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Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer

An analysis of 5 cases with immunohistochemical investigations

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Summary

In 5 cases of invasive ductal and lobular carcinoma of the breast multiple epithelioid and giant cell containing granulomas were detected, localized mainly in circumferential regions, but also in the center of the carcinomas. These granulomas were interpreted as sarcoid-like stromal reactions, occurring as sarcoid-like lesions in uni- and bilateral primaries, in a recurrent tumour, and also in axillary lymph nodes. Histopathologically, these granulomas were not quite uniform, some of them corresponding to typical sarcoidosis, others showing marked proliferations of epithelioid or giant cells or containing fibrinoid exudate or necroses. The granulomas were surrounded by dense infiltrates of mononuclear cells. Tuberculosis and mycosis was excluded. There were no hints of generalized sarcoidosis. Pathogenetically, these are reactions in the tumour stroma of varying intensity, and are not caused by necroses of the tumour tissue nor by microbial infections. Such tumour-associated sarcoid-like stroma reactions are interpreted as a T-cell mediated immune response to an antigen expression of the carcinoma acting as the local trigger; in 2 cases they were connected with sarcoid-like lesions of the axillary lymph nodes. Their occurrence in bilateral carcinoma of the breast points to an immunological disposition for this special kind of host-versus-tumour response. The intensity of these changes in a recurrent tumour reflects an immunological hypersensitivity reaction.

The pathogenetic and differential diagnostic aspects of epithelioid granulomas of the female breast in chronic granulomatous mastitis, panniculitis, foreign body reaction, rare infections, and in therapeutically induced sarcoidosis are described and discussed.

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References

  • Abdi EA, Nguyen G, Ludwig RN, Dickout WJ (1987) Pulmonary sarcoidosis following interferon therapy for advanced renal cell carcinoma. Cancer 59:896–900

    Google Scholar 

  • Azzopardi JG (1979) Problems in breast pathology. WB Saunders, London, Philadelphia, Toronto

    Google Scholar 

  • Bässler R, Dittmann AM, Dittrich M (1981) Mononuclear stromal reactions in mammary carcinoma, with special reference to medullary carcinomas with a lymphoid infiltrate. Virchows Arch A (Pathol Anat) 393:75–91

    Google Scholar 

  • Banik S, Bishop PW, Ormerod LP, O'Brien TEB (1986) Sarcoidosis of the breast. J Clin Pathol 39:446–448

    Google Scholar 

  • Bodo M (1978) Boeck's sarcoidosis of the breast: cytologic findings with aspiration biopsy cytology. Acta Cytologica 22:1–2

    Google Scholar 

  • Bohrer MH (1985) Epitheloidzellig-granulomatöse Myositis des Musculus pectoralis major bei ipsilateralem Mammacarcinom. Bet Pathol 106:256

    Google Scholar 

  • Bonnecchi L, Nanni MR (1981) Sarcoide de Boeck della mamella. Radiol Med 67:656–657

    Google Scholar 

  • Caselitz J, Stegner HE, Spiegel A (1986) Stroma reaction of mammary cancer. In: Bässler R, Hübner K (ed) Pathology of neoplastic and endocrine induced diseases of the breast. Fischer, Stuttgart, pp 157–159

    Google Scholar 

  • Dalmark G (1942) Lymphogranulomatose benigne. Acta Chir Scand 86:168–178

    Google Scholar 

  • Ellman P, Hanson A (1958) The co-existence of bronchial carcinoma and sarcoidosis. Br J Tuberculosis 52:218–222

    Google Scholar 

  • Fischer R (1984) Lymphknoten. In: Remmele W (ed) Pathologic. Ein Lehr- und Nachschlagebuch. Bd. 1. Springer, Berlin, Heidelberg, New York, pp 563–681

    Google Scholar 

  • Fisher ER, Gregorio RM, Fisher B (1975) The pathology of invasive breast cancer. Cancer 36:1–85

    Google Scholar 

  • Fitz-Gibbons PL, Smiley DF, Kern WH (1985) Sarcoidosis presenting initially as breast mass: report of two cases. Hum Pathol 16:851–852

