Lathishna and Priya. C: Histopathological variants of breast carcinoma


Introduction

The most common malignant tumor in women is the mammary carcinoma. It has an incidence of greater than or equal to 1,000,000 cases occurring worldwide annually. It accounts for one quarter of all cancer in females approximately and one of the most common neoplasm among humans.1 Among Indian females, breast cancer has ranked number one with a rate as high as 25.8 per 1,00,000 women and mortality with the rate of 12.7 per 1,00,000 women.2 It accounts for 25% to 32% of all female carcinoma in the metropolitan cities. That is, breast cancer is 1/4 of all female cancer cases. A statistical study done by ICMR has revealed that India had 14 lakh cancer patient said in 2016. Thus breast cancer is becoming more prevalent in incident as well as mortality.

Primarily, it arises from the inner lining epithelium of the lobules or the ducts. In this criteria, it is important to rule out whether the tumour is limited to the epithelium or invading the stroma and other areas to become an invasive type. DCIS type is more common compared with the LCIS type.3

Breast carcinoma exhibits a wide scope of different immunohistochemical profiles, morphological features and histopathological subtypes that are clinically specific. The subtypes include both infiltrating and non infiltrating type,

The infiltrating types were listed below

  1. Medullary – It accounts for less than 5% of invasive breast carcinom.

  2. Lobular - It accounts for about 10% of the invasive type.

  3. Ductal - About 80% of all breast carcinoma are of invasive ductal type.

  4. Colloid - It accounts for less than 2% of all breast carcinomas.

  5. Papillary - It includes different types such as invasive papillary, invasive micropapillary, intracystic / encapsulated/ encysted papillary and papillary ductal types.

  6. Tubular – The prevalence is about 1 to 4% of all breast carcinomas.

  7. Metaplasic – It constitutes about less than 1 % of all breast carcinoma.

  8. Signet ring – Its prevalence is about 2 to 4.5% of all breast carcinomas.4

The non infiltrating types were listed below:

  1. Intraductal – It constitutes 15 to 20 % of all breast carcinomas

  2. Lobular – It s prevalence is about 20 % of all breast cancer.

  3. Both intraductal and lobular – The incidences have been steadily increasing in recent decades.4

Materials and Methods

The case study includes 30 malignant cases of breast carcinoma along with the histopathological variants which were taken from the pathology department of Saveetha mededical college, Chennai and the study period includes 12 months.

Lymph node biopsy was done in all the 30 cases and the specimens where send for histolopathological examination and study w as done to conclude the specific diagnosis among the variants. Based on the histological data, the size, site, number of lymph nodes involved, the subtypes of the carcinoma can be determined.5

Results

The parameters to be recorded include age group, tumor site, tumor focality, tumor location, lymph node invasion, vascular invasion, tumor grade and histological type.5

The estimated prevalence of tumor with unifocality is 93.3% and that of multifocality is 6.67%. Malignant tumors of grade I, II and III accounts for 3.34 %, 53.33% and 43.33 % respectively of the total cases with a high prevalence in late stages.

Figure 1
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image2.png

Figure 2
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image3.png

It has been identified with 30 patients that (90% ) of cases were of invasive ductal type insisting its prevalence followed by invasive mammary carcinoma (2%) and adenosquamous carcinoma (1%).

Figure 3
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image4.png

Out of 30 cases analyse d the median age group was 47 with a significant high risk of breast carcinoma. The malignancy is most common in the age group between 40-50 years.

Figure 4
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image5.png

   

Discussion

The histological type of a tumor is of great use in providing clinical information and predict the prognosis. It is of crucial importance in patient management and screening programmes of breast carcinoma.6,7

The current study includes 30 cases of breast malignancy which involves the age group between 30-80 years. The median age group of presentation is 47.8,9 The study shows that the incidence of breast carcinoma peaks in the age group of 40-50 years.10 A study by Jitendra Singh Nigam et al11 states that the common presentation of age was in 4th -5th decade of life which is in concordance with this study.12,13,14

Figure 5
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image6.png

The study reveals that invasive ductal carcinoma has the highest and common occurance of about 90% followed by invasive mammary carcinoma and adenosquamous carcinoma. Jitendra Singh Nigam et al11 observed that infiltrating ductal carcinoma was the most common histolopathologi cal type followed by medullary and mucinous type accounting for 81.40%, 10.36% and 2.74% respectively. On comparing, the present study correlates with the findings of Jitendra Singh Nigam et al.

