Sharply circumscribed pushing borders: Edge of tumor pushes rather than infiltrating
Carcinoma cells should not invade as single cells or small nests
Marked lymphoplasmacytic reaction: Must involve periphery and diffusely involve tumor itself
High nuclear grade with frequent mitoses
Absence of glandular or fatty tissue within tumor
DCIS scant or absent
Atypical MC = IDC NST with medullary features, at least 1 key feature lacking
Distinguish from MC
WHO classification of breast tumors (2013): Carcinoma with medullary features (CMF) to include both MC and atypical MC
Adequate treatment indicated for either; aggressive triple-negative features often present
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Rechsteiner M et al: Somatic BRCA1 mutations in clinically sporadic breast cancer with medullary histological features. J Cancer Res Clin Oncol. 144(5):865-74, 2018
Romero P et al: Medullary breast carcinoma, a triple-negative breast cancer associated with BCLG overexpression. Am J Pathol. 188(10):2378-91, 2018
Zangouri V MD et al: Medullary breast carcinoma and invasive ductal carcinoma: a review study. Iran J Med Sci. 43(4):365-71, 2018
Kouhen F et al: Prognosis of medullary carcinoma of the breast: 10 years' experience in a single institution. Breast J. 23(1):112-4, 2017
Mateo AM et al: Chemotherapy significantly improves survival for patients with T1c-T2N0M0 medullary breast cancer: 3739 cases from the National Cancer Data Base. Ann Surg Oncol. 24(4):1050-6, 2017
Stelmach A et al: Typical medullary breast carcinoma: clinical outcomes and treatment results. Breast J. 23(6):770-1, 2017
Mateo AM et al: Atypical medullary carcinoma of the breast has similar prognostic factors and survival to typical medullary breast carcinoma: 3,976 cases from the National Cancer Data Base. J Surg Oncol. 114(5):533-6, 2016
Wang XX et al: Difference in characteristics and outcomes between medullary breast carcinoma and invasive ductal carcinoma: a population based study from SEER 18 database. Oncotarget. 7(16):22665-73, 2016
Chu Z et al: Clinicopathologic characteristics of typical medullary breast carcinoma: a retrospective study of 117 cases. PLoS One. 9(11):e111493, 2014
Dieci MV et al: Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist. 19(8):805-13, 2014
Larribe M et al: Breast cancers with round lumps: correlations between imaging and anatomopathology. Diagn Interv Imaging. 95(1):37-46, 2014
Cao AY et al: Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China: a comparison with infiltrating ductal carcinoma-not otherwise specified. World J Surg Oncol. 11:91, 2013
Park I et al: Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma. J Breast Cancer. 16(4):417-25, 2013
Sinn HP et al: A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition. Breast Care (Basel). 8(2):149-54, 2013
Huober J et al: Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials. Ann Oncol. 23(11):2843-51, 2012
Jeong SJ et al: Medullary carcinoma of the breast: MRI findings. AJR Am J Roentgenol. 198(5):W482-7, 2012
Karan B et al: Unusual malignant breast lesions: imaging-pathological correlations. Diagn Interv Radiol. 18(3):270-6, 2012
Work ME et al: Risk factors for uncommon histologic subtypes of breast cancer using centralized pathology review in the Breast Cancer Family Registry. Breast Cancer Res Treat. 134(3):1209-20, 2012
Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
Tominaga J et al: MR imaging of medullary carcinoma of the breast. Eur J Radiol. 70(3):525-9, 2009
Vu-Nishino H et al: Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT). Int J Radiat Oncol Biol Phys. 62(4):1040-7, 2005
Eichhorn JH: Medullary carcinoma, provocative now as then. Semin Diagn Pathol. 21(1):65-73, 2004
Gombos EC et al: Infiltrating carcinoma with medullary features in the male breast: imaging and pathologic findings. Breast J. 10(6):548-9, 2004
Iau PT et al: Are medullary breast cancers an indication for BRCA1 mutation screening? A mutation analysis of 42 cases of medullary breast cancer. Breast Cancer Res Treat. 85(1):81-8, 2004
Osin P et al: Distinct genetic and epigenetic changes in medullary breast cancer. Int J Surg Pathol. 11(3):153-8, 2003
Yilmaz E et al: Comparison of mammographic and sonographic findings in typical and atypical medullary carcinomas of the breast. Clin Radiol. 57(7):640-5, 2002
Cheung YC et al: Sonographic and pathologic findings in typical and atypical medullary carcinomas of the breast. J Clin Ultrasound. 28(7):325-31, 2000
Jensen ML et al: Prognostic comparison of three classifications for medullary carcinomas of the breast. Histopathology. 30(6):523-32, 1997
Liberman L et al: Overdiagnosis of medullary carcinoma: a mammographic-pathologic correlative study. Radiology. 201(2):443-6, 1996
Cook DL et al: Comparison of DNA content, S-phase fraction, and survival between medullary and ductal carcinoma of the breast. Am J Clin Pathol. 104(1):17-22, 1995
Moore OS Jr et al: The relatively favorable prognosis of medullary carcinoma of the breast. Cancer. 2(4):635-42, 1949
Foote Jr FW et al: A histologic classification of carcinoma of the breast. Surgery. 19:74-99, 1946
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
Medullary carcinoma (MC)
Definitions
Medullary carcinoma (MC): Rare special type of invasive ductal carcinoma (IDC)
Medullary refers to marrow of bones → soft mass
Lack of desmoplastic stroma and soft consistency differentiates medullary from other carcinomas
