Medullary Carcinoma of the Breast
Grading / Staging / Report
Grading
- Bloom-Scarff-Richardson grading does not apply to medullary carcinoma
- It is histologically high grade by definition
- It is clinically low grade as long as the nodes are negative
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
- Usually identified by immunohistochemistry
- 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
- At least one carcinoma focus over 2.0 mm
- Note extranodal extension
- Isolated tumor cell clusters
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
- Grade
- 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
