Invasive Cribriform Carcinoma of the Breast: A Rare Carcinoma with An Excellent Prognosis

Danielle Gomes, Diego Lima, Rodrigo Farias, Emanuelle Alvarez, Denise Chaves, Ana Cruz, Lizelle Correia, Juliana Vale, Danielle Quintella, Sérgio Monteiro, Anke Bergmann, Luiz Thuler, Marcelo Bello

Abstract


INTRODUCTION: Invasive cribriform carcinoma (ICC) is a rare type of invasive breast carcinoma associated with an excellent prognosis. It exhibits cribriform pattern in the majority of the invasive component and was first recognized as a distinct clinicopathological entity by Page et al. In 1983. The incidence of ICC is 0. 8% to 3.5% of invasive breast carcinomas. It was divided into classical and mixed forms. The aim of this study is to report the pathological and clinical features of 17 cases of ICC treated in the Brazilian National Cancer Institute (INCA).
MATERIAL AND METHODS: Seventeen cases of ICC were identified between 2000 and 2010 in INCA. Data were obtained from Cancer Hospital Registry and medical records. Variables collected were related to socio-demographic factors, clinical features, pathology, treatment and follow-up.
RESULTS: The 17 cases of ICC corresponded to approximately 0. 1% of all invasive breast carcinomas treated in INCA between 2000 and 2010. The mean age at diagnosis was 54. 47 years (SD 15, 31). Classical ICC corresponded to 82. 4% and 15. 6% were of mixed type. Histological grade I was observed in 81. 8% of tumors. All cases were positive to estrogen receptor (ER) and 82. 4% were positive to progesterone receptor (PR). HER 2 was evaluated in only 23.5% of the cases and all were negative. The surgical treatment in all cases was mastectomy (modified radical mastectomy in 88. 2% and simple mastectomy with sentinel node biopsy in 11. 8%). Most of the tumors were staged as T4 (43. 8%), followed by T2 (31. 3%), T1 (12.5%??) and T3 (12.5%). The axilla has proved to be involved in 53% of cases. The most frequent stage was IIIB corresponding to 35. 3% of the cases. Radiotherapy was performed in 64. 7% of patients and systemic treatment with hormone therapy was held in 94. 1%. Chemotherapy was performed in 76.5% of cases (53. 8% neoadjuvant and 46. 2% adjuvant). The patients had a mean follow-up of 64. 15 months (SD 33. 91), and there was no locoregional or distant relapses. During this period there were two deaths (11. 76%) from unrelated causes.
DISCUSSION: in the described population we have found a high rate of locally advanced disease, with the majority (52. 9%) of the patients belonging to stage III. Seven (41%) of them needed neoadjuvant chemotherapy and two (11%) needed neoadjuvant hormone therapy. In the study group we have found a higher rate of lymph nodes involvement (53%) than described in previous studies (14. 3%). Even with all these poor prognosis features we observed that there were no recurrences and no deaths related with breast cancer in a mean follow up of 64. 15 months.
CONCLUSION: Analysis of our data corroborates that ICC consists in a well-differentiated neoplasm with a favorable clinical course even in locally advanced tumors at diagnosis.

SIS Journal is the Electronic Journal of the Senologic International Society, the World Society of Breast Diseases. ISSN: 1688-8170