Lipid-rich breast carcinoma
Lipid rich breast carcinoma is sometimes also referred to as lipid secreting carcinoma of the breast. It is a type of invasive breast cancer in which the carcinoma cells have abundant fat (lipid) in their cytoplasm. It is a very rare type of breast cancer, accounting for between 1% to 2% of all breast carcinomas. Basically, to be identified as lipid-rich breast cancer, around 90% of the cells should have prominent intracytoplasmic neutral lipid, or ‘fat‘.
This page is getting somewhat old and a little bit out-dated. However, because of that, I have created a newer version of this page with more up-to-date information on Lipid-rich Breast Carcinoma. Oh, and just to let you know, this page still has great material and I would still recommend on using it as well as the new one.
Though rare, lipid rich breast carcinoma is considered to be an aggressive form of breast cancer. This is because it has a rather high rate of lymph node metastasis.
Histological features typical of lipid-rich carcinoma of the breast
One of the things that distinguishes lipid-rich breast cancer is the presence of clear, multivacuolated or foamy cytoplasm. There also may be areas of oxyphilic cytoplasm. And of course, lipid-rich breast carcinoma is characterized by abundant intracytoplasmic lipids. Usually these lipids will stain with “Oil red O” stain. Malignant cells typically present in a variety of patterns, including sheets, alveoli, cords, and nests.
Cancer cells are typically big, round, or oval, and foamy. Nuclei are often irregular and with coarse chromatin, moderate atypica, and prominent nucleoli. Lipid rich carcinoma cells somewhat resemble clear cells or lipoblasts. The cytoplasm is usually rich and lucent, with visible vacuoles in part of the cells. Lipid-rich breast carcinomas are usually PgR-positive and show varying degrees immunoreactivity for the ER.
Lipid rich breast carcinomas tend not to stain positive for p53 and HER-2/neu. They also tend to be positive for E-cadherin. Lipid rich breast cancer tumors also tend to text positive for cytokeratin, vimentin, and the S-100 protein.
Clinical and mammographical presentation of lipid-rich breast carcinoma
A woman with lipid rich breast cancer will typically present with a painless mass, often in the subareolar region. Upon gross examination, lipid rich breast carcinomas are usually described as lobulated, well or poorly circumscribed, and firm. The can grow to be quite large at the time of initial presentation. Mammography and ultrasound will usually show an irregular, dense mass with lobulated borders.
Treatment and Prognosis for Lipid-rich breast carcinoma
The prognosis for women with lipid rich breast cancer tends to be poor. This is mostly due to the fact that in up to 70% of cases, nodal metastasis has already occurred at the time of clinical presentation. However, there is really no evidence that lipid rich breast cancer is worse than any other kind of breast cancer.
The most telling prognostic indicators are the common, traditional ones such as tumor stage, grade, and hormone receptor status. Approximately 80% of women will develop lymph node metastasis after two years. The mortality rate for women with lipid rich breast carcinoma is quite high, at almost 40% during the first year after diagnosis.
For further reading, I suggest you visit this page on the histological workup for breast cancer diagnosis and treatment, as well as this page which has information about histology grade changes risk for ADH and DCIS.
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