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The Role of Immunohistochemistry in Breast Pathology

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Practical Atlas of Breast Pathology

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Abstract

The current practice of breast pathology is virtually unthinkable without the use of immunohistochemistry (IHC) [1, 2]. However, this indispensable diagnostic technique is burdened by numerous issues. This chapter is intended to outline the main uses of IHC in breast pathology. Furthermore, the problems and pitfalls inherent in the use of this technique are briefly discussed. Some common histopathological dilemmas—including usual versus atypical hyperplasia, benign versus malignant papillary lesions, and pseudoinvasive versus microinvasive carcinoma, etc. are considered. Also, issues relating to sentinel lymph node assessment, “surrogate” molecular classification, and workup of metastatic carcinomas in breast are briefly discussed. The role of immunostaining in assessing prognostic and predictive markers (including ER and HER2) of breast carcinoma are also concisely reviewed.

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References

  1. Yeh IT, Mies C. Application of immunohistochemistry to breast lesions. Arch Pathol Lab Med. 2008;132:349–58.

    PubMed  Google Scholar 

  2. Moriya T, Kozuka Y, Kanomata N, Tse GM, Tan PH. The role of immunohistochemistry in the differential diagnosis of breast lesions. Pathology. 2009;41:68–76.

    Article  CAS  PubMed  Google Scholar 

  3. Gown AM. Diagnostic immunohistochemistry: what can go wrong and how to prevent it. Arch Pathol Lab Med. 2016;140:893–8.

    Article  PubMed  Google Scholar 

  4. Hoda SA, Rosen PP. Contemporaneous H&E sections should be standard practice in diagnostic immunopathology. Am J Surg Pathol. 2007;31:1627.

    Article  PubMed  Google Scholar 

  5. Cserni G. Lack of myoepithelium in apocrine glands of the breast does not necessarily imply malignancy. Histopathology. 2008;52:253–5.

    Article  CAS  PubMed  Google Scholar 

  6. Tramm T, Kim JY, Tavassoli FA. Diminished number or complete loss of myoepithelial cells associated with metaplastic and neoplastic apocrine lesions of the breast. Am J Surg Pathol. 2011;35:202–11.

    Article  PubMed  Google Scholar 

  7. Geyer FC, Berman SH, Marchiò C, Burke KA, Guerini-Rocco E, Piscuoglio S, et al. Genetic analysis of microglandular adenosis and acinic cell carcinomas of the breast provides evidence for the existence of a low-grade triple-negative breast neoplasia family. Mod Pathol. 2017;30:69–84.

    Article  CAS  PubMed  Google Scholar 

  8. Gatalica Z. Immunohistochemical analysis of apocrine breast lesions. Consistent over-expression of androgen receptor accompanied by the loss of estrogen and progesterone receptors in apocrine metaplasia and apocrine carcinoma in situ. Pathol Res Pract. 1997;193:753–8.

    Article  CAS  PubMed  Google Scholar 

  9. Mills AM, Gottlieb EC, Wendroth MS, Brenin MC, Atkins KA. Pure apocrine carcinomas represent a clinicopathologically distinct androgen receptor-positive subset of triple-negative breast cancers. Am J Surg Pathol. 2016;40:1109–16.

    Article  PubMed  Google Scholar 

  10. Nofech-Mozes S, Holloway C, Hanna W. The role of cytokeratin 5/6 as an adjunct diagnostic tool in breast core needle biopsies. Int J Surg Pathol. 2008;16:399–406.

    Article  PubMed  Google Scholar 

  11. Lee AH. Use of immunohistochemistry in the diagnosis of problematic breast lesions. J Clin Pathol. 2013;66:471–7.

    Article  CAS  PubMed  Google Scholar 

  12. Khazai L, Rosa M. Use of Immunohistochemical stains in epithelial lesions of the breast. Cancer Control. 2015;22:220–5.

    Article  PubMed  Google Scholar 

  13. Canas-Marques R, Schnitt SJ. E-cadherin immunohistochemistry in breast pathology: uses and pitfalls. Histopathology. 2016;68:57–69.

    Article  PubMed  Google Scholar 

  14. Butler D, Rosa M. Pleomorphic lobular carcinoma of the breast: a morphologically and clinically distinct variant of lobular carcinoma. Arch Pathol Lab Med. 2013;137:1688–92.

    Article  PubMed  Google Scholar 

  15. Eisenberg RE, Hoda SA. Lobular carcinoma in situ with collagenous spherulosis: clinicopathologic characteristics of 38 cases. Breast J. 2014;20:440–1.

    Article  PubMed  Google Scholar 

  16. Jorns JM. Papillary lesions of the breast: a practical approach to diagnosis. Arch Pathol Lab Med. 2016;140:1052–9.

    Article  PubMed  Google Scholar 

  17. Tse GM, Tan PH, Moriya T. The role of immunohistochemistry in the differential diagnosis of papillary lesions of the breast. J Clin Pathol. 2009;62:407–13.

