View source for BRST5:Tall cell carcinoma with reversed polarity

==Primary Author(s)*==

H. Evin Gulbahce, MD, MSCI, University of Utah, UT, and Katherine Geiersbach, MD, Mayo Clinic

__TOC__

==Cancer Category/Type==

Breast cancer / Epithelial Tumours of the Breast 

==Cancer Sub-Classification / Subtype==

Tall cell carcinoma with reversed polarity  

==Definition / Description of Disease==

Tall cell carcinoma with reversed polarity is a rare variant of invasive breast carcinoma with unusual histopathologic features. In 2019, 5th edition of the World Health Organization (WHO) classification of breast tumors, it is in the group of rare and salivary gland-type tumors and is associated with favorable prognosis.  

==Synonyms / Terminology==

*Breast tumor resembling tall cell variant of papillary thyroid carcinoma
*Solid papillary breast carcinoma resembling the tall cell variant of papillary thyroid neoplasms (Historical)

*Breast cancer with altered nuclear polarity (Historical)
*Solid papillary carcinoma with reverse polarity (Historical)
*Tall cell variant of papillary breast carcinoma (Historical)

==Epidemiology / Prevalence==

Rare; fewer than 100 cases reported. No specific epidemiologic data are available. All patients have been women with a mean age of 64 years.

==Clinical Features==
{| class="wikitable"
|'''Signs and Symptoms'''
|Mammographic or palpable mass

Axillary lymph node metastasis (rare; reported in only three patients)
|-
|'''Laboratory Findings'''
|Not applicable
|}

==Sites of Involvement==

There is no specific predilection for location in the breast.

==Morphologic Features==

*Circumscribed nests of cells, many of which have fibrovascular cores. Foamy histiocytes are often present within the fibrovascular cores.  
*Occasionally true papillae and cyst-like structures with colloid-like material are identified.
*Epithelial cells are tall, may have nuclear grooves and intranuclear cytoplasmic inclusions.  
*The most characteristic feature is the presence of nuclei in the apical rather than basal pole of the cells hence the “reverse polarity.”

==Immunophenotype==

*Most carcinomas do not express estrogen or progesterone receptors (ER, PR). Those that tend to show staining of only a small fraction of the cells.  
*No cases reported to be HER2 positive (3+) or amplified by ISH.  
*Proliferative index (Ki67) has been less than 20%.

{| class="wikitable sortable"
|-
!Finding!!Marker
|-
|Positive (universal)||Cytokeratin 7, cytokeratin 5/6
|-
|Positive (subset)||GCDFP-15, GATA3, IDH1/2 mutant<ref name=":3">{{Cite journal|last=Pareja|first=Fresia|last2=da Silva|first2=Edaise M.|last3=Frosina|first3=Denise|last4=Geyer|first4=Felipe C.|last5=Lozada|first5=John R.|last6=Basili|first6=Thais|last7=Da Cruz Paula|first7=Arnaud|last8=Zhong|first8=Elaine|last9=Derakhshan|first9=Fatemeh|date=2020-06|title=Immunohistochemical analysis of IDH2 R172 hotspot mutations in breast papillary neoplasms: applications in the diagnosis of tall cell carcinoma with reverse polarity|url=https://pubmed.ncbi.nlm.nih.gov/31896809|journal=Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc|volume=33|issue=6|pages=1056–1064|doi=10.1038/s41379-019-0442-2|issn=1530-0285|pmc=7286791|pmid=31896809}}</ref>, calretinin
|-
|Negative (universal)||HER2 (ERBB2) expression or amplification; TTF-1, thyroglobulin, myoepithelial markers (p63, myosin)
|-
|Negative (subset)||
|}<br />
==Chromosomal Rearrangements (Gene Fusions)==

{| class="wikitable sortable"
|-
!Chromosomal Rearrangement!!Genes in Fusion (5’ or 3’ Segments)!!Pathogenic Derivative!!Prevalence
!Diagnostic Significance (Yes, No or Unknown)
!Prognostic Significance (Yes, No or Unknown)
!Therapeutic Significance (Yes, No or Unknown)
!Notes
|-
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|}		
			
