Histopathologic Feature of Breast Cancer Patients in Young Women

M. S. Sitorus

, L. I. Laksmi

Department of Anatomy, Universitas Sumatera Utara

Department Of Pathology Anatomy, Universitas Sumatera Utara

Keywords: Breast Cancer, Histopathologic Feature, Young Woman.

Abstract. : Breast malignancy is still the most common cancer in the worldwide that attacks women. Causing a high

mortality rate that is about 15% of all deaths in women. The incidence of breast cancer cases in young age

under the 40 years of age is low but they have particular attention because of its unique behavior. Breast

cancer biology in young women is more aggressive than women of premenopausal age. This is related to

many factors associated with poor prognosis, including high proliferation index, grade three and four disease

and negative Estrogen Receptor expression. This study aims to explore further histopathologic feature,

immunohistochemical expression, and subtype of breast cancer biology, in women under 40 years of age. It

was found that the most common type, of breast cancer histopathology was invasive breast cancer (88%). The

most histopathologic grading was grade I which is 74%. Based on the ER immunohistochemical staining

found that 60% gives a negative expression, only 40% gives positive. A total of 68% gave a positive PR

expression, 68% Her-2 positive one, 30% Her-2 positive three. As many as 56% positive Ki-67. All cases are

Her-2 positive and have a moderate to poor prognosis.

1 INTRODUCTION

Breast cancer is the most common malignancy in

women. Each year affects 1.5 million women, with a

high number of deaths. By 2015, 570,000 women die

caused by breast cancer - about 15% of all deaths in

women (WHO, 2018). The incidence of breast cancer

is more frequent in developing countries while the

death is higher in less developed countries

(Ghoncheh, 2016). In Indonesia, this cancer is also

the most cancer with a number of cases 48,998 in

2014, with a mortality rate of 21.4% (WHO, 2014).

Now, it is so rapidly progressing concerning

therapeutic and screening of breast cancer to reduce

mortality at all ages. However, breast cancer in young

age although rarely encountered has its uniqueness

compared with old age sufferers. However breast

cancer in young age woman has an aggressive

behaviour (Lee HB, 2014). Around 7% of breast

cancers are found in young women under 40 years

old. The survival rate is worse than that of older

people (Anders CK , 2009). This paper aims to obtain

a histopathologic feature, immunohistochemical

expression, and subtype of breast cancer biology, in

young women under 40 years old.

2 METHODOLOGY

The sample of the study was female breast cancer

patients aged under 40. Patient has performed surgery

and histopathology examination of the network in

Installation of Pathology Anatomy of Adam Malik

Hospital Medan. Anatomy Pathology examination

results indicate the presence of breast cancer. The

number of samples is 50 people with a distribution

showed in table 1.

Table 1 : Distribution of breast cancer patients by age.

ears

)

Number

erson

)

Percenta

(

)

35-40 45 90

30-34 3 6

25-30 2 4

<24 - -

50 100

Some breast cancer patients aged 35-40 people were

found as much as 90%. Only two persons (4%) aged

25-30 years, which are one person age 29 years and

one person aged 26 years. There were no breast

cancer patients under 24 years of age.

578

Sitorus, M. and Laksmi, L.

Histopathologic Feature of Breast Cancer Patients in Young Women.

DOI: 10.5220/0010079205780581

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

578-581

ISBN: 978-989-758-449-7

3 RESULTS

3.1 Histopathology Feature

A tumor had removed and sent to Installation of

Pathology Anatomy. The tissue is processed in the

Installation of Pathology Anatomy RS Adam-Malik

Medan to become a slide. Then stained with

Hematoxylin-Eosin to be observed with a light

microscope. The type and grading histopathologic

breast cancer are established. The most frequently

type of histopathologic breast malignancy is invasive

breast cancer with no specific type (44 cases) (88%),

five patients are invasive lobular cancer and one clear

cell carcinoma patient as shown in table 2.

Table 2: Breast malignancy types.

Breast cancer

malignancy types

Number Percentage

(%)

Invasive breast

carcinoma

44 88

Invasive lobular

carcinoma

5 10

Clear cell

carcinoma

1 2

50 100

The Bloom & Richardson classification

determines histopathologic grading. Classification is

determined by tubular formation, cell atypia, and

mitosis. The histopathologic Grading was found in

Table 3.

Table 3: Grading breast cancer.

Grading breast

cancer

Number Percentage

(%)

Grade

12 24

Grade I

37 74

Grade III 1 2

50 100

The most histopathologic grading was grade I of

74%, at least grade III of 2%.

Figure 1: Microscopic view of invasive ductal carcinoma of

breast. A. Grade III (HE, 50x), B. Grade III infiltratif

pattern (HE,50x), C.Solid pattern (HE,50x), D(HE,100x).

