Invasive Cribriform Carcinoma
A special type of invasive carcinoma with an excellent prognosis that grows in a pattern similar to that seen in intraductal cribriform carcinoma.
Incidence: Invasive cribriform carcinoma accounts for 0.3–0.8% of breast carcinomas (Venable et al. 1990; Li et al. 2005; Louwman et al. 2007); however, a frequency of up to 4% has been reported in some series (Page et al. 1983; Venable et al. 1990).
Age: Mean patient age is 53–58 years (Venable et al. 1990).
Sex: Female; rare in male as for other forms of breast cancer.
Site: Anywhere in the breast but most frequent in the upper outer quadrant like other types of breast cancer.
Treatment: Local control and hormone therapy are the main treatment options. Even when patients have axillary metastases from pure invasive cribriform carcinoma, the prognosis is good. The use of systemic adjuvant chemotherapy is typically not needed in pure early-stage invasive cribriform carcinomas.
Outcome: Invasive cribriform carcinoma, like tubular carcinoma, has a favorable outcome with 10-year overall survival of 90% (Ellis et al. 1992) to 100% (Page et al. 1983; Louwman et al. 2007). The outcome of mixed invasive cribriform carcinoma is less favorable than that of the pure form but better than that of no special type (NST) carcinoma (Page et al. 1983). Axillary node metastases occur in 14% of cases (Page et al. 1983) and rarely involve more than one or two axillary lymph nodes.
There is no specific macroscopic feature that distinguishes invasive cribriform carcinoma from no special type (NST) or mixed types. Mean tumor size is 3 cm (Page et al. 1983). The consistency is generally hard, but foci of hemorrhage may be seen. Necrosis is not a feature of cribriform carcinoma. Calcification is common and may be the presenting sign on mammography.
DCIS, generally of cribriform architecture, is frequent (80%) (Page et al. 1983). If axillary metastasis develops, the cribriform pattern is typically retained. Invasive cribriform carcinoma can show prominent tubular component similar to that of tubular carcinoma in up to 50% of the tumor (Page et al. 1983). Cases with a 10–40% component of another morphological type (other than tubular carcinoma) are regarded as mixed type (Page et al. 1983; Venable et al. 1990).
Invasive cribriform carcinoma typically displays a luminal A phenotype with high expression of hormone receptors, luminal cytokeratins, and E-cadherin. Pure invasive cribriform carcinoma does not express basal cytokeratins and lacks HER2 gene amplification and p53 expression.
Invasive cribriform carcinoma and tubular carcinoma have similar genomic and transcriptomic features.
Invasive cribriform carcinoma should be differentiated from cribriform DCIS, adenoid cystic carcinoma, and other types of breast carcinoma with cribriform areas. Invasive cribriform carcinoma is distinguished from cribriform DCIS by the lack of a myoepithelial cell layer around its invasive islands and its haphazard distribution and irregular configuration. Adenoid cystic carcinoma has a second population of cells as well as intracystic secretory and basement membrane-like (e.g., laminin positive) material (Wells and Ferguson 1988). The presence of osteoclast-like giant cells in the stroma is mostly seen in ICC, but such giant cells may be seen in other types of invasive mammary carcinoma and are not diagnostic of invasive cribriform carcinoma.
- Louwman, M. W., Vriezen, M., van Beek, M. W., Nolthenius-Puylaert, M. C., van der Sangen, M. J., Roumen, R. M., Kiemeney, L. A., & Coebergh, J. W. (2007). Uncommon breast tumors in perspective: Incidence, treatment and survival in the Netherlands. International Journal of Cancer, 121, 127–135.CrossRefGoogle Scholar