Breast tumors : an overview
2005-05-01 Maria Luisa Carcangiu  , Patrizia Casalini  , Sylvie Ménard   Affiliation1.Molecular Targeting Unit, Department of Experimental Oncology, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy
2.Laboratoire dOncologie Moléculaire, U.119 Inserm, Institut de Cancérologie et dImmunologie de Marseille, 27 Bd. Le Roure, 13009 Marseille, France
3.Molecular Targeting Unit, Department of Experimental Oncology, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy
Classification
Classification
- ductal
- lactating
- tubular
- apocrine
- blunt duct
- microglandular
- sclerosing
Invasive breast carcinomas are divided into two major categories on the basis of their cytoarchitectural features:
- acinic cell carcinoma
- adenoid cystic carcinoma
- apocrine carcinoma
- cribriform carcinoma
- glycogen-rich/clear cell
- inflammatory carcinoma
- lipid-rich carcinoma
- medullary carcinoma
- metaplastic carcinoma
- micropapillary carcinoma
- mucinous carcinoma
- neuroendocrine carcinoma
- oncocytic carcinoma
- papillary carcinoma
- sebaceous carcinoma
- Secretory Breast Carcinoma
- tubular carcinoma
- pleomorphic
- signet ring cell
The recognized precursor lesions of invasive breast carcinoma are :
- atypical ductal hyperplasia
- ductal carcinoma in situ
- florid
- usual
The terminology Invasive ductal/lobular carcinoma does not imply an origin form ducts and lobules, respectively, but the presence of cytoarchitectural and phenotypical features of ductal-type and lobular-type, respectively.
Ductal adenocarcinoma is the most common.
Lobular carcinoma is the second malignant breast tumour.
Medullary carcinoma is rare.
Hyperplasia is a proliferation without criteria of malignancy.
Fibroadenomas are benign breast tumours.
Clinics and Pathology
Etiology
Epidemiology
The main factors of risk are:
The areas of higher risk are the affluent populations of North America, Europa and Australia, where 6% of women develop invasive breast carcinoma before age 75.
Pathology
Many morphologic variants of invasive ductal carcinoma exist, some of them extremely rare. They include: tubular, cribriform, medullary, mucinous, neuroendocrine, papillary, micropapillary, apocrine, metaplastic, lipid-rich, secretory, oncocytic, adenoid cystic, acinic cell, glycogen-rich (clear cell), sebaceous, and inflammatory carcinoma. The prognosis of these subtypes varies, some of them having a better and some a worse outcome than invasive ductal carcinoma, NOS.
These different forms of breast cancer may occur with (hereditary or familial forms) or without (sporadic forms) a familial background.
Prognosis
Cytogenetics
Cytogenetics morphological
Alterations of chromosome arms 1q, 3p, 6q, 8p are often present; i(1q) and der t(1;16) are frequent as sole anomalies; +7, +8 and +20 are also frequent; cytogenetic signs of DNA amplification, such as homogeneously staining regions (HSR), are commonly observed in breast carcinomas and seem preferentially associated to 8p.
Cytogenetics molecular
CGH : Comparative genomic hybridization (CGH) is a molecular cytogenetics method designed to detect and map chromosomal regions showing abnormal copy numbers in tumors; theoretically, it is possible to detect equally copy number gains (DNA amplification or polyploidies) or losses using this approach; it appears, however, that CGH has a greater sensitivity for gains than for losses; this could be related to the fact that gains are generally of higher magnitude than losses and that losses can be obscured by intratumoral heterogeneity;
Overall CGH data show that breast tumor genomes undergo severe rearrangements; on average, breast tumors show 5-7 copy number changes/tumor; less than 10% of the tumors analyzed by CGH show neither gains nor losses; almost every chromosome presents at least one site with aberrant copy numbers, however, gains or losses are not evenly distributed throughout the genome.
Hot spots for gains are routinely observed at 1q (50-55% of the tumors), 8q (60%), 17q (25-30%), 20q (20-25%); gains generally involve subregions of each chromosomal arm and most prevalent regions are 1q31-q32, 8q12 and 8q24 (with MYC and other genes), 17q12 (ERBB2) and 17q23-q24, and 20q13; other regions of recurrent gains are 11q13 (20%, with CCND1), 8p12 (10-15%, and FGFR1), 16p (10-15%); recurrent losses are observed at 1p, 6q, 8p, 11q23-qter, 13q, 16q, 17p and 22q
CGH has revealed that copy number gains are common in breast tumors and involve 26 (!) chromosomal arms; these data somewhat contradict karyotypical analysis and LOH studies which indicate that losses are more frequent that gains; furthermore, it appears from CGH data that the number of events (gains and losses) increases in advanced cancer.
Genetics
Note
Genes Involved and Proteins
Gene name
Location
Gene name
Location
Gene name
Location
Protein description
Somatic mutations
Gene name
Location
Dna rna description
Protein description
Somatic mutations
Gene name
Location
Protein description
Somatic mutations
Amplification : the ERBB2 gene is amplified and overexpressed in 20-25% of breast tumors; tumors showing ERBB2 amplification have predominantly lost estrogen receptor expression (ER-) and are of ductal invasive type; interestingly, 70% of intraductal comedo carcinomas show ERBB2 expression, suggesting a role of this gene in the etiology of this breast tumor subtype ;
Although ERBB2 amplification and overexpression are related to a worsened course of the disease, they do not represent independent prognostic indicators;
However, the p185-ERBB2 protein being a transmembrane receptor with low levels of expression in normal tissues has turned out to be a very interesting target for therapeutical approaches; several protocols using engineered anti-ERBB2 antibodies have shown a good success rate.