Circumscribed carcinoma with poorly differentiated cells, little stroma, and lymphoid infiltration
Sharply circumscribed pushing borders: Edge of tumor pushes rather than infiltrating
Carcinoma cells should not invade as single cells or small nests
Marked lymphoplasmacytic reaction: Must involve periphery and diffusely involve tumor itself
High nuclear grade with frequent mitoses
Absence of glandular or fatty tissue within tumor
DCIS scant or absent
Atypical MC = IDC NST with medullary features, at least 1 key feature lacking
Distinguish from MC
WHO classification of breast tumors (2013): Carcinoma with medullary features (CMF) to include both MC and atypical MC
Adequate treatment indicated for either; aggressive triple-negative features often present
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Rechsteiner M et al: Somatic BRCA1 mutations in clinically sporadic breast cancer with medullary histological features. J Cancer Res Clin Oncol. 144(5):865-74, 2018
Romero P et al: Medullary breast carcinoma, a triple-negative breast cancer associated with BCLG overexpression. Am J Pathol. 188(10):2378-91, 2018
Zangouri V MD et al: Medullary breast carcinoma and invasive ductal carcinoma: a review study. Iran J Med Sci. 43(4):365-71, 2018
Kouhen F et al: Prognosis of medullary carcinoma of the breast: 10 years' experience in a single institution. Breast J. 23(1):112-4, 2017
Mateo AM et al: Chemotherapy significantly improves survival for patients with T1c-T2N0M0 medullary breast cancer: 3739 cases from the National Cancer Data Base. Ann Surg Oncol. 24(4):1050-6, 2017
Stelmach A et al: Typical medullary breast carcinoma: clinical outcomes and treatment results. Breast J. 23(6):770-1, 2017
Mateo AM et al: Atypical medullary carcinoma of the breast has similar prognostic factors and survival to typical medullary breast carcinoma: 3,976 cases from the National Cancer Data Base. J Surg Oncol. 114(5):533-6, 2016
Wang XX et al: Difference in characteristics and outcomes between medullary breast carcinoma and invasive ductal carcinoma: a population based study from SEER 18 database. Oncotarget. 7(16):22665-73, 2016
Chu Z et al: Clinicopathologic characteristics of typical medullary breast carcinoma: a retrospective study of 117 cases. PLoS One. 9(11):e111493, 2014
Dieci MV et al: Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist. 19(8):805-13, 2014
Larribe M et al: Breast cancers with round lumps: correlations between imaging and anatomopathology. Diagn Interv Imaging. 95(1):37-46, 2014
Cao AY et al: Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China: a comparison with infiltrating ductal carcinoma-not otherwise specified. World J Surg Oncol. 11:91, 2013
Park I et al: Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma. J Breast Cancer. 16(4):417-25, 2013
Sinn HP et al: A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition. Breast Care (Basel). 8(2):149-54, 2013
Huober J et al: Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials. Ann Oncol. 23(11):2843-51, 2012
Jeong SJ et al: Medullary carcinoma of the breast: MRI findings. AJR Am J Roentgenol. 198(5):W482-7, 2012
Karan B et al: Unusual malignant breast lesions: imaging-pathological correlations. Diagn Interv Radiol. 18(3):270-6, 2012
Work ME et al: Risk factors for uncommon histologic subtypes of breast cancer using centralized pathology review in the Breast Cancer Family Registry. Breast Cancer Res Treat. 134(3):1209-20, 2012
Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
Yoo JL et al: Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics. 30(6):1689-702, 2010
Tominaga J et al: MR imaging of medullary carcinoma of the breast. Eur J Radiol. 70(3):525-9, 2009
Vu-Nishino H et al: Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT). Int J Radiat Oncol Biol Phys. 62(4):1040-7, 2005
Eichhorn JH: Medullary carcinoma, provocative now as then. Semin Diagn Pathol. 21(1):65-73, 2004
Gombos EC et al: Infiltrating carcinoma with medullary features in the male breast: imaging and pathologic findings. Breast J. 10(6):548-9, 2004
Iau PT et al: Are medullary breast cancers an indication for BRCA1 mutation screening? A mutation analysis of 42 cases of medullary breast cancer. Breast Cancer Res Treat. 85(1):81-8, 2004
Osin P et al: Distinct genetic and epigenetic changes in medullary breast cancer. Int J Surg Pathol. 11(3):153-8, 2003
Yilmaz E et al: Comparison of mammographic and sonographic findings in typical and atypical medullary carcinomas of the breast. Clin Radiol. 57(7):640-5, 2002
Cheung YC et al: Sonographic and pathologic findings in typical and atypical medullary carcinomas of the breast. J Clin Ultrasound. 28(7):325-31, 2000
Jensen ML et al: Prognostic comparison of three classifications for medullary carcinomas of the breast. Histopathology. 30(6):523-32, 1997
Liberman L et al: Overdiagnosis of medullary carcinoma: a mammographic-pathologic correlative study. Radiology. 201(2):443-6, 1996
Cook DL et al: Comparison of DNA content, S-phase fraction, and survival between medullary and ductal carcinoma of the breast. Am J Clin Pathol. 104(1):17-22, 1995
Moore OS Jr et al: The relatively favorable prognosis of medullary carcinoma of the breast. Cancer. 2(4):635-42, 1949
Foote Jr FW et al: A histologic classification of carcinoma of the breast. Surgery. 19:74-99, 1946
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