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Session 4. Biopsies. Professor Sarah Pinder

Session 4. Biopsies. Professor Sarah Pinder. Case A - SP08-9685. Diagnosis - Angiosarcoma. 5 years after radiotherapy for breast carcinoma in wide local excision. Angiosarcoma. Majority of angiosarcomas negative for CKs but epithelioid areas may stain positively in up to 35% of cases

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Session 4. Biopsies. Professor Sarah Pinder

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  1. Session 4. Biopsies.Professor Sarah Pinder

  2. Case A - SP08-9685

  3. Diagnosis - Angiosarcoma.5 years after radiotherapy for breast carcinoma in wide local excision

  4. Angiosarcoma • Majority of angiosarcomas negative for CKs but epithelioid areas may stain positively in up to 35% of cases • Conversely, less than 2% stain of breast carcinomas positive for CD31 and CD34 • Macias-Martinez V. Am J Surg Pathol 1997;21:599-604 • Meis-Kindblom JM. Am J Surg Pathol 1998;22:683-697

  5. Epithelioid haemangioendothelioma • Infiltrative margins • Nests, cords & strands of epithelioid tumour cells within a myxohyaline stroma • Epithelioid cells show prominent intracytoplasmic vacuolisation, occasionally containing erythrocytes • IHC profile may suggest carcinoma - CK 7 +ve and CK 18 +ve, but express vascular antigens (CD31, CD34 & Factor VIII) • Also negative for high molecular weight cytokeratins, e.g. CK 14, characteristic feature of metaplastic breast carcinoma

  6. Case B - Core 08/261

  7. Diagnosis - Seeding of epithelial cells after previous core biopsy of papillary lesion

  8. Seeding of Malignant Cells • After core biopsy • Harter. Radiology. 1992;185;713-4 • May be relatively common • 2 out of 47 consecutive cases • Grabau. Eur J Surg Oncol. 1993;19;192-4 • Uncertain significance • Benign and malignant epithelial displacement also noted after FNA and other needling procedures • Youngson. Am J Clin Pathol 1995;103;598-602 Youngson. Am J Surg Pathol 1994;18;896-903

  9. Epithelial displacement in breast lesions • 53 cases of epithelial cell displacement • US core (24 cases), mammotome core (16), FNAC (8), anaesthetic injection (3), suture placement (5) & wire localization (1) • Displacement of epithelial cells occurred in biopsy tract (42 cases), lymphatic channels (5), both (4), breast stroma (2) • Diagnoses included intraductal papilloma (6 cases), DCIS (45; 15 with invasive carcinoma), 2 pure invasive carcinoma • Except in 3 cases, associated with underlying papillary lesion • Nagi C. Arch Pathol Lab Med. 2005;129:1465-9

  10. Malignant Cell Displacement • 352 cancer excisions • Tumour cell displacement in 32% patients after large-gauge needle core biopsy • 76 cases displacement of 1 or 2 clusters, 38 cases displacement of multiple fragments • Incidence & amount inversely related to interval between core & excision • 42% of patients with interval of <15 days • 31% of patients with interval of 15-28 days • 15% of tumours excised >28 days after core • Diaz LK. AJR Am J Roentgenol. 1999;173:1303-13

  11. Case C -(1) Core biopsy - SP08-8208(2) Excision - SP08-10287

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