Gene name
Location
Protein description
Somatic mutations
Gene name
Location
Protein description
Somatic mutations
Gene name
Location
Dna rna description
Protein description
Germinal mutations
the germline mutations are dispersed throughout the coding sequence; although a majority of these variations are unique, recurrent mutations such as 185delAG and 5382insC are observed; they were initially described in the Ashkenazy Jewish population; more than 80% of the sequence variants lead to a truncated protein; in contrast, the majority of missense mutations are of unknown clinical significance, excepted those in the RING finger region; in the BRCA1 families, an excess of breast, ovarian, and prostate cancers are seen; all mutations combined, penetrance at age 70 years works out at 56% to 87% in the case of breast cancer, and 16% to 63% in that of ovarian cancer
BRCA1-associated breast cancers have specific morphological features; they are more frequently of histoprognostic grade 3, highly proliferating and poorly differentiated tumors with a very pleomorphotic nuclear pattern; high frequencies of P53 alterations and negativity of steroid receptors are found in these tumors; a high rate of medullary breast carcinomas is observed among BRCA1-associated breast cancers; evidence for possible genotype-phenotype correlations have been provided concerning the tumor spectrum (breast/ovarian cancer incidence rate), the penetrance, and the proliferation rate of tumors
Somatic mutations
Gene name
Location
Dna rna description
Protein description
Germinal mutations
BRCA2 germline mutations are associated with a high risk of male and female breast cancer; initially, the breast cancer risk was considered as equivalent to that of BRCA1, but in a recent work based only on the Icelandic recurrent BRCA2 999del5 mutation, the estimated risk of breast cancer at age 70 years is considered of only 37%; the ovarian cancer risk is lower than that of BRCA1; in addition, an excess of prostate and pancreas cancers is also seen
at the morphological level, BRCA2 breast cancers seem to be different from both BRCA1-associated breast cancers and sporadic cases, with a poor differentiation but no high proliferation rate; evidence for possible genotype-phenotype correlation has been provided concerning the tumor spectrum (breast/ovarian cancer incidence rate)
Somatic mutations
Gene name
Location
One such gene might be located on chromosome arm 8p; a positive linkage has first been found in a small set of French families, and then a lod score of almost 3 was obtained in one German family; in addition, the chromosome 8p12-22 region seems to be frequently involved in breast carcinogenesis as well as in different types od tumors (lung, prostate, ovarian); while the 8p12-22 region remain a strong candidate locus, whole-genome linkage studies are in progress to identify the other gene(s) that predispose to breast cancer.
Gene name
Location
Dna rna description
Protein description
Germinal mutations
Somatic mutations
In spite of the initial description of PTEN homozygous deletion in two breast tumor xenografts and biallelic inactivation of PTEN in two breast carcinoma cell lines, very few PTEN mutations have been observed in sporadic breast carcinoma (1 described mutation in more than 100 analyzed tumors).
Gene name
Location
Dna rna description
Protein description
Germinal mutations
Gene name
Protein description
Somatic mutations
Gene name
Location
Somatic mutations
Article Bibliography
| Pubmed ID | Last Year | Title | Authors |
|---|---|---|---|
| 9669664 | 1998 | CCND1 and FGFR1 coamplification results in the colocalization of 11q13 and 8p12 sequences in breast tumor nuclei. | Bautista S et al |
| 9739012 | 1998 | Characterization of recurrent homogeneously staining regions in 72 breast carcinomas. | Bernardino J et al |
| 9529600 | 1998 | Functions of the BRCA1 and BRCA2 genes. | Bertwistle D et al |
| 8557030 | 1995 | E-cadherin is a tumour/invasion suppressor gene mutated in human lobular breast cancers. | Berx G et al |
| 8605112 | 1995 | Genetic alterations in breast cancer. | Bièche I et al |
| 9331099 | 1997 | Mapping of DNA amplifications at 15 chromosomal localizations in 1875 breast tumors: definition of phenotypic groups. | Courjal F et al |
| 9818225 | 1998 | Recent advances in breast cancer biology. | Eisen A et al |
| 9563465 | 1998 | Mutations at BRCA1: the medullary breast carcinoma revisited. | Eisinger F et al |
| 9407952 | 1997 | Genome-wide search for loss of heterozygosity shows extensive genetic diversity of human breast carcinomas. | Kerangueven F et al |
| 9205089 | 1997 | Chromosomal imbalance maps of malignant solid tumors: a cytogenetic survey of 3185 neoplasms. | Mertens F et al |
| 9288766 | 1997 | Mutation analysis of the putative tumor suppressor gene PTEN/MMAC1 in primary breast carcinomas. | Rhei E et al |
| 7692948 | 1993 | FGFRI and PLAT genes and DNA amplification at 8p12 in breast and ovarian cancers. | Theillet C et al |
Citation
Maria Luisa Carcangiu ; Patrizia Casalini ; Sylvie Ménard
Breast tumors : an overview
Atlas Genet Cytogenet Oncol Haematol. 2005-05-01
Online version: http://atlasgeneticsoncology.org/solid-tumor/5018/chromosome-explorer/4
Historical Card
1999-01-01 Breast tumors : an overview by Daniel Birnbaum,Francois Eisinger,Jocelyne Jacquemier,Michel Longy,Hagay Sobol,Charles Theillet  Affiliation
