Lipid-rich carcinoma of the breast. A dinicopathological study of 49 cases

Department of General Surgery Shandong University Shandong Provincial Hospital, Jinan, 250021, China.
Tumori (Impact Factor: 1.27). 05/2008; 94(3):342-6.
Source: PubMed

ABSTRACT Lipid-rich carcinoma is a very rare variant of breast cancer with an aggressive clinical course and poor prognosis. The present study aimed to explore its clinicopathologic characters.
We reviewed 3,206 cases treated in two centers in the last 10 years. They all met the criteria of positive oil red O staining, were PAS negative and had the typical histological features included in the study. Their clinical data were collected. The expression of estrogen and progesterone receptors, HER2 and Ki67 was evaluated by immunohistochemistry.
Forty-nine patients were diagnosed with lipid-rich carcinomas. They were all female and ranged in age from 22 to 72 years (mean, 45). The presenting symptoms included a breast mass or lump and nipple discharge. Axillary lymph node metastases were found in 79.2% of the patients at the time of surgery. Respectively 100% and 89.8% were negative for estrogen and progesterone receptors, whereas 71.4% were positive for HER2. All patients received surgery plus chemotherapy with or without radiotherapy. In vitro MTT assay showed taxol- or platinum-based chemotherapy to be the most effective. The 2- and 5-year overall survival rates were 64.6% and 33.2%, respectively.
Lipid-rich carcinoma has a biopathological profile significantly different from other types of breast cancer, with a predominance of unfavorable prognostic parameters. Early diagnosis and active treatment may be helpful to increase its overall survival.

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    • "Regardless of the small number of cases of lipid-rich carcinoma reported, the prognosis of this type of cancer seems to be very poor [4] [11], with 2-and 5-year overall survival rates 64, 6% and 33, 2%, respectively [2]. Many of the patients with lipid-rich carcinoma reported had nodal metastasis in the time of presentation and developed distant metastasis in next two years [11]. "
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    ABSTRACT: A 56-year-old woman noticed a palpable mass in her left breast during self-examination. Patient was admitted to our hospital and malignant bifocal tumour was diagnosed by ultrasonography, digital mammography, magnetic resonance, and core-cut biopsy. The patient underwent planned conservative surgery (biquadrantectomy) with a sentinel node examination, but after results of the frozen section with positive resection margins and positive sentinel lymph nodes subsequent mastectomy with axillary lymph node dissection were realized. Histology in the resection specimen revealed two isolated and distinct tumours. One of the lesions represented conventional invasive ductal carcinoma of histological grade 3, and the second tumour was evaluated as invasive lipid-rich carcinoma, containing tumour cells with clear and foamy cytoplasm. Lipids in neoplastic cells were detected by Oil Red O staining and ultrastructural examination. Immunohistochemical analysis of both carcinomas was almost identical with negative steroid receptors, positive staining of HER-2, and p53 and with high proliferation activity (Ki-67). Mastectomy specimen contained residual foci of invasive ductal carcinoma and dissected axillary lymph nodes were free of metastasis. Patient underwent first cycles of chemotherapy with paclitaxel and Herceptin together with local radiotherapy and two month after surgery is without any evidence of the disease.
    09/2012; 2012:387045. DOI:10.1155/2012/387045
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    • "lipid-rich carcinomas were ER+ and/or PgR+ and 35 of 49 (71.4%) lipid-rich carcinomas were HER2+ [20]. Thus, the positive rate of ER and/or PgR tended to be low, and HER2 expression tended to be high in these studies of lipid-rich carcinomas. "
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    ABSTRACT: A 57-year-old Japanese woman with schizophrenia, who had received long-term treatment with neuroleptics, noticed a painless, pea-sized lump in her right breast. She was admitted to our hospital and a malignant tumor was diagnosed. The patient underwent a conservative radical mastectomy (Patey's operation). The excised tumor measured 2.0 × 1.2 × 1.1 cm in diameter, and its cut surface was grayish-white. Histologically, tumor cells with clear to foamy cytoplasm were invariably Oil Red O-positive and periodic acid Schiff-negative with or without diastase digestion. The tumor was diagnosed as a lipid-rich carcinoma accompanied by an in situ component. Neuroleptics increase serum prolactin levels by interfering with dopaminergic inhibition of prolactin secretion. Immunohistochemical analysis revealed that, although prolactin was not detected, the tumor cells expressed prolactin receptor, indicating prolactin as the genesis of this neoplasm. In immunohistochemical intrinsic subtype analysis, the tumor was negative for estrogen receptor, progesterone receptor, human epidermal growth factor receptor 1 and 2, and basal cytokeratins (CK5, CK6, and CK14), indicating an unclassified (all-marker negative) subtype. Axillary lymph nodes were free of metastasis (stage I), and the patient has been well for 20 years without any evidence of recurrence.
    Case Reports in Oncology 05/2011; 4(2):275-80. DOI:10.1159/000328804
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    ABSTRACT: Most pancreatic endocrine neoplasms (PENs) show characteristic and well-recognized endocrine morphology; however, a lipid-rich pattern, which can present a diagnostic problem in biopsies, has been reported, mostly as individual cases. Some have been included in descriptions of the rare clear-cell variant associated with von Hippel-Lindau (VHL) syndrome. The histogenesis, clinicopathologic characteristics, and significance of this lipid-rich pattern have not been unraveled. In this study, 11 PENs exhibiting foamy, microvesicular cytoplasm were analyzed. In some cases, the nuclei were distorted by the vesicles, and the usual endocrine chromatin pattern was not evident. The growth pattern was relatively diffuse, with vague compartmentalization of the cells by a delicate vasculature; prominent nesting was noted in only 4 cases. Pathology reports indicated substantial diagnostic challenge in these cases; on biopsies, 1 case was originally diagnosed as adrenal cortical carcinoma, another as renal cell carcinoma, a third as solid-pseudopapillary tumor, and a fourth had a fine needle aspiration cytologic diagnosis of adenocarcinoma. All cases were chromogranin and synaptophysin positive. Electron microscopy in 3 cases confirmed the cytoplasmic vesicles to be lipid vacuoles. Neurosecretory granules were also evident. Clinically, as in conventional PENs, there appeared to be two distinct subsets: Two cases were familial or functional/syndromic (1 with VHL and the other with MEN-1 and glucagonoma syndrome) and occurred in younger adults (ages 41 and 47 years); the majority (n = 9) were nonfunctional/nonsyndromic and nonfamilial. The latter group was mostly represented by elderly males (mean age: 65 vs. 58 years in conventional sporadic PENs). Immunohistochemically, markers implicated in VHL-associated neoplasia, including HIF-1alpha, inhibin, and Melan-A (in clear-cell PENs) and MUC6 (in serous cystadenomas) were mostly negative in lipid-rich PENs (1 of 10, 1 of 10, 0 of 10 and 0 of 10, respectively). In conclusion, the lipid-rich pattern, reminiscent of adrenal cortical cells, represents a distinct subset of PENs. It presents a diagnostic challenge for surgical pathologists, especially in biopsies. EM supports the name lipid-rich for this variant. The findings suggest that the pathogenesis of lipid-rich tumors may be different from the VHL-associated clear-cell variants of PENs.
    American Journal of Surgical Pathology 03/2006; 30(2):194-200. DOI:10.1097/ · 5.15 Impact Factor
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