==Individual Region Genomic Gain/Loss/LOH==

{| class="wikitable sortable"
|-
!Chr #!!Gain / Loss / Amp / LOH!!Minimal Region Genomic Coordinates [Genome Build]!!Minimal Region Cytoband
!Diagnostic Significance (Yes, No or Unknown)
!Prognostic Significance (Yes, No or Unknown)
!Therapeutic Significance (Yes, No or Unknown)
!Notes
|-
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|N/A
|}
==Characteristic Chromosomal Patterns==

{| class="wikitable sortable"
|-
!Chromosomal Pattern
!Diagnostic Significance (Yes, No or Unknown)
!Prognostic Significance (Yes, No or Unknown)
!Therapeutic Significance (Yes, No or Unknown)
!Notes
|-
|N/A
|N/A
|N/A
|N/A
|N/A
|}
==Gene Mutations (SNV/INDEL)==

{| class="wikitable sortable"
|-
!Gene; Genetic Alteration!!'''Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other)'''!!'''Prevalence (COSMIC /  TCGA / Other)'''!!'''Concomitant Mutations'''!!'''Mutually Exclusive Mutations'''
!'''Diagnostic Significance (Yes, No or Unknown)'''
!Prognostic Significance (Yes, No or Unknown)
!Therapeutic Significance (Yes, No or Unknown)
!Notes
|-
|''IDH2'' codon 172 mutations<ref name=":1">{{Cite journal|last=Chiang|first=Sarah|last2=Weigelt|first2=Britta|last3=Wen|first3=Huei-Chi|last4=Pareja|first4=Fresia|last5=Raghavendra|first5=Ashwini|last6=Martelotto|first6=Luciano G.|last7=Burke|first7=Kathleen A.|last8=Basili|first8=Thais|last9=Li|first9=Anqi|date=2016-12-15|title=IDH2 Mutations Define a Unique Subtype of Breast Cancer with Altered Nuclear Polarity|url=https://pubmed.ncbi.nlm.nih.gov/27913435|journal=Cancer Research|volume=76|issue=24|pages=7118–7129|doi=10.1158/0008-5472.CAN-16-0298|issn=1538-7445|pmc=5502804|pmid=27913435}}</ref><ref name=":2">{{Cite journal|last=Lozada|first=John R.|last2=Basili|first2=Thais|last3=Pareja|first3=Fresia|last4=Alemar|first4=Barbara|last5=Paula|first5=Arnaud Da Cruz|last6=Gularte-Merida|first6=Rodrigo|last7=Giri|first7=Dilip D.|last8=Querzoli|first8=Patricia|last9=Cserni|first9=Gabor|date=2018-08|title=Solid papillary breast carcinomas resembling the tall cell variant of papillary thyroid neoplasms (solid papillary carcinomas with reverse polarity) harbour recurrent mutations affecting IDH2 and PIK3CA: a validation cohort|url=https://pubmed.ncbi.nlm.nih.gov/29603332|journal=Histopathology|volume=73|issue=2|pages=339–344|doi=10.1111/his.13522|issn=1365-2559|pmc=6783257|pmid=29603332}}</ref><ref name=":0">{{Cite journal|last=Alsadoun|first=Nadjla|last2=MacGrogan|first2=Gaëtan|last3=Truntzer|first3=Caroline|last4=Lacroix-Triki|first4=Magali|last5=Bedgedjian|first5=Isabelle|last6=Koeb|first6=Marie-Hélène|last7=El Alam|first7=Elsy|last8=Medioni|first8=Dan|last9=Parent|first9=Michel|date=2018-09|title=Solid papillary carcinoma with reverse polarity of the breast harbors specific morphologic, immunohistochemical and molecular profile in comparison with other benign or malignant papillary lesions of the breast: a comparative study of 9 additional cases|url=https://pubmed.ncbi.nlm.nih.gov/29785016|journal=Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc|volume=31|issue=9|pages=1367–1380|doi=10.1038/s41379-018-0047-1|issn=1530-0285|pmid=29785016}}</ref>
|Gain of function (Oncogene)
|<1 % (TCGA)  
|''PIK3CA'' (most commonly H1047R), PIK3R1
|*
|Yes
|No
|No
|90% of cases show ''IDH2'' hot spot mutation. 
No targeted therapy for ''IDH2'' mutated breast cancer. 

<br />
|}
<nowiki>*</nowiki>A single case without ''IDH2'' mutation but with a ''TET2'' Q548* truncating mutation and with a ''PIK3CA'' H1047R mutation has been reported in one study.<ref name=":1" />


Note: A more extensive list of mutations can be found in cBioportal (https://www.cbioportal.org/), COSMIC (https://cancer.sanger.ac.uk/cosmic), ICGC (https://dcc.icgc.org/) and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.

==Epigenomic Alterations==

Global DNA hypermethylation 

==Genes and Main Pathways Involved==

Put your text here and fill in the table
{| class="wikitable sortable"
|-
!Gene; Genetic Alteration!!Pathway!!Pathophysiologic Outcome
|-
|''IDH2'' codon 172 mutations (majority are R172S, R172T; other mutations include R172G, R172W, R172I)<ref name=":4">{{Cite journal|last=Zhong|first=Elaine|last2=Scognamiglio|first2=Theresa|last3=D'Alfonso|first3=Timothy|last4=Song|first4=Wei|last5=Tran|first5=Hung|last6=Baek|first6=Inji|last7=Hoda|first7=Syed A.|date=2019-04|title=Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma: Molecular Characterization by Next-Generation Sequencing and Histopathological Comparison With Tall Cell Papillary Carcinoma of Thyroid|url=https://pubmed.ncbi.nlm.nih.gov/30227763|journal=International Journal of Surgical Pathology|volume=27|issue=2|pages=134–141|doi=10.1177/1066896918800779|issn=1940-2465|pmid=30227763}}</ref><ref name=":2" /><ref name=":1" /><ref name=":0" />
|Carbon metabolism: citrate cycle
|Increased conversion of α-ketoglutarate (α-KG) to the oncometabolite R-2-hydroxylglutarate (R-2-HG). Increased levels of 2-HG result in hypermethylation of epigenetic targets and a subsequent block in cellular differentiation. Due to widespread hypermethylation, there is increased H3K27me3 nuclear immunoreactivity in tumors harboring ''IDH2'' R172 mutations.
|-
|''PIK3CA'' mutations: H1047R most common<ref name=":2" />
|PI3K/AKT/mTOR pathway
|Three most common ''PIK3CA'' mutations are H1047R, E542K, and E545K; ''PIK3CA'' mutations induce hyperactivation of the alpha isoform of the catalytic subunit (p110α) of class IA PI3K kinase. Mutations are often co-occurring with other drivers in ER-positive breast cancers and are associated with endocrine resistance. ''PIK3CA'' mutations are targetable with the PI3K inhibitor alpelisib in ER positive breast cancers; however, tall cell carcinoma with reverse polarity is usually ER negative.
|-
|
|
|
|}
==Genetic Diagnostic Testing Methods==

Next generation sequencing (NGS); immunohistochemistry with monoclonal antibodies against ''IDH2'' mutant codon R172S (monoclonal antibody clone 11C8B1 is reactive against R172S or R172T); pyrosequencing; Sanger sequencing; PCR with allele detection (examples include PCR with melting curve analysis, or PCR with use of allele-specific probes); allele-specific PCR; single base extension.  

==Familial Forms==

None  

==Additional Information==

==Links==

[https://www.pathologyoutlines.com/topic/breastmalignantspcrp.html PathologyOutlines.com]

==References==
<references />

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==Notes==
<nowiki>*</nowiki>Primary authors will typically be those that initially create and complete the content of a page.  If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the CCGA coordinators (contact information provided on the homepage).  Additional global feedback or concerns are also welcome.