Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Lipid Rich Breast Cancer

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 a little bit old.  However, because of that, I have a newer version  with more up-to-date information on Rare Types of Breast Cancer including 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.

lipid rich breast cancer cells

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.

lipid-rich-breast-carinomca-cells-2

Clinical and mammographical presentation of Lipid Rich Breast Cancer

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 Cancer

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.

References

  • Chen, J., Zhang, J., Liang, Q., Bao, Z., Zheng, Z., Hu, N., Yan., H. Bilateral breast cancer with a unilateral lipid-rich carcinoma: A case report. Chinese Journal of Clinical Oncology. Volume 4, Number 5, 376-377
  • Shi P, Ma R, Gao HD, Jiang LY, Sun JZ. Lipid-rich carcinoma of the breast: a case report. Acta Chir Belg. 2008 Jan-Feb;108(1):115-8.
  • Mazzella FM, Sieber SC, Braza F. Ductal carcinoma of male breast with prominent lipid-rich component. Pathology. 1995 Jul;27(3):280-3.
  • Varga Z, Robl C, Spycher M, Burger D, Caduff R.Metaplastic lipid-rich carcinoma of the breast.Pathol Int. 1998 Nov;48(11):912-6.
  • Reis-Filho JS, Fulford LG, Lakhani SR, Schmitt FC.Pathologic quiz case: a 62-year-old woman with a 4.5-cm nodule in the right breast. Lipid-rich breast carcinoma. Arch Pathol Lab Med. 2003 Sep;127(9):e396-8.
  • Insabato, L. , R. Russo , A. M. Cascone , and P. Angrisani . Fine needle aspiration cytology of lipid-secreting breast carcinoma: a case report. Acta Cytol 1993. 37:752–755.
  • Huang, H. Y. and C. R. Antonescu . Epithelioid variant of pleomorphic liposarcoma: a comparative immunohistochemical and ultrastructural analysis of six cases with emphasis on overlapping features with epithelial malignancies. Ultrastruct Pathol 2002. 26:299–308.
  • Vera-Sempere, F. and A. Llombart-Bosch . Lipid-rich versus lipid-secreting carcinoma of the mammary gland. Pathol Res Pract 1985. 180:553–558.
  • Wrba F, Ellinger A, Reiner G, et al. Ultrastructural and immunohistochemical characteristics of lipid-rich carcinoma of the breast. Virchows Arch A Pathol Anat Histopathol 1988; 413:381-5.
  • Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumors. Nature 2000;406:747-52.

Back to Types of Lesions List or to the brand new Breast Cancer Homepage.

About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.