Centrally necrotizing carcinomas of the breast - A distinct histologic subtype with aggressive clinical behavior

Most breast carcinomas exhibit ductal differentiation. However, recognition of less common histologic patterns provides clinically useful data. This r eport describes a distinctive subtype of breast carcinoma that we have term ed "centrally necrotizing carcinoma" (CNC; in this study, N = 34), which is characterized by an unusual and aggressive natural history. Centrally necr otizing carcinomas are composed of well-circumscribed, unicentric nodules w ith extensive central necrosis that are surrounded by a narrow rim of viabl e high-grade tumor cells. These tumor cells show minimal ductal differentia tion (i.e., tubule formation), but are usually associated with focal ductal carcinoma in situ. The mean age of the patients in this study was 57.5 +/- 11.6 years, and the mean tumor size was 2.5 +/- 1.2 cm. Twenty-eight perce nt of the patients had positive axillary lymph nodes (mean number of lymph nodes involved, 2.1 +/- 1.2). Ninety-four percent of cases were negative fo r estrogen and progesterone receptors. In 21 patients (62%), local and/or d istant recurrences developed (median time to recurrence, 16.2 months), and, to date, 20 have died from breast cancer (median time to death, 22.5 month s). Progression of disease (defined as the development of either a recurren ce or death resulting from disease) occurred in 24 patients (71%). Comparis on with a set of 26 poorly differentiated ductal carcinomas with (nonextens ive, patchy) necrosis matched for age, tumor size, and lymph node status sh owed a significantly worse progression-free survival rate for the CNC group (p <0.004). We conclude that CNC is an uncommon but readily identifiable s ubtype of breast carcinoma and is characterized by early systemic metastasi s and an accelerated clinical course.