title: Clinicopathologic features of triple negative breast cancers: an experience from Pakistan.
abstract: BACKGROUND
  Young age breast cancers are quite prevalent in our setup, a significant number of which exhibit triple negative phenotype. These cancers behave in an aggressive fashion and unresponsive to targeted adjuvant therapy. We aimed to evaluate clinical and histopathologic features of triple negative cancers in our population.
  
  
  METHODS
  We retrospectively evaluated 1104 cases of primary breast cancers. Immunohistochemical studies for ER, PR and Her2neu followed by Her2neu gene amplification by FISH testing were done to identify 205 (18.6%) cases of triple negative breast cancers.
  
  
  RESULTS
  Mean age for triple negative breast cancer patients was 48.4 years (±12.3) and 60% of patients were diagnosed at less than 50 years of age. Although ductal carcinoma was the most frequent histologic type, a meaningful number of cases exhibited metaplastic and medullary like features (10.7% and 5.9% respectively). Similarly geographic necrosis involving more than 40% of tumor and extensive lymphocytic infiltration was a considerable finding. Mean Ki67 index was 45.2% (±25.2) and as a reflection of tumor grade, a significantly higher proportion of cases (66.3%) were under high risk Ki67 category (>30%).
  
  
  CONCLUSIONS
  Triple negative breast cancers typify high grade breast cancers with a higher frequency of atypical medullary and metaplastic histologies. Their prevailing occurrence at a younger age raises question of under lying BRCA mutations in our population. Therefore, we suggest that risk factors including BRCA 1 mutations should be uncovered in reproductive age group breast cancers especially those disclosing basal like phenotype.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9042440621102239.
authors.forename: Atif Ali
authors.initials: AA
authors.lastname: Hashmi
authors.forename: Muhammad Muzzammil
authors.initials: MM
authors.lastname: Edhi
authors.forename: Hanna
authors.initials: H
authors.lastname: Naqvi
authors.forename: Naveen
authors.initials: N
authors.lastname: Faridi
authors.forename: Amna
authors.initials: A
authors.lastname: Khurshid
authors.affiliation: Dhaka Medical College, Dhaka, Bangladesh. mehmoodkhan955@yahoo.com.
authors.forename: Mehmood
authors.initials: M
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D064726:Triple Negative Breast Neoplasms / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor