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Surgical Pathology Criteria
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Breast Carcinoma with Osteoclast-like Giant Cells

Definition

  • Breast carcinoma with associated multinucleated cells

Alternate/Historical Names

  • Carcinoma with osteoclastic giant cells
  • Carcinoma with stromal multinucleated giant cells

Diagnostic Criteria

  • Background carcinoma is otherwise unremarkable
    • Most types of carcinoma have been reported
      • Infiltrating ductal most common
      • Lobular, adenoid cystic, cribriform, tubular, papillary also reported
  • Multinucleated giant cells associated with the carcinoma
    • 3-50 nuclei
      • Cytologically bland
        • May have prominent nucleoli
      • No mitotic activity in giant cells
    • Usually located in stroma
      • Usually immediately adjacent to nests of carcinoma cells
      • Frequently associated with prominent thin walled vessels and hemosiderin
    • Occasionally located within lumens formed by carcinoma cells
  • Gross appearance frequently spongy and brown/red
  • Must not have sarcomatous or metaplastic stroma

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 15, 2006

Supplemental studies

Immunohistology

  • Giant cells
    • Negative: keratin, EMA, CEA, GCDFP15, S100, Factor VIIIRa, ER, PR
    • Positive: CD68, LCA

Differential Diagnosis

Metaplastic Carcinoma of the Breast with Mesenchymal Differentiation Carcinoma of the Breast with Osteoclast-like Giant Cells
Sarcomatous (malignant) stroma Only giant cells, no neoplastic stroma
May form osteoid (osteosarcoma) No osteoid
Other metaplastic carcinomas with non-mesenchymal differentation would not be confused with carcinomas with osteoclast-like giant cells

Clinical

  • No clear clinical difference from breast carcinomas without giant cells
  • Age range 32-84 years
  • Reported to be about 0.5-1.2% of breast carcinomas

Grading / Staging / Report

Grading

  • Grade should be determined by the underlying carcinoma
    • The giant cells have no impact on grading

  • Bloom-Scarff-Richardson grading scheme is most widely used
  • Total score and each of the three components should be reported
  • Based on invasive area only
Tubule formation Score
>75% tubules 1
10-75% tubules 2
<10% tubules 3

 

Nuclear pleomorphism (most anaplastic area) Score
Small, regular, uniform nuclei, uniform chromatin 1
Moderate varibility in size and shape, vesicular, with visible nucleoli 2
Marked variation, vesicular, often with multiple nucleoli 3

 

Mitotic figure count per 10 40x fields (depends on area of field, see key below) Score
0.096 mm2 0.12 mm2 0.16 mm2 0.27 mm2 0.31 mm2
0-3 0-4 0-5 0-9 0-11 1
4-7 5-8 6-10 10-19 12-22 2
>7 >8 >10 >19 >22 3
  • Olympus BX50, BX40 or BH2 or AO or Nikon with 15x eyepiece: 0.096 mm2
  • AO with 10x eyepiece: 0.12 mm2
  • Nikon or Olympus with 10x eyepiece: 0.16 mm2
  • Leitz Ortholux: 0.27 mm2
  • Leitz Diaplan: 0.31 mm2
  • Mitotic count figures based on original data presented for Leitz Ortholux by Elston and Ellis 1991, with modifications based on pubished and measured areas of view
  • Evaluate regions of most active growth, usually in cellular areas at periphery
  • We employ strict criteria for identification of mitotic figures
Sum of above three components Overall grade
3-5 points Grade I (well differentiated)
6-7 points Grade II (moderately differentiated)
8-9 points Grade III (poorly differentiated)

Staging

  • TNM staging is the most widely used scheme for breast carcinomas but is not universally employed
  • Critical staging criteria for regional lymph nodes
    • Isolated tumor cell clusters
      • Usually identified by immunohistochemistry
        • Term also applies if cells identified by close examination of H&E stain
      • No cluster may be greater than 0.2 mm
      • Multiple such clusters may be present in the same or other nodes
    • Micrometastasis
        • Greater than 0.2 mm, none greater than 2.0 mm
    • Metastasis
      • At least one carcinoma focus over 2.0 mm
        • If one node qualifies as >2.0 mm, count all other nodes even with smaller foci as involved
      • Critical numbers of involved nodes: 1-3, 4-9 and 10 and over
    • Note extranodal extension

Report

  • Excisions: the following are important elements that must be addressed in the report for infiltrative breast carcinomas
    • Grade
      • Total score and individual components
    • Size of neoplasm
      • Give 3 dimensions or greatest dimension
      • Critical cutoffs occur at 0.5 cm and at 2 cm
    • Margins of resection
      • Measure and report the actual distance of both invasive and in situ carcinoma
    • Angiolymphatic invasion
      • Indicate if confined to tumor mass, outside tumor mass or in dermis
    • (Extensive DCIS is not currently felt to be a significant predictor of behavior)
    • Results of special studies performed for diagnosis
    • Results of prognostic special studies performed
      • ER, PR, Proliferation marker, Her2neu
      • If studies were performed on a prior specimen, refer to that report and give results
  • Needle or core biopsies
    • Provisional grade may be given but may defer to excision for definitive grade
    • Presence of absence of angiolymphatic invasion
    • Results of special studies performed for diagnosis
    • Results of prognostic special studies if performed
      • ER, PR, Proliferation marker, Her2neu
      • State if studies are deferred for a later excision specimen
  • Regional lymph nodes
    • Report findings as described above

Lists

Infiltrating Breast Carcinomas

Bibliography

  • Cai N, Koizumi J, Vazquez M. Mammary carcinoma with osteoclast-like giant cells: a study of four cases and a review of literature. Diagn Cytopathol. 2005 Oct;33(4):246-51.
  • Nielsen BB, Kiaer HW. Carcinoma of the breast with stromal multinucleated giant cells. Histopathology. 1985 Feb;9(2):183-93.
  • Holland R, van Haelst UJ. Mammary carcinoma with osteoclast-like giant cells. Additional observations on six cases. Cancer. 1984 May 1;53(9):1963-73.
  • Agnantis NT, Rosen PP. Mammary carcinoma with osteoclast-like giant cells. A study of eight cases with follow-up data. Am J Clin Pathol. 1979 Sep;72(3):383-9.
  • Iacocca MV, Maia DM. Bilateral infiltrating lobular carcinoma of the breast with osteoclast-like giant cells. Breast J. 2001 Jan-Feb;7(1):60-5.
  • Tavassoli FA, Norris HJ. Breast carcinoma with osteoclastlike giant cells. Arch Pathol Lab Med. 1986 Jul;110(7):636-9.
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