    Article  CAS  PubMed  Google Scholar 

  18. Wynveen CA, Nehhozina T, Akram M, Hassan M, Norton L, Van Zee KJ, et al. Intracystic papillary carcinoma of the breast: an in situ or invasive tumor? Results of immunohistochemical analysis and clinical follow-up. Am J Surg Pathol. 2011;35:1–14.

    Article  PubMed  Google Scholar 

  19. Rakha EA, Tun M, Junainah E, Ellis IO, Green A. Encapsulated papillary carcinoma of the breast: a study of invasion associated markers. J Clin Pathol. 2012;65:710–4.

    Article  PubMed  Google Scholar 

  20. Hilson JB, Schnitt SJ, Collins LC. Phenotypic alterations in myoepithelial cells associated with benign sclerosing lesions of the breast. Am J Surg Pathol. 2010;34:896–900.

    Article  PubMed  Google Scholar 

  21. Cheng E, D'Alfonso TM, Arafah M, Marrero Rolon R, Ginter PS, Hoda SA. Subareolar sclerosing ductal hyperplasia. Int J Surg Pathol. 2017;25:4–11.

    Article  PubMed  Google Scholar 

  22. Ozerdem U, Swistel A, Antonio LB, Hoda SA. Invasive Paget disease of the nipple: a brief review of the literature and report of the first case with axillary nodal metastases. Int J Surg Pathol. 2014;22:566–9.

    Article  PubMed  Google Scholar 

  23. Liegl B, Leibl S, Gogg-Kamerer M, Tessaro B, Horn LC, Moinfar F. Mammary and extramammary Paget’s disease: an immunohistochemical study of 83 cases. Histopathology. 2007;50:439–47.

    Article  CAS  PubMed  Google Scholar 

  24. Park S, Suh YL. Useful immunohistochemical markers for distinguishing Paget cells from Toker cells. Pathology. 2009;41:640–4.

    Article  PubMed  Google Scholar 

  25. Ross DS, Hoda SA. Microinvasive (T1mic) lobular carcinoma of the breast: clinicopathologic profile of 16 cases. Am J Surg Pathol. 2011;35:750–6.

    Article  PubMed  Google Scholar 

  26. Rakha EA, Aleskandarany MA, Lee AH, Ellis IO. An approach to the diagnosis of spindle cell lesions of the breast. Histopathology. 2016;68:33–44.

    Article  PubMed  Google Scholar 

  27. Chia Y, Thike AA, Cheok PY, Yong-Zheng Chong L, Man-Kit Tse G, Tan PH. Stromal keratin expression in phyllodes tumours of the breast: a comparison with other spindle cell breast lesions. J Clin Pathol. 2012;65:339–47.

    Article  PubMed  Google Scholar 

  28. Cimino-Mathews A, Sharma R, Illei PB, Vang R, Argani P. A subset of malignant phyllodes tumors express p63 and p40: a diagnostic pitfall in breast core needle biopsies. Am J Surg Pathol. 2014;38:1689–96.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Arafah MA, Ginter PS, D'Alfonso TM, Hoda SA. Epithelioid mammary myofibroblastoma mimicking invasive lobular carcinoma. Int J Surg Pathol. 2015;23:284–8.

    Article  PubMed  Google Scholar 

  30. Hoda SA, Hoda RS, Merlin S, Shamonki J, Rivera M. Issues relating to lymphovascular invasion in breast carcinoma. Adv Anat Pathol. 2006;13:308–15.

    Article  PubMed  Google Scholar 

  31. Rosen PP. Tumor emboli in intramammary lymphatics in breast carcinoma: pathologic criteria for diagnosis and clinical significance. Pathol Annu. 1983;18(Pt 2):215–32.

    PubMed  Google Scholar 

  32. Patton KT, Deyrup AT, Weiss SW. Atypical vascular lesions after surgery and radiation of the breast: a clinicopathologic study of 32 cases analyzing histologic heterogeneity and association with angiosarcoma. Am J Surg Pathol. 2008;32:943–50.

    Article  PubMed  Google Scholar 

  33. Rabban JT, Chen YY. D2–40 expression by breast myoepithelium: potential pitfalls in distinguishing intralymphatic carcinoma from in situ carcinoma. Hum Pathol. 2008;39:175–83.

    Article  CAS  PubMed  Google Scholar 

  34. Rivera M, Merlin S, Hoda RS, Gopalan A, Hoda SA. Controversies in surgical pathology: minimal involvement of sentinel lymph node in breast carcinoma: prevailing concepts and challenging problems. Int J Surg Pathol. 2004;12:301–6.

