CK5 and CK14, Cam5.2, CK7 and CK19, and EMA), of which all were negative in the stromal components of 26 PTs.…”

Section: Cytokeratinsmentioning

confidence: 99%

“…Chia and colleagues 69 investigated a larger cohort of PTs using a wide panel of commonly used keratins, including MNF116, 34bE12, CK7, CK14, Cam5.2, and AE1/3. Contrary to other studies, they observed some expression of keratins MNF116, 34bE12, CK7, CK14, AE1/3, and Cam5.2 in the stromal cells of 11.9%, 22%, 28.4%, 1.8%, 8.3%, and 1.8% of PTs, respectively.…”

Section: Cytokeratinsmentioning

confidence: 99%

Fibroepithelial Tumors of the Breast: Pathologic and Immunohistochemical Features and Molecular Mechanisms

Yang

Kandil

Cosar

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.—The 2 main prototypes of fibroepithelial tumors of the breast include fibroadenoma and phyllodes tumor (PT). Although both tumors share some overlapping histologic features, there are significant differences in their clinical behavior and management. Phyllodes tumors have been further divided into clinically relevant subtypes, and there is more than one classification scheme for PT currently in use, suggesting a lack of consistency within different practices. Accurate differentiation between fibroadenoma and PT, as well as the grading of PT, may sometimes be challenging on preoperative core needle biopsy. Some immunohistochemical markers have been suggested to aid in the pathologic classification of these lesions. Objective.—To discuss the salient histopathologic features of fibroepithelial tumors and review the molecular pathways proposed for the initiation, progression, and metastasis of PTs. Also, to provide an update on immunohistochemical markers that may be useful in their differential diagnosis and outline the practice and experience at our institution from a pathologic perspective. Data Sources.—Sources included published articles from peer-reviewed journals in PubMed (US National Library of Medicine). Conclusions.—Fibroepithelial tumor of the breast is a heterogenous group of lesions ranging from fibroadenoma at the benign end of the spectrum to malignant PT. There are overlapping histologic features among various subtypes, and transformation and progression to a more malignant phenotype may also occur. Given the significant clinical differences within various subtypes, accurate pathologic classification is important for appropriate management. Although some immunohistochemical markers may be useful in this differential diagnosis, histomorphology still remains the gold standard.

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Stromal keratin expression in phyllodes tumours of the breast: a comparison with other spindle cell breast lesions

Abstract: The use of keratins as an adjunctive immunohistochemical diagnostic tool in the differential work-up of spindle cell tumours of the breast has to be interpreted with caution especially on limited core biopsy material.

Cited by 66 publications

References 36 publications

Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates

Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates

Use of immunohistochemistry in the diagnosis of problematic breast lesions

Fibroepithelial Tumors of the Breast: Pathologic and Immunohistochemical Features and Molecular Mechanisms

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