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Medullary breast cancers are high-grade, triple-negative tumours with a sharp border and a heavy immune-cell infiltrate that, despite looking aggressive, do better than ordinary breast cancers of the same grade. They are linked to BRCA1. Pathologists now call them a medullary pattern of common breast cancer rather than a type of their own.
Medullary carcinoma was defined by a circumscribed, syncytial growth pattern, high nuclear grade and a dense lymphoplasmacytic infiltrate; because pathologists agreed poorly on the diagnosis and the molecular profile overlaps basal-like carcinoma, the 5th edition of the WHO classification (2019) reclassified it as invasive breast carcinoma of no special type with medullary pattern, alongside the other patterns of common ductal-origin carcinoma (Cserni 2020; Thomas 2023). Its behaviour is better than its grade suggests: among 12,409 patients in 13 International Breast Cancer Study Group trials, 14-year distant recurrence-free interval was 76 percent for 127 medullary against 64 percent for 8,096 invasive ductal tumours (hazard ratio 0.52) and overall survival 66 against 57 percent (0.75); restricted to ER-negative grade 3 tumours the figures were 89 against 63 percent (0.24) and 74 against 54 percent (0.55) (Huober 2012). Medullary tumours are BRCA1-related (odds ratio for BRCA2 versus BRCA1 carrier status 0.25 in the CIMBA pathology series, Mavaddat 2012), and the claudin-low subtype shows frequent medullary differentiation (Prat 2010). The immune infiltrate is the same feature now scored as stromal tumour-infiltrating lymphocytes across triple-negative disease.
About 1 percent of breast cancers in trial populations: 127 of 12,409 patients in 13 IBCSG trials were recorded as medullary (Huober 2012). The 2019 WHO classification no longer lists it as a separate type.
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, 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 breast carcinoma with medullary pattern (medullary carcinoma), Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
As for triple-negative disease of no special type, including germline testing; the medullary pattern is recorded because of its better prognosis but does not change the NICE pathway.
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Query for this cancer: (TITLE:"Carcinoma with medullary pattern" OR ABSTRACT:"Carcinoma with medullary pattern" OR TITLE:"medullary breast cancer" OR ABSTRACT:"medullary breast cancer" OR TITLE:"Medullary carcinoma of the breast" OR ABSTRACT:"Medullary carcinoma of the breast" OR TITLE:"Medullary breast cancer" OR ABSTRACT:"Medullary breast cancer" OR TITLE:"Invasive carcinoma of no special type with medullary pattern" OR ABSTRACT:"Invasive carcinoma of no special type with medullary pattern" 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 Carcinoma with medullary pattern (medullary breast cancer), not a curated reading list.
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