Definition/General
Introduction:
Villoglandular adenocarcinoma of the breast is an extremely rare variant of adenocarcinoma characterized by a papillary and glandular architecture
It is considered a well-differentiated, low-grade malignancy with a favorable prognosis
It is more commonly described in the cervix and endometrium.
Origin:
It is thought to arise from the ductal epithelium of the breast.
Classification:
It is a rare variant of invasive ductal carcinoma with papillary features.
Epidemiology:
Extremely rare, with only a few case reports in the literature
It typically affects postmenopausal women.
Clinical Features
Presentation:
Presents as a palpable breast mass
The clinical and radiological features are non-specific.
Symptoms:
A painless breast lump is the most common symptom.
Risk Factors:
The risk factors are similar to those for conventional breast cancer.
Screening:
Usually diagnosed after investigation of a palpable mass
Mammographic and ultrasound findings are non-specific.
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Gross Description
Appearance:
A well-circumscribed, soft to firm mass.
Characteristics:
Size is variable
The cut surface may appear granular or papillary.
Size Location:
Can occur anywhere in the breast.
Multifocality:
Rare.
Microscopic Description
Histological Features:
The tumor is characterized by long, slender papillae lined by stratified, non-squamous epithelium
The papillae have a central fibrovascular core
The base of the tumor shows a glandular, infiltrative pattern.
Cellular Characteristics:
The tumor cells are typically low-grade, with minimal nuclear atypia and low mitotic activity.
Architectural Patterns:
A mixture of papillary and glandular patterns is characteristic.
Grading Criteria:
These are typically low-grade (Grade 1) tumors.
Immunohistochemistry
Positive Markers:
The tumor cells are positive for cytokeratins (e.g., CK7)
They are typically ER and PR positive.
Negative Markers:
HER2 is usually negative
Myoepithelial markers are absent in the invasive component.
Diagnostic Utility:
IHC is used to support the diagnosis and to determine hormone receptor status.
Molecular Subtypes:
Most are of the Luminal A molecular subtype.
Molecular/Genetic
Genetic Mutations:
The molecular genetics are not well characterized due to its rarity.
Molecular Markers:
No specific molecular markers are routinely used for diagnosis.
Prognostic Significance:
The prognosis is generally excellent, with a low risk of recurrence and metastasis.
Therapeutic Targets:
Treatment is primarily surgical
Endocrine therapy is often used due to the high rate of ER positivity.
Differential Diagnosis
Similar Entities:
Papillary carcinoma (intraductal or invasive)
Adenoma of the nipple.
Distinguishing Features:
Other papillary carcinomas of the breast typically have more complex architecture and higher-grade cytology
Adenoma of the nipple is a benign lesion confined to the nipple.
Diagnostic Challenges:
The main challenge is its rarity and distinguishing it from other papillary lesions of the breast.
Rare Variants:
The entire entity is a rare variant.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Final Diagnosis
Final diagnosis: [complete diagnosis]