    Article  PubMed  Google Scholar 

  35. Hoda SA, Chiu A, Resetkova E, Harigopal M, Hoda RS, Osborne MP. Pathological examination of sentinel lymph node in breast cancer: potential problems and possible solutions. Microsc Res Tech. 2002;59:85–91.

    Article  PubMed  Google Scholar 

  36. Ozerdem U, Hoda SA. Endosalpingiosis of axillary sentinel lymph node: a mimic of metastatic breast carcinoma. Breast J. 2015;21:194–5.

    Article  PubMed  Google Scholar 

  37. Robinson BD, Amin BD, Hoda SA. Alternaria simulating metastatic breast carcinoma in cytokeratin-stained axillary sentinel node sections. Breast J. 2008;14:120–1.

    Article  PubMed  Google Scholar 

  38. Scognamiglio T, Hoda RS, Edgar MA, Hoda SA. The need for vigilance in the pathologic evaluation of sentinel lymph nodes: a report of two illustrative cases. Breast J. 2003;9:420–2.

    Article  PubMed  Google Scholar 

  39. Hoda SA, Resetkova E, Yusuf Y, Cahan A, Rosen PP. Megakaryocytes mimicking metastatic breast carcinoma. Arch Pathol Lab Med. 2002;126:618–20.

    PubMed  Google Scholar 

  40. Chiu A, Hoda RS, Hoda SA. Pseudomicrometastasis in sentinel lymph node-multinucleated macrophage mimicking micrometastasis. Breast J. 2001;7:440–1.

    Article  CAS  PubMed  Google Scholar 

  41. Chiu A, Hoda SA, Yao DX, Rosen PP. A potential source of false-positive sentinel nodes: immunostain misadventure. Arch Pathol Lab Med. 2001;125:1497–9.

    PubMed  CAS  Google Scholar 

  42. DeLair DF, Corben AD, Catalano JP, Vallejo CE, Brogi E, Tan LK. Non-mammary metastases to the breast and axilla: a study of 85 cases. Mod Pathol. 2013;26:343–9.

    Article  PubMed  Google Scholar 

  43. Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60:1333–41.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Miettinen M, McCue PA, Sarlomo-Rikala M, Rys J, Czapiewski P, Wazny K, et al. GATA3: a multispecific but potentially useful marker in surgical pathology: a systematic analysis of 2500 epithelial and nonepithelial tumors. Am J Surg Pathol. 2014;38:13–22.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hoda S, Rao R, Hoda RS. Breast implant-associated anaplastic large cell lymphoma. Int J Surg Pathol. 2015;23:209–10.

    Article  PubMed  Google Scholar 

  46. Fitzgibbons PL, Dillon DA, Alsabeh R, Berman MA, Hayes DF, Hicks DG, et al. Template for reporting results of biomarker testing of specimens from patients with carcinoma of the breast. Arch Pathol Lab Med. 2014;138:595–601.

    Article  PubMed  Google Scholar 

  47. Yi M, Huo L, Koenig KB, Mittendorf EA, Meric-Bernstam F, Kuerer HM, et al. Which threshold for ER positivity? a retrospective study based on 9639 patients. Ann Oncol. 2014;25:1004–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.

    Article  PubMed  Google Scholar 

  49. Prat A, Pineda E, Adamo B, Galván P, Fernández A, Gaba L, et al. Clinical implications of the intrinsic molecular subtypes of breast cancer. Breast. 2015;24(Suppl 2):S26–35.

    Article  PubMed  Google Scholar 

  50. Leidy J, Khan A, Kandil D. Basal-like breast cancer: update on clinicopathologic, immunohistochemical, and molecular features. Arch Pathol Lab Med. 2014;138:37–43.

    Article  CAS  PubMed  Google Scholar 

  51. Vasconcelos I, Hussainzada A, Berger S, Fietze E, Linke J, Siedentopf F, et al. The St. Gallen surrogate classification for breast cancer subtypes successfully predicts tumor presenting features, nodal involvement, recurrence patterns and disease free survival. Breast. 2016;29:181–5.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA

    Syed A. Hoda MD

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  1. Syed A. Hoda MD
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Correspondence to Syed A. Hoda MD .

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Editors and Affiliations

  1. Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

    Simona Stolnicu

  2. Department of Pathology, Hospital de Oncologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Isabel Alvarado-Cabrero

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Hoda, S.A. (2018). The Role of Immunohistochemistry in Breast Pathology. In: Stolnicu, S., Alvarado-Cabrero, I. (eds) Practical Atlas of Breast Pathology . Springer, Cham. https://doi.org/10.1007/978-3-319-93257-6_17

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  • DOI: https://doi.org/10.1007/978-3-319-93257-6_17

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-93257-6

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