3.2 Immunohistochemical (ihc)

Expression

Then all histopathologic tissue blocks were

immunohistochemically stained (ihk) with Estrogen

Receptor (ER), Progesterone Receptor (PR), Her-2,

and Ki-67 antibodies. The immunohistochemical

examination is assessed on a scoring system.

Immunohistochemical examination are shown in

Table 4.

Table 4: Immunohistochemical expression of breast cancer.

Ihc

expres

sion

ER(%) PR(%) Her-

2(%)

Ki-

67(%)

Negati

30(60) 34(68) 1(2) 22(44)

+20

(

)

(

)

(

)

(

)

++ 0 0 0 0

+++ 0 0 15

(

)

50(100) 50(100) 50(100) 50(100)

Based on the ER ihc expression found that 60%

gives a negative expression, only 40% gives a

positive. A total of 68% gave a positive PR

expression, 68% Her-2 positive one, 30% Her-2

positive three. As many as 56% positive Ki-67.

Histopathologic Feature of Breast Cancer Patients in Young Women

579

Figure 2: ER expression negative (A), PR +(B), Her-2

+1(C), Her-2 2+(D), Her-2 3+(E), Ki6 +(F).

3.3 Histopathology Subtypes

Through ihc examination, a subtype of breast cancer

can be grouped based on a classification of St. Gallen.

There were five intrinsic subtypes of breast cancer,

Luminal-A, Luminal-B, Her-2 overexpression,

Basal-like and Normal-like as in table 5.

Table 5: Classification of molecular subtypes of breast

cancer (Dai X, 2015).

Intrinsic Subtype Ihc

Luminal A [ER+

PR+] HER2-KI67-

Luminal B [ER+|PR+] HER2-KI67+

[ER+

PR+] HER2+KI67+

HER2

Overexpression

[ER-PR-] HER2+

Basal

(Triple neg)

[ER-PR-] HER2-, basal

marker+

Normal-like [ER+|PR+] HER2-KI67-

In this study, it was found that all cases were Her-

2 positive, and had a moderate to poor prognosis

(table 6). No Luminal-A subtype was found.

Table 6. Molecular subtypes of breast cancer.

Intrinsic

Subtype

Number Percentage (%)

Luminal A 0 0

Luminal B 21 52

HER2

Overexpression

28 56

Basal

(Triple

neg)

0 0

Normal-like 1 2

Jumlah 50 100

4 DISCUSSION

The risk of breast cancer will increase with age. Also,

will decrease in young age. So the amount of breast

cancer patients in young age women is lower. In

United States, an estimated 11,000 women diagnosed

with invasive breast cancer are under 40 years old.

That is 4.7% -4.9% of all breast cancer patients (Lee

HB, 2014). The less number of breast cancer in young

age is associated with pathogenesis and breast cancer

risk factors. There are two risk factors: internal and

external factors. The internal factors are age,

hormonal status (age of menarche, menopause,

breastfeeding) and genetics. External factors are the

form of low-fiber diet, carcinogenic food, radiation

exposure, smoking, hormonal therapy also play an

important role in the pathogenesis of breast

malignancy (Cable AM , 2015).

In this study, the most common type of breast

cancer was invasive breast cancer in 44 cases (88%).

While invasive lobular carcinoma were 5 cases

(10%). When viewed from the literature, this type of

cancer is indeed the most cases of 60-75% (Eliyatkin

N, 2015, Malhotra GK, 2010).

Breast malignancy at a young age, although

slightly but has unique biological characteristics. This

makes the researchers interested in exploring more

about this. Breast cancer biology in young age women

is more aggressive than women of premenopausal

age. This is related to many factors associated with

poor prognosis, including high proliferation index,

grade three and four disease and negative ER (Lee

HB, 2014).

In this study, no luminal-A subtype had a good

prognosis. In fact, 98% of cases show positive Her-2

and 56% of cancer with Her-2 overexpression. The

presence of Her-2 overexpression has been stated to

be an adverse prognostic factor of breast cancer. This

situation is found in 20-25% of cases that can be

detected with ihc. Her-2 is a member of the epidermal

growth factor receptor functioning in the stimulation

of cell growth, survival and differentiation (Punglisi

F, 2015).

The existence of these different subtypes of breast

cancer biology, as well as the basis for determining

prognosis, may also determine appropriate treatment

measures. In breast cancer that expressed positive ER

will be treated with antihormonal, Her-2 positive will

be treated with anti-HER-2. Targeting therapy can

increase the life expectancy rate and the death rate

decreases.

Another worse prognostic factor is triple negative

breast cancer (ER-/PR-/Her-2-). In some papers, it is

said that this subtype more often found at a young

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

580

age. This will make two bad things together. The risk

of death would be 2.7-fold if a triple negative was

encountered at a young age. There was no triple

negative subtype in this study(Bano R et., 2015).

5 CONCLUSION

Breast cancer at a young age woman is a rare case.

However, cancer cases in young age will show a

worse prognosis. The grading, ihc appearance and

subtype biology of breast cancer are worse compared

with cancer found in older age.

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