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Histological features of medullary carcinoma and prognosis in triple-negative basal-like carcinomas of the breast.

Abstract
Medullary carcinomas have a better prognosis than other grade 3 mammary carcinomas, but they typically show basal-like biological features, which are associated with a poor prognosis. In this study we examined the associations and prognostic relevance of medullary histological features in a series of 165 invasive carcinomas with a basal-like phenotype: triple-negative (oestrogen receptor, progesterone receptor, HER2) and expressing at least one basal marker (CK5/6, CK14, CK17 or EGFR). The following histological features were associated with each other: prominent inflammation, anastomosing sheets, absence of fibrosis, absence of infiltrative margin and absence of gland formation. Prominent inflammation and anastomosing sheets in at least 30% of the tumour were associated with a better prognosis on univariate analysis. The combination of these two features (a simplified definition of medullary-like type) was present in 17% of tumours and was an independent prognostic factor on multivariate analysis. This simplified definition had good inter-observer reproducibility (κ=0.61) and is worthy of more detailed assessment in an unselected group of mammary carcinomas. A fibrotic focus was present in 36% of carcinomas. Only 3% of tumours with a fibrotic focus had features of medullary-like carcinomas. Fibrotic focus of greater than 30% of the tumour was associated with a poor prognosis. This study emphasizes the heterogeneity of morphology and behaviour of triple-negative basal-like carcinomas.
AuthorsFelicia Marginean, Emad A Rakha, Bernard C Ho, Ian O Ellis, Andrew H S Lee
JournalModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (Mod Pathol) Vol. 23 Issue 10 Pg. 1357-63 (Oct 2010) ISSN: 1530-0285 [Electronic] United States
PMID20581807 (Publication Type: Journal Article)
Chemical References
  • Biomarkers, Tumor
  • Keratin-14
  • Keratin-17
  • Keratin-5
  • Keratin-6
  • Receptors, Estrogen
  • Receptors, Progesterone
  • ErbB Receptors
Topics
  • Aged
  • Biomarkers, Tumor (analysis)
  • Breast Neoplasms (genetics, mortality, pathology)
  • Carcinoma, Medullary (genetics, mortality, pathology)
  • ErbB Receptors (biosynthesis)
  • Female
  • Genes, erbB-2
  • Humans
  • Immunophenotyping
  • Kaplan-Meier Estimate
  • Keratin-14 (biosynthesis)
  • Keratin-17 (biosynthesis)
  • Keratin-5 (biosynthesis)
  • Keratin-6 (biosynthesis)
  • Middle Aged
  • Prognosis
  • Receptors, Estrogen (biosynthesis, genetics)
  • Receptors, Progesterone (biosynthesis, genetics)

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