Breast Carcinoma with choriocarcinomatous features

Some breast cancers are able to synthesize hormones which are not normally considered to be products of the breast, and certain peptide hormones which would fall into this category include calcitonin, epinephrine, and human chorionic gonadotrophin (hCG). So, a breast carcinoma with choriocarcinomatous features is simply one of any of the common sub-types of breast cancer which shows elevated serum levels for beta-hCG and histologic evidence of choriocarcinomatous differentiation.

I just want to let you know that I have created a newer versio of this page with more up-to-date information on Breast Cancers with Choriocarcinomatous Features. However, this page is still very useful, it has great material.

It is estimated that 12-18% of women with breast cancer may show elevated serum levels of b-human chorionic gonadotrophin. (Beta human chorionic gonadotrophin hormone is on of two subunits of hCG). Conventional infiltrating ductal carcinomas such as solid tubular carcinoma and mucinous carcinoma of the breast are some of the more common breast cancers known to develop with choriocarcinomatous components.

Breast carcinomas that display choriocarcinomatous differentiation and produce human chorionic gonadotropin are extremely rare. The most common age for developing breast cancer with choriocarcinomatous differentiation is in the early 50s.

Human chorionic gonadotrophin hormone is usually associated with pregnancy and egg fertilization, so it is a bit unusual to see it associated with a breast cancer later in life. Human chorionic gonadotropin is a glycoprotein hormone produced in pregnancy by the developing embryo after conception, and later on by the syncytiotrophoblast (part of the placenta), and its main role is to maintain progesterone production during pregnancy.

Human chorionic gonadotrophin hormone also plays a role in cellular differentiation and proliferation, and may activate apoptosis (Apoptosis is the process of ‘programmed cell death‘, as opposed to ‘necrosis‘, which is due to disease or injury).

Histological characteristics of Breast Carcinoma with choriocarcinomatous features

Fine needle aspiration cytology of Breast Carcinoma with choriocarcinomatous features will tend to reveal abundant multinucleated giant cells with highly pleomorphic tumor cells in a hemorrhagic necrotic background. The high nuclear-to-cytoplasmic ratio is often quite high, with increased nuclear chromatin. The cytoplasm of the tumor cells tends to be pale to eosinophilic with occasional periodic acid-Schiff stain-positive intracytoplasmic eosinophilic globules. Periodic acid-Schiff (PAS) is a staining method used to detect glycogen in tissues.

Choriocarcinomatous breast tumors tend to be cytokeratin positive

The immunohistochemistry of breast carcinoma with choriocarcinomatous features tends to be positive for human chorionic gonadotrophin in pleomorphic areas of tumors, while the less pleomorphic areas tend to test positive for synaptophysin and chromogranin. Tumors formed due to breast carcinoma with choriocarcinomatous features tend be positive for cytokeratin (AE-1/AE-3).

These tumors are frequently negative for progesterone receptors, with focal positivity for estrogen receptors. In the image of breast carcinoma with choriocarcinomatous features shown below, one notes large and bizarre tumor cells showing positivity for chorionic gonadotrophin.

Prognosis for carcinoma of the breast with choriocarcinomatous features

The clinical course for breast carcinoma with choriocarcinomatous features is unfortunately quite aggressive. Nearly half of all patients with breast carcinoma with choriocarcinomatous features will develop axillary node metastasis.

The recurrence rate, and also the mortality rate for carcinoma of the breast with choriocarcinomatous features is actually higher than for most invasive breast cancers of a generic type. Sadly, a majority of women who develop breast carcinoma with choriocarcinomatous features die within a few months of diagnosis due to multiple metastases. However, a small percentage of women treated for carcinoma of the breast with choriocarcinomatous features do survive disease free after four years or more.

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For further reading, I suggest you visit this page on breast carcinoma with melanotic features, as well as this page with information on infiltrating ductal carcinoma features.

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References

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2. Erhan Y, Ozdemir N, Zekioglu O, Nart D, Ciris M. Breast carcinomas with choriocarcinomatous features: case reports and review of the literature. Breast J. 2002 Jul-Aug;8(4):244-8.
3. Siddiqui NH, Cabay RJ, Salem F. Fine-needle aspiration biopsy of a case of breast carcinoma with choriocarcinomatous features. Diagn Cytopathol. 2006 Oct;34(10):694-7.
4. Akbulut M, Zekioglu O, Ozdemir N, Kapkac M. Fine needle aspiration cytology of mammary carcinoma with choriocarcinomatous features: a report of 2 cases. Acta Cytol. 2008 Jan-Feb;52(1):99-104.
5. Green DM. Mucoid carcinoma of the breast with choriocarcinoma in its metastasis. Histopathology 1990;16:504-6.
6. Saigo PE, Rosen PP. Mammary carcinoma with "choriocarcinomatous" features. Am J Surg Pathol 1981;5:773-8.
7. Murata T, Ihara S. Breast cancer with choriocarcinomatous features: a case report with cytopathological details. Pathol International 1999;49:816-9.
8. Filho, OG., Miiji, LNO., Vainchenker, M., Gordan, AN. Breast cancer with choriocarcinomatous and neuroendocrine features. Sao Paulo Med. J. vol.119 no.4
9. Canbay, E., Bozkurt, B., Ergul, G., Agrali, G., Cengiz, O. Breast Carcinoma with Choriocarcinomatous Features. The Breast Journal (Mar. 2010) Volume 16 Issue 2, Pages 202 – 203
10. Cole LA "New discoveries on the biology and detection of human chorionic gonadotropin". Reprod. Biol. Endocrinol. (2009). 7: 8.
11. Gregory JJ, Finlay JL (April 1999). "Alpha-fetoprotein and beta-human chorionic gonadotropin: their clinical significance as tumour markers". Drugs 57 (4): 463–7.

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