Image Description
Molecular Subtypes of Breast Cancer - Luminal B: They are less common than Luminal A (about 20% of all breast cancers) and have comparatively worse prognosis. As compared to luminal A, they have higher Nottingham grade, show lower expression levels of ER-related genes, variable expression of HER2 cluster (may be HER2 positive), and higher expression levels of proliferation-related genes.
The image shows invasive ductal carcinoma with positive ER and PR, negative HER2, and high Ki-67. IHC stains. 10X. Image courtesy of: Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA.
About the Disease
Like most other cancers, breast carcinoma exhibits an abnormal pattern of gene expression. With the advancements in technology, it has become possible to study thousands of mRNAs simultaneously from a group of tumors to develop gene expression profiles (molecular signatures). These molecular signatures may become useful for diagnosis, predicting tumor behavior, as well as selecting appropriate therapy for individual patients. The major drivers of breast cancer pathogenesis are hormone receptor-related genes, HER2 cluster of genes, and proliferation-associated genes. Based on the similarities of gene expression profiles using a hierarchical clustering, breast cancer has been subdivided into luminal A, luminal B, HER2-enriched, and basal-like subtypes. The features of individual subtypes are discussed with the photomicrographs. The clinical utility of routine molecular profiling of individual breast cancers is still uncertain. The results appear to be dependent on the platform and data analysis techniques used. Meanwhile, the traditional histopathologic grading (Nottingham combined histologic grade) is the standard of care and is unlikely to be replaced soon. References:1. DeVita, V. T., Lawrence, T. S., & Rosenberg, S. A. (2015). Cancer - Principles & Practice of Oncology: Primer of the Molecular Biology of Cancer - Second Edition. Wolters Kluwer. 2. Allison, K. H.; Molecular Pathology of Breast Cancer - What a Pathologist Needs to Know. Am J Clin Pathol 2012;138:770-780.