Difference between revisions of "Metaplastic breast carcinoma"
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'''Metaplastic breast carcinoma''', also '''metaplastic carcinoma''', is rare form of [[invasive breast cancer]]. | |||
==General== | |||
*May be difficult to diagnose. | |||
*Prognosis - poor. | |||
*Top of the [[differential diagnosis]] for [[spindle cell lesions]] of the breast.{{fact}} | |||
==Microscopic== | |||
Features - one of the following:<ref name=metaplastic>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html]. Accessed on: 28 November 2010.</ref><ref name=pmid15868445>{{Cite journal | last1 = Barnes | first1 = PJ. | last2 = Boutilier | first2 = R. | last3 = Chiasson | first3 = D. | last4 = Rayson | first4 = D. | title = Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression. | journal = Breast Cancer Res Treat | volume = 91 | issue = 2 | pages = 173-8 | month = May | year = 2005 | doi = 10.1007/s10549-004-7260-y | PMID = 15868445 }}</ref> | |||
#Malignant mesenchymal elements - either: | |||
##Spindle cells. | |||
##Osseous, chondroid or rhabdoid differentiation. | |||
#Squamous component. | |||
#*Non-skin [[squamous cell carcinoma]] of the breast = metaplastic breast carcinoma. | |||
Notes: | |||
*Calcifications are uncommon. | |||
*Cytology may be very bland, i.e. it may look very benign. | |||
*May have minimal mitotic activity. | |||
DDx: | |||
*[[Fibromatosis]]. | |||
*Malignant [[phyllodes tumour]]. | |||
*Primary mammary sarcoma. | |||
*[[Mammary myofibroblastoma]]. | |||
*[[Nodular fasciitis]]. | |||
*[[Squamous cell carcinoma of the skin]]. | |||
===Images=== | |||
*[http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html Metaplastic carcinoma (breastpathology.info)].<ref name=metaplastic>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html]. Accessed on: 28 November 2010.</ref> | |||
*[http://path.upmc.edu/cases/case116.html Metaplastic carcinoma - case 1 - several images (upmc.edu)]. | |||
*[http://path.upmc.edu/cases/case294.html Metaplastic carcinoma - case 2 - several images (upmc.edu)]. | |||
===Subclassification=== | |||
*There are various way to subclassify this subtype of breast cancer. This a consequence of physician automomy. | |||
**There is a series of articles on the topic by ''Wargotz & Norris'' that is quite old... yet it is mentioned in ''Sterberg'':<ref>{{Ref Sternberg5|328}}</ref> | |||
*#Matrix-producing carcinoma:<ref>{{Cite journal | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma. | journal = Hum Pathol | volume = 20 | issue = 7 | pages = 628-35 | month = Jul | year = 1989 | doi = | PMID = 2544506 }}</ref> | |||
*#*Features: cartilaginous and/or osseous stromal matrix; '''no''' osteoclastic giant cells. | |||
*#Spindle cell carcinoma:<ref>{{Cite journal | last1 = Wargotz | first1 = ES. | last2 = Deos | first2 = PH. | last3 = Norris | first3 = HJ. | title = Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. | journal = Hum Pathol | volume = 20 | issue = 8 | pages = 732-40 | month = Aug | year = 1989 | doi = | PMID = 2473024 }}</ref> | |||
*#*Features: (non-malignant) spindle cells. | |||
*#*Prognosis: better prognosis than other metaplastic carcinomas. | |||
*#Carcinosarcoma:<ref>{{Cite journal | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. III. Carcinosarcoma. | journal = Cancer | volume = 64 | issue = 7 | pages = 1490-9 | month = Oct | year = 1989 | doi = | PMID = 2776108 }}</ref> | |||
*#*Features: malignant mesenchymal element. | |||
*#*Prognosis: survival worse when compared to other metaplastic carcinomas. | |||
*#Squamous cell carcinoma of ductal origin:<ref>{{Cite journal | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin. | journal = Cancer | volume = 65 | issue = 2 | pages = 272-6 | month = Jan | year = 1990 | doi = | PMID = 2153044 }}</ref> | |||
*#*Features: purely squamous; metastases are squamous cell carcinoma. | |||
*#Metaplastic carcinoma with osteoclastic giant cells:<ref>{{Cite journal | last1 = Wargotz | first1 = ES. | last2 = Norris | first2 = HJ. | title = Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. | journal = Hum Pathol | volume = 21 | issue = 11 | pages = 1142-50 | month = Nov | year = 1990 | doi = | PMID = 2227922 }}</ref> | |||
*#*Features: osteoclastic [[giant cells]]. | |||
**The WHO subclassifies as follows:<ref>{{Ref BP|214}}</ref> | |||
*#Epithelial - includes: squamous cell carcinoma, adenocarcinoma with spindle cell differentiation, [[adenosquamous carcinoma]]. | |||
*#Mixed epithelial and mesenchymal - includes: carcinosarcoma, carcinoma with metaplasia (chondroid, osseous). | |||
==IHC== | |||
*S100 -ve (r/o [[melanoma]]). | |||
*AE1/AE3 +ve (epithelial elements only). | |||
*CK7 +ve (epithelial elements only). | |||
*p63 +ve (epithelial elements only). | |||
*Vimentin +ve. | |||
*Desmin -ve. | |||
*EMA -ve. (???) | |||
==See also== | |||
*[[Invasive breast cancer]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Invasive breast cancer]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
Revision as of 11:27, 14 February 2014
Metaplastic breast carcinoma, also metaplastic carcinoma, is rare form of invasive breast cancer.
