A Comprehensive Guide to Core Needle Biopsies of the Breast by Sandra J. Shin

Author:Sandra J. Shin
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Differential Diagnosis

MCMD must be distinguished from other lesions showing chondromyxoid matrix, which include malignant phyllodes tumor with heterologous differentiation, sclerosing papilloma with chondroid metaplasia, pleomorphic adenoma (benign mixed tumor), mucinous carcinoma, and primary/metastatic chondrosarcoma and osteosarcoma (Figs. 12.54 and 12.55a–d). The distinction from malignant phyllodes tumor rests on the identification of an associated benign epithelial component with leaf-like architecture or elongated compressed ducts, which may be absent in a core biopsy, as well as immunostains for keratins, p63, p40, and CD34. Metaplastic carcinomas are positive for keratins p63, and p40; and negative for CD34, whereas phyllodes tumors overall demonstrate the reverse staining pattern. However, it should be noted that malignant phyllodes tumors may be CD34 negative and may focally express keratins, p63, and/or p40 [140].

Fig. 12.54Sclerosing papilloma with chondroid stroma . Chondroid metaplasia involving a sclerosed papilloma may raise the differential diagnosis of metaplastic carcinoma with chondroid differentiation. This may be especially challenging on core biopsy. The presence of associated sclerosed benign epithelial elements, lack of cytologic atypia, hypocellularity, and overall circumscription can be useful to make the distinction

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