Estrogen receptor-negative breast carcinomas: a review of morphology and immunophenotypical analysis.
Estrogen receptor (ER)-negative breast cancers are a group of tumors with poor prognosis and fewer cancer prevention and treatment strategies compared to ER-positive tumors. The aim of this study was to assess the morphological characteristics and immunohistochemical profile of ER-negative tumors and thus to understand the biological behavior and unique nature. In total, 291 consecutive ER-negative cases available from our primary breast cancer series were examined. Hematoxylin- and eosin-stained sections of all the cases were studied for several morphological parameters and their immunophenotype profile. These findings were correlated with patient and tumor characteristics and survival data. ER-negative tumors constituted 30% of the primary operable breast cancer series. The majority of tumors were grade 3 (94%) and the commonest histological types were ductal/no specific type (85%), and atypical medullary carcinoma (8%). High-grade comedo-type necrosis, lymphoid stroma, central necrosis/fibrosis and pushing margins were the most common morphological features. The presence of a pushing margin showed a significant relation to androgen receptor negativity, absence of epidermal growth factor receptor expression and negative lymph nodes. Lymphoid stroma and comedo-necrosis correlated with higher tumor grade. ER-negative breast cancers are a distinct group of tumors with several common morphological features. Grade 3 histology, pushing margin, lymphoid stroma, comedo-type necrosis and central fibrosis/necrosis are the dominant morphological findings. The presence of a pushing margin appears to have a significant correlation with negative lymph node status. ER-negative tumors show a higher expression of p53, CerbB2 and epidermal growth factor receptor compared to ER-positive breast cancer. These unique features support the concept that ER-negative tumors are a morphologically and phenotypically distinct entity and provide a rationale for the study and use of newer promising agents in the treatment of ER-negative breast cancer.
Department of Pathology, National University of Singapore, Singapore.
Thomas C
TC
Putti
Dalia M Abd
DM
El-Rehim
Emad A
EA
Rakha
Claire E
CE
Paish
Andrew H S
AH
Lee
Sarah E
SE
Pinder
Ian O
IO
Ellis
D000199:Actins / Q000032:analysis; D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000032:analysis; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology*; D015820:Cadherins / Q000032:analysis; D002352:Carrier Proteins / Q000032:analysis; D005260:Female; D006023:Glycoproteins / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D026901:Membrane Transport Proteins; D008875:Middle Aged; D015999:Multivariate Analysis; D009130:Muscle, Smooth / Q000737:chemistry; D018739:Oncogene Proteins v-erbB / Q000032:analysis; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis*; D016019:Survival Analysis; D046888:Tissue Array Analysis; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
D000199:Actins; D019313:BRCA1 Protein; D015820:Cadherins; D002352:Carrier Proteins; D006023:Glycoproteins; D007633:Keratins; D026901:Membrane Transport Proteins; D018739:Oncogene Proteins v-erbB; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D016159:Tumor Suppressor Protein p53; C488892:PIP protein, human