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Medullary carcinoma is a form of breast cancer with high-grade cells growing in sheets and a dense crowd of immune cells around them. It looks alarming under the microscope and is usually triple-negative, yet it has a better outlook than other triple-negative cancers. Since 2019 it is classed as invasive breast cancer with a medullary pattern and treated as triple-negative disease.
The 2019 WHO classification abandoned medullary carcinoma and atypical medullary carcinoma as separate types because of poor reproducibility, and instead recognises a medullary pattern within invasive breast carcinoma of no special type, treated as one end of the spectrum of tumour-infiltrating lymphocyte-rich triple-negative cancers (Tan 2020). Its histological features are syncytial sheets of high-grade cells, a prominent lymphoplasmacytic infiltrate, a pushing margin and absent gland formation. In 165 triple-negative basal-like carcinomas, prominent inflammation and anastomosing sheets in at least 30 percent of the tumour were each associated with better prognosis, their combination (a simplified medullary-like definition) was present in 17 percent and was an independent prognostic factor with good inter-observer agreement (Modern Pathology 2010). In a Shiraz series of 179 medullary against 3,067 ductal carcinomas, the medullary group had higher grade yet a more favourable clinical outcome (Iranian J Med Sci 2018). Medullary features are over-represented in BRCA1 carriers.
How it differs from its parent: it is the triple-negative pattern in which the immune infiltrate predicts a good outcome, and its pathology overlaps with the immunomodulatory subtype on the triple-negative page.
How common: 5.5 percent of one centre's series (Iranian J Med Sci 2018), but with the 2019 definition it is no longer counted separately.
Treatment: as triple-negative breast cancer, following the parent's early and metastatic triple-negative pages (chemotherapy with pembrolizumab in early disease, and the checkpoint and antibody-drug conjugate pathways when advanced); there is no trial in the medullary pattern itself.
Population figures are lower and depend on the definition used.
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Treated as triple-negative breast cancer on the parent's early and metastatic pages.
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Query for this cancer: (TITLE:"Invasive breast carcinoma with medullary pattern" OR ABSTRACT:"Invasive breast carcinoma with medullary pattern" OR TITLE:"medullary carcinoma" OR ABSTRACT:"medullary carcinoma" OR TITLE:"Medullary carcinoma" OR ABSTRACT:"Medullary carcinoma" OR TITLE:"Medullary breast carcinoma" OR ABSTRACT:"Medullary breast carcinoma" OR TITLE:"Medullary carcinoma of the breast" OR ABSTRACT:"Medullary carcinoma of the breast" OR TITLE:"Atypical medullary carcinoma" OR ABSTRACT:"Atypical medullary carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Invasive breast carcinoma with medullary pattern (medullary carcinoma), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:Pembrolizumab·Printable cards in the navigator
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