Gruppo regionale veneto dei patologi dello screening mammografico Rovigo, 19 maggio 2009 Confronto interistituzionale in patologia mammaria da screening

Carcinoma midollare della mammella

1)Growth in syncytial pattern comprising over 75% of the total neoplastic area 2)Complete microscopic circumscription 3)Moderate to marked stromal lymphoplasmacytic infiltrate 4)Neoplastic cells with indistinct cytoplasmic borders and high nuclear grade 5)High mitotic rate Ridolfi RL et al. Medullary carcinoma of the breast. A clinicopathologic study with 10 year follow up. Cancer 1977; 40: Rosen PP. Rosens Breast Pathology. Eusebi V et al. Rare new entities of the breast and medullary carcinoma. Pathology 2009; 41: 1, 48-56

TIPO ISTOLOGICO 8- carcinoma duttale infiltrante 1- carcinoma midollare GRADING 1- grado 1 8- grado 3

Carcinoma midollare atipico della mammella

75% of syncytial pattern & No more than two of the following features: 1)Tumour margins showing focal or prominent infiltration 2) Mononuclear infiltrate, mild or at the margins of the tumour 3)Low grade nuclei 4)Presence of microglandular features

Carcinoma duttale infiltrante con aspetti midollari

Caso 5

TIPO ISTOLOGICO: 8) carcinoma duttale infiltrante 1) carcinoma midollare atipico 1) carcinoma apocrino GRADING: 1) grado 2 9) grado 3

Caso 10

TIPO ISTOLOGICO: 10) carcinoma duttale infiltrante 1) carcinoma midollare atipico GRADING: 11) grado 3

Syncytial architecture <75% and/or presence of 3 or more other atypical features Carcinoma non midollare

Caso 18

TIPO ISTOLOGICO: 9) carcinoma duttale infiltrante 2) carcinoma midollare GRADO: 11) grado 3

Typical Syncytial > 75% with all the characteristics below Atypical Syncytial < 75% and associated with 2 or 3 of characteristics below Non medullary Syncytial >75% and associsted with only one of the below Syncytial <75% or absent and any of the characteristics below: 1)Complete histologic circumscription 2)Mononuclesr cell infiltration, moderate, marked and diffuse 3)Nuclear pleomorphism, moderate or marked 4)Absence of microglandular structure Rakha EA et al: The prognostic significance of inflammation and medullary histological type in invasive carcinoma of the breast. European Journal of Cancer 2009 Rapin V et al. Medullary breast carcinoma. A reevaluation of 95 cases of breast cancer with inflammatory stroma. Cancer 1988, 61: