ryj 3x@;-Rx0YK5eEq\Xwhx. N8su/'EIV+]6U:Y' URS- I`@V Contributed by Mark R. Wick, M.D. .05%oyFVaE!gEs&AwXR+v1].

mf'G)%GI Y,m5j(C(R05iyT3jFY I?vIsr7!JJPIT:eQ@}#HJ ~ Z4p}XSit6ZaavyS.Qf8QIM|:N5KYcS&["@|x[6A. Comment: H&E sections show a high grade spindle cell lesion with pleomorphic nuclei, irregular nuclear borders and occasional mitotic figures, including atypical mitosis. Solid, tannish white with central necrosis, View July's Tip of the Month on our YouTube channel at. We welcome suggestions or questions about using the website. Invasive breast carcinoma of no special type with medullary pattern, invasive breast carcinoma of no special type, Metastatic high grade carcinoma to the breast from another site, WHO Classification of Tumours Editorial Board: Breast Tumours, 5th Edition, 2019, International TILs Working Group: International Immuno-Oncology Biomarker Working Group on Breast Cancer [Accessed 25 April 2022], Medullary pattern is a histological pattern that can be applied to an invasive breast carcinoma of no special type that contains pushing borders, syncytial growth, high grade nuclei and prominent lymphoid infiltrate, Represents one end of the spectrum of tumor infiltrating lymphocyte (TIL) rich invasive breast carcinomas of no special type rather than a distinct morphological subtype. We welcome suggestions or questions about using the website. American Joint Committee on Cancer (AJCC) stage (, Poor response to neoadjuvant systemic therapy with pathology complete response (pCR) rate of ~ 10% - 17% (, Most appear as a mass on mammography with a mean size of 32mm, Microcalcification is uncommon but may be present, especially in a carcinoma in situ component, Matrix producing metaplastic carcinomas have relatively better prognosis (, 39 year old woman with a recurred, 3.5 cm breast mass (, 41 year old woman with neurofibromatosis type 1 and breast mass (, 47 year old man with a 2.4 cm spiculated nodule and associated nipple retraction (, 47 year old woman with pleomorphic liposarcoma diagnosis on core biopsy (, 48 year old woman with painless calcified breast mass (, 60 year old woman with metaplastic carcinoma arising in microglandular adenosis (, 88 year old woman with huge bleeding tumor (, Mastectomy or local excision, with or without radiation and chemotherapy, Lower response rates to conventional chemotherapy (, Pearly, white to grayish and glistening cut surface in areas of squamous and chondroid differentiation, Mean 3.9 cm, ranging from 2 cm to > 10 cm, Can be epithelial only carcinomas, pure (monophasic) sarcomatoid carcinomas and biphasic epithelial and sarcomatoid carcinomas, Pure (monophasic) sarcomatoid carcinomas include, Heterologous mesenchymal components include chondroid, osseous, rhabdomyosarcomatous, angiosarcomatous, liposarcomatous and neuroglial differentiation or in combination, Mesenchymal component can show a wide spectrum of atypia, ranging from minimal atypia to frankly malignant, May need to look carefully, extensive sampling or performing immunohistochemistry (a combination of several stains) for identification of epithelial component, Large, pleomorphic and spindle shaped cells or malignant squamous cells, Rarely, malignant cartilage or bone or osteoclastic-like giant cells, Basal-like or claudin low molecular subtype.

However, we cannot answer medical or research questions or give advice. Contributed by Shannon M. Welter, M.D. Distinguish cholangiocarcinoma (60% are CK17+) from hepatocellular carcinoma (CK17-. Contributed by Andrey Bychkov, M.D., Ph.D. CK14 is a type I acidic keratin expressed in mitotically active basal cells of stratified epithelium (, CK5/6+ or CK14+ tumors define a basal subtype of DCIS (, In cervix, loss of expression is associated with high grade SIL and high risk HPV (, Prostate tumors with distinct basal cells on H&E that are negative for 34BE12 are also negative for CK14 (, Mutations cause epidermolysis bullosa simplex (.

Contributed by Julie M. Jorns, M.D. "za@]MXiv[VSn-]CZ6=6fU" 6A,s1C};3zLqW?~oC I^XE2 >5giNf/pA^sv]g$%!6 Comment: The differential includes pure squamous cell carcinoma and urothelial carcinoma with extensive squamous differentiation. We welcome suggestions or questions about using the website. In addition, clinical / radiological correlation is advised to ensure the tumor is compatible with a bladder primary. However, we cannot answer medical or research questions or give advice. Distinguish renal urothelial carcinoma (CK5/CK6+, CK17+, vimentin-) from collecting duct carcinoma (CK5/CK6-, CK17-, vimentin+, Considered a marker of or associated with the basal phenotype (also CK 5/6, CK 14) of invasive or in situ ductal carcinoma of breast (, Sensitive marker of sentinel nodal metastases by RT-PCR in oral squamous cell carcinoma (, Breast myoepithelial cells (references above), Cervical reserve and immature metaplastic cells (, Cervical squamous intraepithelial lesions (, Laryngeal premalignant changes or squamous cell carcinoma (. Carcinoma with osteoclast-like giant cells, Well circumscribedmass withcentral bleeding, Metaplastic carcinoma with squamous differentiation, Metaplastic carcinoma by Dr. Alexander Damron, View July's Tip of the Month on our YouTube channel at, Copyright PathologyOutlines.com, Inc. Click, 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Copyright PathologyOutlines.com, Inc. Click, 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). deZ}5O'_ U,N@/!;`B11j4*9$bm B'JV]s{CIr,k\&gl>6\Cz%IW V@9X8@NS">q"r0whm ,rGfz@Aj-T9HdoBb~/`ZivfW4&#ER5F LIZ@L+YyNp`@7~,(w We welcome suggestions or questions about using the website. and Emad Rakha, M.D. Syncytial growth and lymphoplasmacytic infiltrate, View July's Tip of the Month on our YouTube channel at. However, we cannot answer medical or research questions or give advice. Distinguish pancreatobiliary adenocarcinoma (CK17+) from extra-pancreatobiliary nonmucinous adenocarcinoma (CK17-. Copyright PathologyOutlines.com, Inc. Click, 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA).

and Semir Vranić, M.D., Ph.D. Metaplastic carcinoma [TI] breast "free full text" [SB], Ventana PLD1 assay for triple negative breast cancer, invasive breast carcinoma of no special type, Cold Spring Harb Mol Case Stud 2018;4:a002352, Cibas: Cytology - Diagnostic Principles and Clinical Correlates, 5th Edition, 2020, Appl Immunohistochem Mol Morphol 2020 Aug 28 [Epub ahead of print], WHO Classification of Tumours Editorial Board: Breast Tumours, 5th Edition, 2019, Heterogeneous group of invasive breast carcinomas characterized by differentiation of the neoplastic epithelium towards squamous cells or mesenchymal looking elements, including but not restricted to spindle, chondroid and osseous cells, Invasive breast carcinoma with atypical squamous, spindle cell or mesenchymal / matrix producing differentiation, When lacking a ductal carcinoma in situ or conventual mammary carcinoma component, a panel of immunohistochemical stains (cytokeratins, including high molecular weight and p63) is needed to confirm the presence of epithelial differentiation, Not recommended: carcinosarcoma, sarcomatoid carcinoma, carcinoma with pseudosarcomatous metaplasia, carcinoma with pseudosarcomatous stroma, Some studies indicate a monoclonal origin of the heterogeneous components (, Biological behavior variable from low to high grade, Tends to have large tumor size, less nodal involvement and higher We welcome suggestions or questions about using the website. vudSWs?Z MBa39a3=tM-^zd24 and Semir Vranic, M.D. Other tissue specific transcription factors: Glandular differentiation (microvilli and terminal bars on luminal side), ER+ pathway: characterized by gains of 1q, loss of 16q, sometimes amplification of 17q12. This website is intended for pathologists and laboratory personnel but not for patients. Breast, right, 3:00, ultrasound guided core biopsy: Secretory carcinoma, 0.7 cm in greatest length, Cells with clear cytoplasm (hypernephroid pattern), Expresses proteins of the salivary gland counterpart of, Lacks vacuolated cytoplasm and secretions, Cysts containing abundant, homogenous intraluminal secretions resembling thyroid colloid, Cells lining cysts are bland, flat or cuboidal / columnar cells lacking vacuolated / granular cytoplasm, Presence of intact myoepithelial cell layer, Can demonstrate any grade of nuclear atypia, 1q chromosomal gains and 16q chromosomal losses, t(6;9)(q22-23;p23-24), resulting in fusion of, Abundant PAS+, diastase sensitive secretions, High grade cytologic atypia with brisk mitotic activity, Irregular clusters of epithelial cells floating in pools of extracellular mucin, Low grade cytologic atypia, triple negative for ER, PR and HER2, Negative for basal-like markers CK5/6 or CK14. luminal [title] phenotype carcinoma breast, Appl Immunohistochem Mol Morphol 2008;16:411, Classification is based on gene expression (molecular) profile studies; subtype reflects clustering of genes activated by ER signaling pathways, Distribution by molecular typing is: luminal A: 71%; luminal B: 8%; HER2+: 6% basal-like: 15% (, Luminal subtypes include luminal A (ER+ [strong], PR+, HER2-) and luminal B (ER+ [weak / moderate], PR-, sometimes HER2+), Some authors also include categories of luminal A-HER2 and luminal B-HER2 hybrids (, Luminal cytokeratins are CK7 / 8, 18 and 19, Luminal A and B subtypes are associated with mutations in E-cadherin and MAP2K4, and amplifications of Cyclin D1, HER2 and HDM2 (, Luminal A breast cancers are usually low grade, with slow growth and better prognosis than luminal B (, Luminal B breast cancers: some are HER2+, but the major biological distinction from Luminal A is the proliferation signature, in which CCNB1, MKI67 and MYBL2 genes have higher expression in luminal B than in luminal A tumors (, Luminal A and most grade 1 luminal B (HER2+) cases are low proliferative (, "Basal like" because tumors have high expression of genes characteristic of basal epithelial cells of normal mammary gland, including CK 5 / 6, CK14, CK15 and CK17, Not rigidly defined, usually positive for CK5 / 6, CK14 or CK17, and triple negative (ER-, PR-, HER2-), often positive for EGFR, Original definition based on gene expression profile (, Generally considered to not be comparable to triple negative tumors by immunostains (, Classification of particular tumors may vary based on which classification system is used (, 15% of all invasive ductal carcinoma NOS (, Basal-like expression also present in 17% of infiltrating lobular carcinoma based on CK5 / 6 expression, these cases are more likely to be ER- (, Associated with younger age, African-American women, high grade tumors, metaplastic subtype (, Of academic interest, not currently used clinically (, Associated with epithelial-mesenchymal transition, defined by the loss of epithelial characteristics and the acquisition of a mesenchymal phenotype (, Poorer survival if express CK 17 or CK 5 / 6 (, High grade or metaplastic morphology, may have medullary features (, Also geographic necrosis, pushing borders, stromal lymphocytic response, increased mitotic count. cPHjgR*(7Ep}Vh|X_V-)4j>N-G`WXRq,S~X9 mF=K}=Skc MYPK* Z5gP m ~,%BG(BZi4LHBsl`q72&@U]>[V=l /`nD!pDg&\K?HF@ What histological and immunophenotypic features are most likely to be observed in a breast secretory carcinoma?

Breast, left, 3:00 (mass), ultrasound guided core needle biopsy: Malignant spindle cell lesion, consistent with spindle cell carcinoma (see comment). [Gd|~E8VAa8%{xT2!zQZ{tjb6C!x6a?~\>@ gEe>vZBzs.=JU4#_p>UBO(}e}ep `10"CytN8:I\,o/+tO%a3e]KyUv@$Pi/(-CQmZK(%1}B{=jC03:]"6Lj\jjMdP!Xwrwj'BTPp#~|v]i ^,|tQc}iOsBS}wD~EgC/EQUP@(: V"4=Ek%+H ZS\cJWDi\)ss2rOB= I e1[dXMqEN~%p)P7. and Mark R. Wick, M.D.

However, we cannot answer medical or research questions or give advice. Invasive breast cancer of no special type (NST), NIH: SEER Cancer Statistics Review (CSR) 1975-2018 [Accessed 23 June 2022], Cancer Epidemiol Biomarkers Prev 2019;28:303, Stanford University: Infiltrating Ductal Carcinoma of the Breast [Accessed 23 June 2022], Breast Cancer Now: The Research and Care Charity [Accessed 23 June 2022], Most common type of invasive breast carcinoma (75 - 80%), Invasive carcinoma with evidence of mammary epithelial origin either by morphology or immunohistochemistry, Diagnosis of exclusion, lacks the histologic features to classify morphologically as a special subtype of breast cancer, Arises from epithelial (progenitor / stem) cells at the terminal duct lobular unit (as do lobular and other types of breast carcinoma), Although the ductal and lobular nomenclature does not reflect the histogenesis of these tumor types, this terminology remains in common use, Patient age, tumor stage, lymph node status, histologic grade, clinical biomarker profile and gene expression signature are important prognostic factors, Treated with surgical excision, with or without radiotherapy, systemic chemotherapy or targeted therapies, ASCO / CAP guidelines require assessment by standard breast biomarkers (estrogen and progesterone receptors and HER2), Large and heterogenous group of tumors that lack features diagnostic of special types, Range in morphology, grade, biomarker profile, molecular subtype and clinical behavior, Invasive breast carcinoma, not otherwise specified (NOS), Breast cancer is the commonly diagnosed cancer in females (24%) (, Leading cause of female cancer death worldwide (, 8 - 9% of women diagnosed with invasive breast cancer before age 75 in North America and West Europe (, Majority are sporadic; 5 - 10% of all breast cancers are associated with hereditary cancer susceptibility genes (, Can occur in axilla accessory breast tissue, Origin of breast cancer is multifactorial and complex but most studies point to hormones, reproductive factors, diet, environment and genetics as general factors, After menopause, about 40% of risk is modifiable (, Prolonged exposure to estrogen: early menarche, late menopause, nulliparity, having first child after age 30 and lack of breast feeding (, Postmenopausal women with obesity and estrogen producing ovarian tumors (, Women using combined hormone replacement therapy with progestins or estrogens alone (, Risk with oral contraceptives is controversial (, Associated with increased risk of hormone receptor positive breast cancer (, Parity may be associated with an increased risk of triple negative breast cancers. ^|_ MRI is sensitive but nonspecific technique is reserved for screening patients at high risk (e.g., Stage as determined by pT size and lymph node status (, Histologic grade is an independent prognostic factor (, Lymphovascular invasion associated with higher risk of local recurrence and distant recurrence (, Hormone receptor expression associated with better short term survival, HER2 expression associated with improved survival when anti-HER2 therapy is received, Gene expression signature, observed survival is highest in luminal A, lowest in basal-like (, 47 year old woman with a subareolar breast mass (, 56 year old woman with cystic breast lesion (, 70 year old woman with a benign appearing breast mass (, Surgical excision by breast conserving surgery (lumpectomy) or mastectomy, with or without axillary lymph node dissection, May be offered local radiotherapy to the breast after lumpectomy or to the chest wall after mastectomy to reduce local recurrence risk, May be offered systemic chemotherapy either neoadjuvantly or adjuvantly, May be offered targeted therapies (e.g., antiendocrine or anti-HER2 directed), Selection of treatment (type of surgery, inclusion of radiotherapy and selection of systemic therapies) is based on multifactorial consideration of several factors including but not limited to tumor size, histologic grade, stage, biomarker status, results of genomic risk assessment (e.g., Oncotype DX Recurrence Score ), anatomic location, patient age and comorbidities, heritable breast cancer risk (e.g., BRCA status), prior exposure to chemotherapy or radiation therapy, cosmetic outcome and patient's preference, Grossly evident mass, with an irregular, stellate outline or nodular configuration, Mass is usually poorly circumscribed and contracts from surrounding tissue, Firm or even hard on palpation and may have a gritty feel when cut with a knife, grating sound when scraped, May show streaks of chalky white elastotic stroma penetrating surrounding stroma (crab-like), calcification, Large tumors have hemorrhage, necrosis and cystic degeneration, May be fixed to chest wall and cause skin dimpling or nipple retraction, Some tumors, including neoadjuvant treated cancers, may be grossly inapparent and require careful correlation with the imaging at the time of gross examination and tissue sampling, Histologic grading is based on the Nottingham / modified Bloom & Richardson Score (, Small, regular, uniform, similar to normal ductal epithelial cells, 2 - 3x RBC (1 point), Moderate increase in size / variability (2 points), Large nuclei, marked variation, often vesicular chromatin with prominent nucleoli (3 points), Mitotic count (1 - 3 points), dependent on microscopic field area. However, we cannot answer medical or research questions or give advice. Squamous cell carcinoma [title] bladder review[ptyp], Clin Genitourin Cancer 2020 Dec 2 [Epub ahead of print], Urothelial carcinoma with squamous differentiation, Malignant epithelial neoplasm arising in the urinary bladder, renal pelvis or ureter demonstrating a pure squamous cell phenotype, This topic describes classic squamous cell carcinoma; please see separate topic on, Uncommon subtype of carcinoma showing pure squamous morphology without any component of conventional urothelial carcinoma, May be associated with keratinizing squamous metaplasia / dysplasia of the mucosa, Must be distinguished from urothelial carcinoma with squamous differentiation, secondary spread of squamous cell carcinoma primary to another site, e.g. However, we cannot answer medical or research questions or give advice. Chronic bladder irritation / inflammation associated with: Nephrolithiasis, such as staghorn calculi (, Anatomic anomalies of the kidney, such as horseshoe kidney, duplicated renal pelvis (, May also present with dysuria, urgency and frequent urination, recurrent urinary tract infection, urinary obstruction and flank or suprapubic pain, Cystoscopy and biopsy / transurethral resection of bladder tumor, Bladder: tumors may appear plaque-like, polypoid, papillary or circumferential bladder wall thickening (, Renal pelvis / ureter: solid mass may be seen, along with other nonspecific findings, such as hydronephrosis, calcifications and nephrolithiasis (, CT or MRI may be used for local staging to delineate suspected depth of tumor invasion (, Prognosis determined by tumor stage (staged in the same way as urothelial carcinoma), lymph node involvement and tumor grade (, Often advanced stage at diagnosis resulting in poor prognosis (, Upper urinary tract squamous cell carcinoma presents with higher stage (and with frequent renal parenchyma invasion) than bladder squamous cell carcinoma (, Schistosomiasis associated squamous cell carcinoma appears to have better prognosis than non-schistosomiasis associated (, 45 year old woman with poorly differentiated squamous cell carcinoma arising on a background of recurrent condyloma acuminatum (, 46 year old woman with basaloid squamous cell carcinoma of the bladder and concomitant HPV infection of the genital tract (, 57 year old man with recurrent stone formation presenting with muscle invasive squamous cell carcinoma of the bladder (, 61 year old woman with enterovesical fistula secondary to squamous cell carcinoma of the bladder (, 76 year old woman with squamous cell carcinoma of the upper urinary tract presenting with paraneoplastic syndrome (, 79 year old woman with squamous cell carcinoma of the renal pelvis associated with staghorn calculi (, 80 year old woman with squamous cell carcinoma in the renal pelvis of a horseshoe kidney (, Radical cystectomy / nephrectomy / nephroureterectomy, Neoadjuvant radiation may improve outcome (, Insufficient evidence to support the use of chemotherapy, Usually large exophytic bulky tumor; some cases are predominantly flat with ulcerating / infiltrating appearance (, Often necrotic with flaky keratin material on the surface, May be well, moderately or poorly differentiated, Moderately or poor differentiated tumors are most common, Irregular infiltrating nests or sheets of malignant squamous cells with destructive stromal invasion, Squamous differentiation in the form of keratin pearls, individual cell keratinization or intercellular bridges; findings may be focal in poorly differentiated tumors, Often associated with surface keratinizing squamous metaplasia and dysplasia / squamous carcinoma in situ (, Must not show any component of conventional urothelial carcinoma or urothelial carcinoma in situ, If present, even focally, tumor is designated as urothelial carcinoma with squamous differentiation, Keratinized cells demonstrate dense orangeophilic cytoplasm on Pap stain, Hyperchromatic nuclei with irregular nuclear membranes, Generally negative or reduced expression of urothelial markers, HPV DNA in situ hybridization negative; HPV positivity may be seen in association with condyloma or chronic injury (, Basal / squamous molecular subgroup of muscle invasive bladder cancer show frequent mutations in.

