A comprehensive morphological study for basal-like breast carcinomas with comparison to nonbasal-like carcinomas

Abstract

Background: Breast carcinomas can be classified into five subtypes based on gene expression profiling or immunohistochemical characteristics. Among these subtypes, basal-like breast carcinomas (BLBCs) are one of the most studied group, due to their poor prognosis. The aim of this study was to investigate the prevalance, morphological and immunohistochemical features of BLBCs, in Turkish population.

Methods: Five hundred invasive breast carcinomas were reviewed for several morphological features and immunostained for oestrogen and progesterone receptors, c-ERB-B2, cytokeratin5/6, cytokeratin14, vimentin and epidermal growth factor receptor (EGFR). Basal-like breast carcinoma was defined as a triple negative tumor with cytokeratin5/6 and/or EGFR positive.

Results: The prevalance of BLBC was 9.6%. All medullary carcinomas and 55.6% of metaplastic carcinomas showed basal-like immunophenotype. Patients with BLBC were younger (p=0.04) and had higher-grade tumors (p<0.0001). Morphologic features associated with BLBC included increased mitosis, nuclear pleomorphism, presence of geographic and/or central necrosis, pushing margin of invasion and stromal lymphocytic response (p<0.0001). Presence of prominent nucleoli and vesicular nuclear chromatin were the cytological features correlated with basal-like phenotype (p<0.0001). On multivariate analyses, BLBCs were associated with high mitotic number (p<0.0001), the presence of vesicular chromatin (p=0.004), high tubular grade (p=0.011), lymphocytic response (p=0.031) and the absence of carcinoma insitu (p=0.039). Vimentin was positive in 53.2% of BLBCs, while cytokeratin14 was less frequently expressed (27.7%).

Conclusions: BLBCs have some distinctive, but not pathognomonical, morphological features. Paying attention to these features and adding cytokeratin14 and vimentin to the immunohistochemical panel can help the definitive diagnosis of BLBCs.

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Figure 1

Morphological features of BLBCs (HE staining).A. Metaplastic carcinoma shows pushing growth and necrosis (x40). B. Medullary carcinoma with marked lymphocytic response and lacking tubule formation (x200). C. Tumor shows large central necrosis (x200). D. Invasive ductal carcinoma demonstrates moderate lymphocytic response and large central scar (x200). E. Tumor cells exhibit varying amount of cytoplasm, numerous mitosis and nuclear atypia; most of the tumor cells have vesicular chromatin and prominent nucleoli (x400).

Figure 2

Immunohistochemical staining of BLBCs (All photographs were taken at x100 magnification).A. CK 5/6. B. EGFR. C. CK14. D. Vimentin.