A clinical perspective on triple negative invasive breast carcinomas with comedo necrotic features

Abstract

Triple-negative breast carcinomas are characterized by its unique molecular profile, histological and clinical features and distinct patterns of metastasis, and lack of targeted therapies. Most, but not all, triple negative tumours (TNTs) have aggressive clinical behaviour and poor prognosis, yet they are grouped together, when studying their behaviour and management because of their triple negativity. Some members of this group, particularly adenoid cystic and secretory carcinomas, have a distinct microscopic appearance which is well recognised by pathologist and can be easily separated from the rest and managed differently. However, there are other morphological subgroups of triple negative breast carcinomas which are not well recognized and or characterised. One of these includes TNTs with extensive ‘comedo’ necrosis. This study aimed at comparing the demographic features and prognosis of triple negative tumours with comedo necrosis with the rest of triple negative carcinomas. In this study we found no statistically significant difference regarding age, tumours size or the expression of CK 5, CD10, Maspin or Claudin3 and 4. Claudin1 was significantly less expressed in tumours with comedo necrosis (13% vs 26%) for tumours with no comedo necrosis and a significant difference in lymph node status and metastases follow up was observed. This can suggest that tumours with comedo necrosis does attribute different behavioural pattern from those without, they are less aggressive and have a good outcome and can be a good prognostic indicator, knowledge of these tumours can be valuable in patient management.