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Review
. 2021 Nov 14;13(22):5694.
doi: 10.3390/cancers13225694.

Triple-Negative Breast Cancer Histological Subtypes with a Favourable Prognosis

Gábor Cserni  1   2 , Cecily M Quinn  3   4 , Maria Pia Foschini  5 , Simonetta Bianchi  6 , Grace Callagy  7 , Ewa Chmielik  8 , Thomas Decker  9   10   11 , Falko Fend  12 , Anikó Kovács  13 , Paul J van Diest  14 , Ian O Ellis  15 , Emad Rakha  15 , Tibor Tot  16 , European Working Group For Breast Screening Pathology
Affiliations
Review

Triple-Negative Breast Cancer Histological Subtypes with a Favourable Prognosis

Gábor Cserni et al. Cancers (Basel). .

Abstract

Triple-negative breast cancers (TNBC), as a group of tumours, have a worse prognosis than stage-matched non-TNBC and lack the benefits of routinely available targeted therapy. However, TNBC is a heterogeneous group of neoplasms, which includes some special type carcinomas with a relatively indolent course. This review on behalf of the European Working Group for Breast Screening Pathology reviews the literature on the special histological types of BC that are reported to have a triple negative phenotype and indolent behaviour. These include adenoid cystic carcinoma of classical type, low-grade adenosquamous carcinoma, fibromatosis-like metaplastic carcinoma, low-grade mucoepidermoid carcinoma, secretory carcinoma, acinic cell carcinoma, and tall cell carcinoma with reversed polarity. The pathological and known molecular features as well as clinical data including treatment and prognosis of these special TNBC subtypes are summarised and it is concluded that many patients with these rare TNBC pure subtypes are unlikely to benefit from systemic chemotherapy. A consensus statement of the working group relating to the multidisciplinary approach and treatment of these rare tumour types concludes the review.

Keywords: acinic cell carcinoma; adenoid cystic carcinoma; fibromatosis like metaplastic carcinoma; low-grade adenosquamous carcinoma; mucoepidermoid carcinoma; secretory carcinoma; tall cell carcinoma with reversed polarity; triple negative breast cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heterogeneity of triple negative breast cancers. (A) Low magnification view of acinic cell carcinoma (ACC) with microglandular architecture composed of small glands, tightly packed together. The ACC glands are lined by cells with bland morphology and mild atypia; (B) Low magnification view of classic adenoid-cystic carcinoma with cribriform architecture composed of glandular structures containing basophilic and eosinophilic mucins; (C) Low magnification view of fibromatosis like metaplastic carcinoma characterized by a proliferation of spindle cells entrapping normal breast glands; (D) Low magnification view of low-grade adenosquamous carcinoma; glandular structures are elongated, with pointed edges and intermingled with small nests of squamous cells; (E) Medium power view of low grade mucoepidermoid carcinoma presenting with prominent cystic architecture; the cystic spaces are lined by cells with epidermoid features, intermingled with mucoid cells; (F) Medium power view of secretory carcinoma with tightly packed secretion filled glandular lumina; (G) Medium power view of tall cell carcinoma with reversed polarity with nests of tumour cells forming glands including follicle-like ones; note that the outer layer of several nests has nuclei away from the basal aspect of the cells; (H) Medium power view of a triple negative breast cancer (TNBC) of no special type (NST) with high grade nuclei, relative circumscription, lymphocyte rich stroma and predicted aggressive behaviour for comparison with (A) to (G) as differing subtypes with better prognosis.
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