Virchows Archiv

, Volume 450, Issue 5, pp 539–547

Myoepithelial cells in solid variant of intraductal papillary carcinoma of the breast: a potential diagnostic pitfall and a proposal of an immunohistochemical panel in the differential diagnosis with intraductal papilloma with usual ductal hyperplasia

  • Suzuko Moritani
  • Shu Ichihara
  • Ryoji Kushima
  • Hidetoshi Okabe
  • Masamichi Bamba
  • Tadao K. Kobayashi
  • Takanori Hattori
Original Article

Abstract

We examined myoepithelial status in intraductal papillary carcinoma (IPC) along with the expression of high-molecular weight cytokeratin (HMWK) and neuroendocrine markers, with special reference to the differential diagnosis of solid intraductal papillary carcinoma(SIPC) and intraductal papilloma with usual ductal hyperplasia (IP-UDH). Twenty-six (93%) of the twenty-eight intraductal papillomas (IP) had myoepithelial cells in >70% of the epithelial–stromal interface of the intraluminal proliferating component. Six (29%) of twenty-one SIPC had almost complete myoepithelial layer like IP-UDH at the epithelial–stromal interface. HMWK (34βE-12) was diffusely positive in 14 (93%) of 15 IP-UDH, but 16 (76%) of 21 SIPC were completely negative for HMWK. Neuroendocrine markers were positive in 14 (67%) of SIPC, but all 28 IPs were completely negative. If only the presence of myoepithelial cells is emphasized as a benign hallmark, about 30% of SIPCs may be underdiagnosed as IP-UDH. However, by using a combination of myoepithelial markers, HMWK, and neuroendocrine markers, all of the 36 solid intraductal papillary lesions were properly classified as benign and malignant. Solid intraductal papillary lesions meeting at least two of the following criteria are highly likely to be malignant: (1) absence of myoepithelial cells(<10% of epithelial–stromal interface of intraluminal proliferating component), (2) negative HMWK(<10%), (3) positive neuroendocrine markers (>10%).

Keywords

Solid intraductal papillary carcinoma Intraductal papilloma Usual ductal hyperplasia Myoepithelial cell Neuroendocrine differentiation 

