The prognostic significance of inflammation and medullary histological type in invasive carcinoma of the breast
Introduction
Recent gene expression and immunophenotypic studies of breast cancer have reawakened interest in basal-like breast cancers and have placed medullary carcinomas in this class.1, 2, 3, 4, 5 The basal group also includes non-medullary carcinomas with some medullary histological features including a lymphoid rich stroma. The basal-like class has a poor prognosis, but medullary carcinoma has been reported to be associated with a better prognosis than other grade 3 carcinomas.6, 7 The definition of medullary carcinoma and distinction from other histological types remains controversial.8, 9, 10 Recently, the term medullary-like carcinoma was proposed to include both typical and atypical medullary carcinoma.11
The prognostic significance of inflammation, a prominent feature of medullary carcinoma, is also controversial.12, 13 Some mammary carcinomas contain the appropriate cell types required for a cell mediated immune response (macrophages, T cells and dendritic cells), but there is evidence that the function of these cells is often impaired.14, 15, 16 Inflammatory cells can also potentially stimulate tumour growth; mechanisms include the release of proteolytic enzymes and angiogenic factors.17, 18
This study aimed to investigate the prognostic significance of routinely diagnosed medullary carcinomas and tumour associated inflammation and the relationship between these two factors in invasive carcinoma of the breast.
Section snippets
Materials and methods
The study included patients with primary operable invasive breast carcinoma that was clinically less than 5 cm and treated with definitive surgery at Nottingham City Hospital between 1974 and 1988. All the patients were less than 71 years of age at the time of initial surgery. No patient received adjuvant chemotherapy or hormone therapy.
Tumours were incised immediately to ensure good fixation. The Nottingham method was used for histological grading.19 Tumour size was based on macroscopic
The relation of inflammation to other prognostic factors
Prominent inflammation was seen in 9% of tumours. Increasing inflammation was correlated with increasing histological grade (rs = 0.46, P < 0.0001), weakly correlated with increasing tumour size (rs = 0.12, P < 0.0001) and inversely correlated with patient age (rs = −0.12, P < 0.0001) (Table 1). The intensity of inflammation was greater in medullary carcinomas (typical and atypical) than ductal, lobular, tubular/cribriform and mucinous carcinomas (P < 0.0001 for all analyses, Mann–Whitney U test) and more in
Discussion
There has been a reawakening of interest in medullary carcinoma as a result of its morphological and immunophenotypical association with two of the most topical entities in breast cancer; BRCA1 associated tumours23 and basal-like cancers.3, 4, 24 BRCA1 associated tumours and the poor prognostic ‘basal-like’ cancer cross the spectrum of medullary carcinoma (typical and atypical) and invasive ductal carcinoma with high grade nuclei, high mitotic activity, and lymphoid rich stroma. The shared
Conflict of interest statement
None declared.
References (38)
- et al.
Medullary carcinoma of the breast. Prevalence and prognostic importance of classical risk factors in breast cancer
Eur J Cancer
(1995) - et al.
Implications of pathologist concordance for breast cancer assessments in mammography screening from age 40 years
Hum Pathol
(2002) - et al.
Survival of invasive breast cancer according to the Nottingham prognostic index in cases diagnosed in 1990 to 1999
Eur J Cancer
(2007) - et al.
Molecular portraits of human breast tumours
Nature
(2000) - et al.
Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications
Proc Natl Acad Sci USA
(2001) - et al.
Morphological and immunophenotypic analysis of breast carcinomas with basal and myoepithelial differentiation
J Pathol
(2006) - et al.
Typical medullary breast carcinomas have a basal/myoepithelial phenotype
J Pathol
(2005) - et al.
Basal-like breast cancer: a critical review
J Clin Oncol
(2008) - et al.
Pathological prognostic factors in breast cancer. II. Histological type. Relationship with survival in a large study with long-term follow-up
Histopathology
(1992) - et al.
Medullary carcinoma of the breast: interobserver variability in histopathologic diagnosis
Mod Pathol
(1995)
Inter- and intraobserver variability in the histopathological diagnosis of medullary carcinoma of the breast, and its prognostic implications
Breast Cancer Res Treat
Prognostic significance of HER-2/neu expression in breast cancer and its relationship to other prognostic factors
Int J Cancer
Different patterns of inflammation and prognosis in invasive carcinoma of the breast
Histopathology
Tumor specific cytolysis by tumor infiltrating lymphocytes in breast cancer
Cancer
High incidence of interleukin 10 mRNA but not interleukin 2 mRNA detected in human breast tumours
Br J Cancer
Decreased antigen presentation by dendritic cells in patients with breast cancer
Clin Cancer Res
Activity of type IV collagenases in benign and malignant breast disease
Br J Cancer
Platelet-derived endothelial cell growth factor/thymidine phosphorylase expression in macrophages correlates with tumor angiogenesis and prognosis in invasive breast cancer
Int J Oncol
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