Figure 6
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image7.png

Of the reported cases, the most common complaints of breast lump was presented on left side (60%) than on right side (40%) which is similar to the findings stated by Jitendra Singh Nigam et al.11 The study shows that tumor location is significantly high in upper outer quadrant (36.66%) followed by outer inner quadra nt (23.33%) whereas the centre quadrant has a incidence of (20%). Jitendra Singh Nigam et al11 observed that the involvement of tumor is more frequent in upper outer quadrant (49%) followed by central quadrant (18%). Rachell E Ellsworth et al15 observed that tumor location within the breast has a high frequency in upper outer quadrant satisfying the findings of present study.

Figure 7
https://s3-us-west-2.amazonaws.com/typeset-media-server/7004b24c-4910-467d-9f69-891d914f2054image8.png

The study reveals that the grade II and grade III are more common grading accounting for about 53.33% and 42.33% of all cases respectively. A study by Chu Z, Lin H, Hua ng R, Liang X, Zhan Q, Jiang J et al states that early stages were more prevalence, which does not provide a similar result on comparison with this study.10

The study shows the most common pathological type T stage as stage T2(70%) followed by T3(20%), T1(6.67%) and T4(3.34%). Jitendra Singh Nigam et al11 also observed that T2(54.68%) as the most common pathological stage causing malignancy followed by T1(44%), T3(19.53%) and T4(2.35%) 11. In the former T2 is followed by T3, but in the latter T2 is followed by T1. The present study is not satisfying the data given by Jitendra Singh Nigam et al11 but it is in concordance with the observation by Wani et al.16

Parameters such as tumor size, site, focality, nodal involvement, histological staging, and tumor grading and appropriate techniques has to be used for early diagnosis. Early diagnosis of breast cancer is essential to reduce the mortality rate and to increase the quality of life.

Conclusion

Based on the histological features and molecular characteristics breast carcinomas are classified. Each parameter influence the o utcome and response to treatment. In our daily clinical practice, the clinical value of assigning the invasive types other

than histological types, histological grades and biomarkers tests have not yet been established. Although the variants has been diagnosed histolopathologically, the prognosis and survival rate of the patients in later stages has not been answered.17

Conflict of Interest

None.

Source of Funding

None.

References

1 

Jaffar makki Diversity of breast carcinoma:Histological subtypes and clinical references10.4137/Cpath.S31563

2 

Shreshtha Malvia Epidemiology of breast cancer in Indian women10.1111/ajco.12661

3 

C R 2.Eheman K M Shaw A B Ryerson J W Miller U A Ajani M C White The changing incidence of in situ and invasive ductal and lobular breast carcinomasCancer Epidemiol Biomarkers Prev200918617639PubMed] [Google Scholar

4 

Timothy A clinical and histopathological analysis of the results of conservation surgery and radiation therapy

5 

Van Der Walt Al Histopathology reporting of mastectomy specimens – an assessment of inter-hospital variation.

6 

I C Henderson G P Canellos Cancer of the breast. The past decadeN Engl J Med19803027890

7 

RVP Hutter The influence of pathologic factors on breast cancer managementCancer19804696176

8 

N S Murthy U K Agarwal K Chaudhry S Saxena A study on time trends in incidence of breast cancer -Indian scenarioEur J Cancer Care (Engl)2007161856PubMed] [Google Scholar

9 

I I Meshram P A Hiwarkar P N Kulkarni Reproductive risk factors for breast cancer: A case control studyOnline J Health Allied Sci200985Google Scholar

10 

Zhaohui Chu Clinicopathologic characteristics of typical medullary carcinoma: retrospective study of 117 cases

11 

Jitendra Singh Nigham A retrospective study of clinicopathological spectrum of carcinoma breast in west DelhiIndia

12 

S Saxena B Rekhi A Bansal Clinico-morphological patterns of breast cancer including family history in a New Delhi hospital, India--A cross-sectional studyWorld J Surg Oncol2005367PMC free article. PubMed] [Google Scholar

13 

D S Sandhu S Sandhu R K Karwasra S Marwah Profile of breast cancer patients at a tertiary care hospital in north IndiaIndian J Cancer2010471622PubMed] [Google Scholar

14 

S Pakseresht G K Ingle A K Bahadur V K Ramteke M M Singh S Garg Risk factors with breast cancer among women in DelhiIndian J Cancer2009461328PubMed] [Google Scholar

15 

E Rachel Ellsworth Tumor location within the breast; Does tumour site have prognostic ability?

16 

S Q Wani T Khan S Y Wani A H Koka S Arshad L Rafiq Clinicoepidemiological analysis of female breast cancer patients in KashmirJ Cancer Res Ther2012838993PubMed] [Google Scholar

17 

M A Sihawarby D M Ai-Tamimi Ahmed A . Molecular classification of breast.



jats-html.xsl