References

  1. 1.
    Ali-Fehmi R, Carolin K, Wallis T, Visscher DW (2003) Clinicopathologic analysis of breast lesions associated with multiple papillomas. Human Pathol 34:234–239CrossRefGoogle Scholar
  2. 2.
    Boecker W, Buerger H, Schmitz K, Ellis IA, van Diest PJ, Sinn HP, Geradts J, Diallo R, Poremba C, Herbs H (2001) Ductal epithelial proliferations of the breast: biological continuum? Comparative genomic hybridization and high-molecular-weight cytokeratin expression patterns. J Pathol 195:415–421PubMedCrossRefGoogle Scholar
  3. 3.
    Capella C, Eusebi V, Mann B, Azzopardi JG (1980) Endocrine differentiation in mucoid carcinoma of the breast. Histopathology 4:613–630PubMedCrossRefGoogle Scholar
  4. 4.
    Diallo R, Schaefer H, Poremba C, Shivazi N, Willmann V, Buerger H, Dockhorn-Dworniczak B, Boecker W (2001) Monoclonality in normal epithelium and in hyperplastic and neoplastic lesions of the breast. J Pathol 193:27–32PubMedCrossRefGoogle Scholar
  5. 5.
    Douglas-Jones A, Shah V, Morgan J, Dallimore N, Rashid M (2005) Observer variability in the histopathological reporting of core biopsies of papillary breast lesions is reduced by the use of immunohistochemistry for CK5/6, calponin and p63. Histopathology 47:202–208PubMedCrossRefGoogle Scholar
  6. 6.
    Going JJ (2003) Stages on the way to breast cancer. J Pathol 199:1–3PubMedCrossRefGoogle Scholar
  7. 7.
    Gudjonsson T, Rønnov-Jessen L, Villadsen R, Rank F, Bissell MJ, Petersen OW (2002) Normal and tumor-derived myoepithelial cells differ in their ability to interact with luminal breast epithelial cells for polarity and basement membrane deposition. J Cell Sci 115:39–50PubMedGoogle Scholar
  8. 8.
    Hill CB, Yeh IT (2005) Myoepithelial cell staining patterns of papillary breast lesions. From intraductal papillomas to invasive papillary carcinomas. Am J Clin Pathol 123:36–44PubMedCrossRefGoogle Scholar
  9. 9.
    Ichihara S, Fujimoto T, Hashimoto K, Moritani S, Hasegawa M, Yokoi T (2007) Double immunostaining with p63 and high-molecular-weight cytokeratins distinguishes borderline papillary lesions of the breast. Pathol Int 57:126–132PubMedCrossRefGoogle Scholar
  10. 10.
    Jarasch ED, Nagle RB, Kaufmann M, Maurer C, Böcker W (1988) Differential diagnosis of benign epithelial proliferations and carcinomas of the breast using antibodies to cytokeratins. Human Pathol 19:276–289Google Scholar
  11. 11.
    Lefkowitz M, Usar CM, Lefkowitz W, Wargotz ES (1994) Intraductal(intracystic) papillary carcinoma of the breast and its variants: a clinicopathological study of 77 cases. Human Pathol 25:802–809CrossRefGoogle Scholar
  12. 12.
    MacGrogan G, Tavassoli FA (2003) Central atypical papillomas of the breast: a clinicopathological study of 119 cases. Virchows Arch 443:609–617PubMedCrossRefGoogle Scholar
  13. 13.
    Maluf HM, Koerner FC (1995) Solid papillary carcinoma of the breast. A form of intraductal carcinoma with endocrine differentiation frequently associated with mucinous carcinoma. Am J Surg Pathol 19:1237–1244PubMedCrossRefGoogle Scholar
  14. 14.
    Maluf HM, Zukerberg LR, Dickersin GR, Koerner FC (1991) Spindle-cell argyrophilic mucin-producing carcinoma of the breast. Histological, ultrastructural, and immunohistochemical studies of two cases. Am J Surg Pathol 15:677–686PubMedCrossRefGoogle Scholar
  15. 15.
    Moritani S, Kushima R, Sugihara H, Bamba M, Kobayashi TK, Hattori T (2002) Availability of CD10 immunohistochemistry as a marker of breast myoepithelial cells on paraffin sections. Mod Pathol 15:397–405PubMedCrossRefGoogle Scholar
  16. 16.
    Nassar H, Qureshi H, VolkanAdsay N, Visscher D (2006) Clinicopathologic analysis of solid papillary carcinoma of the breast and associated invasive carcinomas. Am J Surg Pathol 30:501–507PubMedCrossRefGoogle Scholar
  17. 17.
    Papotti M, Gugliotta P, Eusebi V, Bussolati G (1983) Immunohistochemical analysis of benign and malignant papillary lesions of the breast. Am J Surg Pathol 7:451–461PubMedCrossRefGoogle Scholar
  18. 18.
    Purcell CA, Norris HJ (1998) Intraductal proliferations of the breast: a review of histologic criteria for atypical intraductal hyperplasia and ductal carcinoma in situ, including apocrine and papillary lesions. Ann Diagn Pathol 2:135–145PubMedCrossRefGoogle Scholar
  19. 19.
    Rabban JT, Koerner FC, Lerwill ME (2006) Solid papillary carcinoma in situ versus usual ductal hyperplasia in the breast: a potentially difficult distinction resolved by cytokeratin5/6. Human Pathol 37:787–793CrossRefGoogle Scholar
  20. 20.
    Raju UB, Zarbo RJ, Crissman JD (1989) Papillary neoplasm of the breast: Immunohistochemically defined myoepithelial cells in the diagnosis of benign and malignant papillary breast neoplasms. Mod Pathol 2:569–576PubMedGoogle Scholar
  21. 21.
    Tavassoli FA (1999) Papillary lesions. In: Pathology of the breast, 2nd edn. McGraw-Hill, New York, NY, pp 325–371Google Scholar
  22. 22.
    Tavassoli FA, Devilee P (eds) (2003) World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organs. IARC, Lyon, pp 76–80Google Scholar
  23. 23.
    Tse GM, Tan PH, Lui PCW, Gilks B, Poon CSP, Ma TKF, Law BKB, Lam WWM (2006) The role of immunohistochemistry for smooth muscle actin, p63, CD10 and CK14 in the differential diagnosis of papillary lesions of the breast. J Clin Pathol 12:(Epub ahead of print)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Suzuko Moritani
    • 1
  • Shu Ichihara
    • 1
  • Ryoji Kushima
    • 2
  • Hidetoshi Okabe
    • 2
  • Masamichi Bamba
    • 3
  • Tadao K. Kobayashi
    • 3
  • Takanori Hattori
    • 4
  1. 1.Department of Pathology and Clinical LaboratoriesNagoya Medical CenterNagoyaJapan
  2. 2.Department of Diagnostic PathologyShiga University of Medical ScienceOhtsuJapan
  3. 3.Department of Pathology, Saiseikai Shiga HospitalImperial Gift Foundation IncRittoJapan
  4. 4.Department of PathologyShiga University of Medical ScienceOhtsuJapan

Personalised recommendations