    Google Scholar 

  • Gansler TS, Wheeler JE (1984) Mammary sarcoidosis. Two cases and literature review. Arch Pathol Lab Med 10:673–675

    Google Scholar 

  • Geschickter CF (1948) Diseases of the breast. JB Lippincott Comp., Philadelphia, London, Montreal

    Google Scholar 

  • Gokel J, Göttlinger HG, Schleiffenbaum HG, Rieber EG, Riethmüller G (1986) Leucocytic infiltrates in human mammary carcinomas. A study using monoclonal antibodies. In: Bässler R, Hübner K (eds) Pathology of neoplastic and endocrine induced diseases of the breast. Fischer, Stuttgart, pp 160–165

    Google Scholar 

  • Gorton G, Linell F (1957) Malignant tumors and sarcoid reactions in regional lymph nodes. Acta Radiol (Stockholm) 47:381–392

    Google Scholar 

  • Gupta K, Chatterjee S (1984) Systemic sarcoidosis involving the breast. J Ass Phys India 32:228–229

    Google Scholar 

  • Gusek W (1965) Histologie und elektronenmikroskopische komparative Zytologie tuberkulöser und epitheloidzelliger Granulome. Fortschr Tuberkuloseforsch 14:97–156

    Google Scholar 

  • Haagensen CD (1971) Diseases of the breast. 2nd ed WB Saunders, Philadelphia

    Google Scholar 

  • Heymer B (1980) Sarcoid-like granulomatous reactions against malignancies. In: Grundmann E (ed) Metastatic tumor growth. Cancer Campaign. Vol 4, Fischer, Stuttgart, pp 67–72.

    Google Scholar 

  • Israel HC (1978) Sarcoidosis, malignancy, and therapy. Arch Int Med 138:907–908

    Google Scholar 

  • Lennert K (1957) Die Differentialdiagnose der epitheloidzelligen Lymphknotenreaktionen. Klin Wochenschr 35:1097–1098

    Google Scholar 

  • Lennert K (1961) Lymphknoten, Diagnostik in Schnitt und Ausstrich. Bandteil A. In: Lubarsch O, Henke F, Roessle R, Uehlinger E (eds) Handbuch der speziellen pathologischen Anatomie und Histologie 1/3. Springer, Berlin, Göttingen, Heidelberg

    Google Scholar 

  • Meyer EM, Grundmann E (1982) Lymph node reactions to cancer. Klin Wochenschr 60:1329–1338

    Google Scholar 

  • Mostofi FK, Price EB (1973) Tumors of the male genital system. Atlas of tumor pathology. Sec Series. Fascicle 8. Armed Forces Institute of Pathology, Washington DC

    Google Scholar 

  • Müller H, Schmidts HL, Sakuma T, Stutte HJ (1986) Investigations of stromal reactions in mammary carcinoma. In: Bässler R, Hübner K (eds) Pathology of neoplastic and endocrine induced diseases of the breast. Fischer, Stuttgart, pp 166–170

    Google Scholar 

  • Müller-Hermelink HK, Kaiserling E (1980) Epitheloidzellreaktionen im lymphatischen Gewebe. Verh Dtsch Ges Pathol 64:77–102

    Google Scholar 

  • Murata Y, Tachibana T, Yugawa E, Tateishi R, Morimura Y, Sakai S, Seno T, Kyo S, Onishi S (1974) Pathological study of sarcoid-like lesions associated with malignant neoplasms. In: Iwai K, Hosoda Y (eds) Proc. VI International Conference on Sarcoidosis. Univ Press, Tokyo, pp 146–151

    Google Scholar 

  • Nickerson DA (1937) Boeck's sarcoid. Report of six cases in which autopsies were made. Arch Pathol 24:19–29

    Google Scholar 

  • Pickartz H, Gerdes R, Schwarting R, Stein H (1986) Significance of the lymphophagocytic infiltrate of human breast cancer and its correlation with lymphonodular metastasation. In: Bässler R, Hübner K (eds) Pathology of neoplastic and endocrine induced diseases of the breast. Fischer, Stuttgart, pp 171–175

