Definition/General
Introduction:
Glassy cell carcinoma of the breast is an extremely rare and aggressive subtype of adenocarcinoma
It is characterized by cells with abundant, eosinophilic, ground-glass cytoplasm, distinct cell borders, and large nuclei with prominent nucleoli
It is more commonly found in the cervix.
Origin:
The origin is uncertain, but it is considered to be a form of high-grade adenosquamous carcinoma.
Classification:
It is a rare variant of invasive breast carcinoma.
Epidemiology:
Extremely rare, with only a few case reports in the literature
It tends to affect younger women and has been reported during pregnancy.
Clinical Features
Presentation:
Presents as a large, rapidly growing, palpable breast mass.
Symptoms:
A painless breast lump is the most common symptom.
Risk Factors:
No specific risk factors are known.
Screening:
Usually presents as a palpable mass
Mammographic and ultrasound findings are non-specific.
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Gross Description
Appearance:
A large, firm, gray-white mass with infiltrative borders.
Characteristics:
The tumor is typically large and solid.
Size Location:
Can occur anywhere in the breast.
Multifocality:
Rare.
Microscopic Description
Histological Features:
The tumor is composed of sheets and nests of large polygonal cells with abundant, finely granular, eosinophilic cytoplasm that has a "glassy" appearance
The cell borders are well-defined
A prominent inflammatory infiltrate, rich in eosinophils and plasma cells, is often present in the stroma.
Cellular Characteristics:
The cells have large, vesicular nuclei with prominent, centrally located, eosinophilic nucleoli
Mitotic activity is high.
Architectural Patterns:
The growth pattern is typically solid and syncytial.
Grading Criteria:
This is a high-grade carcinoma by definition.
Immunohistochemistry
Positive Markers:
The tumor cells are positive for cytokeratins
They can show focal positivity for squamous markers like p63.
Negative Markers:
Typically triple-negative (ER, PR, and HER2 negative).
Diagnostic Utility:
IHC is used to support the diagnosis and to exclude other tumor types.
Molecular Subtypes:
Classified as triple-negative.
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 very poor, with a high rate of local and distant recurrence.
Therapeutic Targets:
Treatment is primarily surgical
As a triple-negative cancer, it does not respond to hormonal or HER2-targeted therapy
Platinum-based chemotherapy is often used.
Differential Diagnosis
Similar Entities:
High-grade adenocarcinoma NST
Apocrine carcinoma
Metaplastic carcinoma.
Distinguishing Features:
High-grade adenocarcinoma NST lacks the characteristic glassy cytoplasm and prominent inflammatory infiltrate
Apocrine carcinoma has more granular cytoplasm and is positive for AR and GCDFP-15
Metaplastic carcinoma may have other mesenchymal components.
Diagnostic Challenges:
The main challenge is its rarity and distinguishing it from other high-grade triple-negative breast cancers.
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]