This website is intended for pathologists and laboratory personnel but not for patients. Left breast, mass, ultrasound guided core needle biopsy: Invasive breast carcinoma, NST (invasive ductal carcinoma), grade 2, measuring 1.5 cm, Estrogen receptor: positive (95%, strong intensity), IBC NST admixed with 10 - 90% of other special subtype(s) is designated as mixed IBC NST and special subtype with description of the percentage of special subtype components provided, Correlation with clinical and radiologic history. This website is intended for pathologists and laboratory personnel but not for patients. This website is intended for pathologists and laboratory personnel but not for patients. This website is intended for pathologists and laboratory personnel but not for patients. Appropriate use of immunohistochemical panel of stains (e.g., Morphology and immunohistochemical profile may be indistinguishable from breast cancer, superficial location centered in the skin versus within the breast (adjacent ducts / lobules), IHC using myoepithelial markers shows retained myoepithelial cell layer, Estrogen receptor and progesterone receptor, Always shows extensive (> 90%) tubular / acinar formation, Generally negative for E-cadherin and p120 (cytoplasmic), Low grade tumors are generally positive for HER2 overexpression by immunohistochemistry, Majority of cases are hereditary due to mutations in either, Requires assessment of standard biomarkers estrogen and progesterone receptors and HER2, Lack of desmoplastic stromal response, positive for S100, positive for laminin and collagen IV around glands, estrogen receptor negative, Positive for hormone receptors (estrogen and progesterone receptors). ), Round, oval or lobulated mass on mammography, Hypoechoic mass on ultrasound with thick echogenic halo, Prognostic factors identical to invasive breast carcinoma of no special type: patient age, tumor histological grade, tumor stage, lymphovascular invasion, ER, PR and HER2 status, molecular subtype, Similar prognosis to stage matched grade 3 ductal carcinoma with prominent inflammation, Better prognosis than grade 3 ductal carcinoma without prominent inflammation (, Tumor infiltrating lymphocytes have been shown to be of prognostic value (, 38 year old woman who presented with a lump in both breasts for 3 months (, 72 year old woman with invasive breast carcinoma with medullary pattern that had spontaneous pathological complete regression (, Identical to treatment options for invasive breast carcinoma of no special type with considerations for targeted therapy based on ER, PR, HER2 status, Tumor infiltrating lymphocytes do not alter therapy currently, Well circumscribed, 2 - 3 cm in size, soft and fleshy (may resemble, Cells in syncytial growth pattern with no glandular structures, High histologic grade, high grade nuclei with prominent nucleoli, Prominent tumor infiltrating lymphocyte infiltrate, Numerous isolated cells and loose clusters, Prominent, often irregular macronucleolus, Most often negative for hormone receptors (, Majority of these tumors fall within the basal-like molecular profile, Invasive breast carcinoma of no special type with medullary pattern (see synoptic report), Carcinoma contains 90% stromal tumor infiltrating lymphocytes, May be within a lymph node or have abundant associated angiolymphatic invasion, Immunohistochemistry is often needed for distinction, Contains capsule or subcapsular sinus; both may have germinal centers. This website is intended for pathologists and laboratory personnel but not for patients. and Abdulaziz Mohamed, M.D. cervix, penis, anus and metastasis, Classic / typical squamous cell carcinoma, 2 - 5% of bladder tumors in Western countries (nonbilharzial) (, Most common nonurothelial subtype of bladder cancer, 20 - 30% of bladder tumors in geographic regions with high prevalence of schistosomiasis (bilharzial) including Egypt and other parts of Africa (, Frequency of squamous cell carcinoma is falling due to declining rates of, 1 - 8% of malignancies involving the renal pelvis and ureter (, Bladder: most commonly involving posterior and lateral walls (, Major risk factor for bladder squamous cell carcinoma in geographic regions with high prevalence of schistosomiasis including Egypt and other parts of Africa, Smoking: 5x increased risk compared with nonsmokers (. (, 5 - 10% of breast cancers are hereditary as result of mutations in various genes, such as. and Julie M. Jorns, M.D. Medullary pattern of invasive breast carcinoma no special type has 4 characteristic histological features (ideally, all 4 should be present for the diagnosis): Preferred term according to WHO: invasive breast carcinoma of no special type with medullary pattern, Historically described as medullary carcinoma, atypical medullary carcinoma, medullary features, Often present earlier in life, median age of 53 (45 - 62) years (, Rare: less than 5% of all invasive breast cancers, May have lymphadenopathy (due to hyperplasia rather than metastasis, which is uncommon), Diagnostic steps are identical to invasive breast carcinoma (screening mammogram, diagnostic mammogram, ultrasound, core biopsy, etc.