BREAST TUMOR MAP

Prepared by C. Krishnan, MD
Ref: WHO Tumors of the Breast (5th ed, 2020).

LEGEND

ER POSITIVE (* at least mostly) SMALL GLAND

PROLIF M
PALPABLE
MASS
NODULAR /
LOBULATED
PAPILLARY
CYSTIC /
ENCAPSULATED INFILTRATIVE
YOUNG
WOMEN
OLD
WOMEN 3
TRIPLE
NEGATIVE

NIPPLE ADENOMA M
PSEUDOANGIOMATOUS STROMAL HYPER.
Proliferative epithelial lesion w/ irregular ducts. Inconspicuous spindle cell myofibroblasts, with
UDH, cribriform and sclerosing patterns. May
MX

artifactual cracking of stroma. Occasionally

MX
have ulceration of nipple skin. fascicular with collagen.
M
BENIGN PHYLLODES TUMOR
POS: MyoEps, ER, CK5/6 (patchy) POS: ER, PR,CD34, Desmin
IHC

Fibroepithelial lesion with broad, leaf-like

IHC
NEG: Ker, S100, CD31, D2-40
projections. No stromal overgrowth, atypia or

MX
Syringoma (based on location), Tubular adenoma Myofibroblastoma (if fascicular), Vascular excess mitoses (<5/10hpf)
DDX

DDX
lesions Epithelium: ER+ (50%), PR+, Ker+

IHC
BENIGN

Stroma: ER+ (50%), PR+

M M Juvenile FA (? same thing) vs cellular FA
MYOFIBROBLASTOMA

TUBULAR ADENOMA
Circumscribed borders, closely packed bilayered
tubules, no compression,, scant stroma; +/-
PAPILLOMA
Rounded lesions with fibrovascular cores,
frequent UDH, slit-like spaces. +/- Apocrine
DDX
Borderline Phyllodes tumor
Bland spindle cells + collagen + entrapped fat
without entrapped DLUs. Not widely infiltrative.

MX
MX
MX

secretions. Usu. younger women changes, squamous metaplasia del13q (RB1) typical
MyoEp+: p63, p40. MyoEp: Around and inside stalks. UDH: CK5/6+ POS: ER, PR, CD34, Desmin, CD99, CD10

IHC
IHC
IHC

Luminal+: EMA, CK19 patchy, ER+ patchy NEG: Ker, S100, Alk, STAT6, EMA
w/ ADH/DCIS, Encapsulated, Papillary Hamartoma, SFT, Fibromatosis,

DDX
Reguar fibroadenoma, Ductal adenoma, AME
DDX
DDX

carcinoma Fasicular PASH

TUBULAR CARCINOMA PAPILLOMA w/ ADH or DCIS PAPILLARY DCIS BORDERLINE PHYLLODES TUMOR
LOW-GRADE / INDOLENT

Usually small sized, infiltrative tubules with Phyllodes tumor that meets some, but not all
angulated/comma-shaped outlines. Often see Papilloma with partial monotonous growth, rigid Papilloma with uniform monotonous growth, malignant criteria or has only well-diff liposarc.

MX
MX

MX

MX
FEA or columnar lesions elsewhere. rounded spaces, rounded nuclei rigid rounded spaces, rounded nuclei heterologous elements M
MyoEp: Around but missing in areas involved. MyoEp: Around periphery only. CK5/6 -, ER+ Epithelium: ER+ (50%), PR+, Ker+
ER+, PR+, HER2-

IHC
IHC

IHC

IHC
ADH/DCIS: CK5/6 -, ER+ uniformly uniformly Stroma: ER+ (50%), PR+
Juvenile FA (? same thing) vs cellular FA
Adenoid cystic ca, LG adenosquamous ca

DDX
DDX

w/ ADH: <3mm w/DCIS: >3 mm Encapsulated Papillary Carcinoma

DDX

DDX
Malignant Phyllodes tumor

M
ENCAPSULATED PAPILLARY CARCINOMA
Papilloma with uniform monotonous growth,
rigid rounded spaces, rounded nuclei. Like DCIS
MX

MUCINOUS CARCINOMA M M clinically, indolent- pTis (if no invasion)

MICROINVASIVE DUCTAL CARCINOMA
> 90% mucinous component, with clusters of Focus/foci measuring <1 mm in size. Often M
MyoEp: Irregular/periphery, ER+ uniformly MALIGNANT PHYLLODES TUMOR
IHC

epithelial tumour cells of low to intermediate associated with lymphoid reaction in HG-DCIS.
MX

NEG: CK5/6
MX

Phyllodes tumor with: infiltrative sarcomatous

HIGHER-GRADE OR AGGRESSIVE BEHAVIOR

nuclear grade. No signet ring morphology. Staged pT1mi regardless of #. overgrowth in 40x field, >10 mites / 10hpf,

MX
w/ microinvasion, Solid papillary carcinoma diffuse cytologic atypia.
DDX

ER+, PR+. HER2 -

IHC

MyoEps: Lost in areas of microinvasion

IHC

Rarely p63 / Ker+ focally positive !! Take

IHC
Mucocele-like lesion (MyoEp+); Invasive lobular care in small biopsies with stroma only
DDX

Cancerization of lobules or ducts

DDX

with extracellular mucin Metaplastic carcinoma (in small samples)

DDX
Stromal sarcoma (if no epithelium seen)

MICROPAPILLARY CARCINOMA SOLID PAPILLARY CARCINOMA

> 90% pattern of hollow or morula-like Closely grouped & solid-appearing, with focal
aggregates neoplastic cells w/o fibrovascular fibrovascular cores. pTis (if all rounded), Inv (if
MX

MX

cores. Usually high-grade cytology. irregular shapes or frank invasive part)

Usually ER+/PR+/HER2+ (20% triple neg) MyoEp: Usually absent. CK5/6-, ER+.
IHC

IHC

EMA with parastromal staining Often synapto or chromo+

Mucinous carcinomas
DDX

Papilloma w/ florid UDH.

DDX