Invasion in breast lesions: the role of the epithelial–stroma barrier |
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| Authors: | Emad A Rakha Islam M Miligy Kylie L Gorringe Michael S Toss Andrew R Green Stephen B Fox Fernando C Schmitt Puay‐Hoon Tan Gary M Tse Sunil Badve Thomas Decker Anne Vincent‐Salomon David J Dabbs Maria P Foschini Filipa Moreno Yang Wentao Felipe C Geyer Jorge S Reis‐Filho Sarah E Pinder Sunil R Lakhani Ian O Ellis |
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| Affiliation: | 1. Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK;2. Cancer Genomics Program, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia;3. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia;4. Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia;5. Institute of Molecular Pathology and Immunology (IPATIMUP) and Medical Faculty, University of Porto, Porto, Portugal;6. Department of Pathology, Singapore General Hospital, Singapore;7. Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong;8. Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA;9. Breast‐Screening‐Pathology, Reference Centre Munster, Gerhard Domagk‐Institute of Pathology, University Hospital Münster, Münster, Germany;10. Department of Pathology, Institute Curie, PSL Research University, Paris, France;11. University of Pittsburgh Medical Centre, Pittsburgh, PA, USA;12. Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, University of Bologna, Bologna, Italy;13. Anatomic Pathology Department, Centro Hospitalar do Porto, Porto, Portugal;14. Pathology, Fudan University Shanghai Cancer Center, Shanghai, China;15. Department of Pathology, Memorial Sloan Kettering Cancer Centre, New York, NY, USA;16. Division of Cancer Studies, King's College London, Guy's Hospital, London, UK;17. Discipline of Molecular & Cellular Pathology, Faculty of Medicine, University of Queensland, The Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia |
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| Abstract: | ![]()
Despite the significant biological, behavioural and management differences between ductal carcinoma in situ (DCIS) and invasive carcinoma of the breast, they share many morphological and molecular similarities. Differentiation of these two different lesions in breast pathological diagnosis is based typically on the presence of an intact barrier between the malignant epithelial cells and stroma; namely, the myoepithelial cell (MEC) layer and surrounding basement membrane (BM). Despite being robust diagnostic criteria, the identification of MECs and BM to differentiate in‐situ from invasive carcinoma is not always straightforward. The MEC layer around DCIS may be interrupted and/or show an altered immunoprofile. MECs may be absent in some benign locally infiltrative lesions such as microglandular adenosis and infiltrating epitheliosis, and occasionally in non‐infiltrative conditions such as apocrine lesions, and in these contexts this does not denote malignancy or invasive disease with metastatic potential. MECs may also be absent around some malignant lesions such as some forms of papillary carcinoma, yet these behave in an indolent fashion akin to some DCIS. In Paget's disease, malignant mammary epithelial cells extend anteriorly from the ducts to infiltrate the epidermis of the nipple but do not typically infiltrate through the BM into the dermis. Conversely, BM‐like material can be seen around invasive carcinoma cells and around metastatic tumour cell deposits. Here, we review the role of MECs and BM in breast pathology and highlight potential clinical implications. We advise caution in interpretation of MEC features in breast pathology and mindfulness of the substantive evidence base in the literature associated with behaviour and clinical outcome of lesions classified as benign on conventional morphological examination before changing classification to an invasive lesion on the sole basis of MEC characteristics. |
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| Keywords: | basement membrane breast cancer ductal carcinoma in situ microenvironment myoepithelial cells |
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