    Google Scholar 

  • Prior JT (1952) Boeck's sarcoid with coexisting carcinoma. Am J Surg 83:201–204

    Google Scholar 

  • Raju GC, McShine LAH (1984) Sarcoid lesion in the breast presenting as carcinoma. Trop Geogr Med 36:297–298

    Google Scholar 

  • Reisner D (1944) Boecks' sarcoid and systematic sarcoidosis. Amer Rev Tuberculosis 39:437–462

    Google Scholar 

  • Reitz ME, Seidman I, Roses DF (1985) Sarcoidosis of the breast. New York State J Med 85:262–263

    Google Scholar 

  • Rennke H, Lennert K (1973) Käsig-tuberkuloide Reaktion bei Lymphknotenmetastasen lymphoepithelialer Carcinome (Schmincke-Tumoren). Virchows Arch A (Pathol Anat) 358:241–247

    Google Scholar 

  • Richter HJ, Leder LD (1979) Lymph node metastases with PAS-positive tumor cells and massive epithelioid granulomatous reaction as diagnostic clue to occult seminoma. Cancer 44:245–249

    Google Scholar 

  • Riefkohl R, Roberts TL, McCarty KS (1985) Lack of adverse effect of silicone implant on sarcoidosis of the breast. Plast Reconst Surg 76:296–298

    Google Scholar 

  • Rigden B (1978) Sarcoid lesion in breast after probable sarcoidosis in lung. Br Med J 2:1533–1534

    Google Scholar 

  • Ross MJ, Merino MJ (1985) Sarcoidosis of the breast. Hum Pathol 16:185–187

    Google Scholar 

  • Scadding JG (1967) Sarcoidosis. Eyre and Spottiswoode, London

    Google Scholar 

  • Schiller W (1934) Disgerminom und Tuberkulose. Arch Gyn 156:513–533

    Google Scholar 

  • Schiødt T (1966) Breast carcinoma. A histologic and prognostic study of 650 follow-up cases. Munksgaard, Copenhagen

    Google Scholar 

  • Scott RB (1938) The sarcoidosis of Boeck. Br Med J 2:777–781

    Google Scholar 

  • Shinoda M, Nomi S, Iwai K, Izumi T (1979) A case of breast sarcoid. Arch Jap Chir 48(3):404–410

    Google Scholar 

  • Shoenfeld Y, Avidor E, Eldar M, Vidne B, Levy M, Pinkhas J (1978) Squamous cell carcinoma asscociated with sarcoidosis in the lung. Oncology 35:112–113

    Google Scholar 

  • Spector WG (1980) The morphology, kinetics and fate of granulomas. Verh Dtsch Ges Pathol 64:21–24

    Google Scholar 

  • Stallard HB, Tait CBV (1939) Boeck's sarcoidosis. A case record. Lancet 1:440–442

    Google Scholar 

  • Symmers WSC (1951) Localized tuberculoid granulomas associated with carcinoma. Their relationship to sarcoidosis. Amer J Pathol 27:493–521

    Google Scholar 

  • Whittington R, Lazarus A, Nerenstone S, Martin A (1986) Sarcoidosis developing during therapy for breast cancer. Chest 89:762–763

    Google Scholar 

  • Wöckel W, Wernert N (1986) Excessive epithelioid cell granulomatous reaction associated with a lymphoepithelial carcinoma (Schmincke-Regaud). Pathol Res Pract 181:349–352

    Google Scholar 

  • Wuketich S (1959) Über die epitheloidzelligen, tuberkuloiden Reaktionen in Lymphknoten bei malignen Geschwülsten. Frankf Z Pathol 70:187–200

    Google Scholar 

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  1. Institute of Pathology, City and Academic Hospital, Pacelliallee 4, D-6400, Fulda, Germany

    R. Bässler & F. Birke

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  1. R. Bässler
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  2. F. Birke
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Dedicated to Prof. Dr. K. Lennert, Kiel, in Honour of his 65th Birthday

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Bässler, R., Birke, F. Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer. Vichows Archiv A Pathol Anat 412, 231–239 (1988). https://doi.org/10.1007/BF00737147

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