General
- May be difficult to diagnose.
- Prognosis - poor.
- Top of the differential diagnosis for spindle cell lesions of the breast.[citation needed]
Microscopic
Features - one of the following:[1][2]
- Malignant mesenchymal elements - either:
- Spindle cells.
- Osseous, chondroid or rhabdoid differentiation.
- Squamous component.
- Non-skin squamous cell carcinoma of the breast = metaplastic breast carcinoma.
Notes:
- Calcifications are uncommon.
- Cytology may be very bland, i.e. it may look very benign.
- May have minimal mitotic activity.
DDx:
- Fibromatosis.
- Malignant phyllodes tumour.
- Primary mammary sarcoma.
- Mammary myofibroblastoma.
- Nodular fasciitis.
- Squamous cell carcinoma of the skin.
Images
- Metaplastic carcinoma (breastpathology.info).[1]
- Metaplastic carcinoma - case 1 - several images (upmc.edu).
- Metaplastic carcinoma - case 2 - several images (upmc.edu).
Subclassification
- There are various way to subclassify this subtype of breast cancer. This a consequence of physician automomy.
- There is a series of articles on the topic by Wargotz & Norris that is quite old... yet it is mentioned in Sterberg:[3]
- Matrix-producing carcinoma:[4]
- Features: cartilaginous and/or osseous stromal matrix; no osteoclastic giant cells.
- Spindle cell carcinoma:[5]
- Features: (non-malignant) spindle cells.
- Prognosis: better prognosis than other metaplastic carcinomas.
- Carcinosarcoma:[6]
- Features: malignant mesenchymal element.
- Prognosis: survival worse when compared to other metaplastic carcinomas.
- Squamous cell carcinoma of ductal origin:[7]
- Features: purely squamous; metastases are squamous cell carcinoma.
- Metaplastic carcinoma with osteoclastic giant cells:[8]
- Features: osteoclastic giant cells.
- The WHO subclassifies as follows:[9]
- Epithelial - includes: squamous cell carcinoma, adenocarcinoma with spindle cell differentiation, adenosquamous carcinoma.
- Mixed epithelial and mesenchymal - includes: carcinosarcoma, carcinoma with metaplasia (chondroid, osseous).
IHC
- S100 -ve (r/o melanoma).
- AE1/AE3 +ve (epithelial elements only).
- CK7 +ve (epithelial elements only).
- p63 +ve (epithelial elements only).
- Vimentin +ve.
- Desmin -ve.
- EMA -ve. (???)
See also
References
- ↑ 1.0 1.1 URL: http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html. Accessed on: 28 November 2010.
- ↑ Barnes, PJ.; Boutilier, R.; Chiasson, D.; Rayson, D. (May 2005). "Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression.". Breast Cancer Res Treat 91 (2): 173-8. doi:10.1007/s10549-004-7260-y. PMID 15868445.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 328. ISBN 978-0781779425.
- ↑ Wargotz, ES.; Norris, HJ. (Jul 1989). "Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma.". Hum Pathol 20 (7): 628-35. PMID 2544506.
- ↑ Wargotz, ES.; Deos, PH.; Norris, HJ. (Aug 1989). "Metaplastic carcinomas of the breast. II. Spindle cell carcinoma.". Hum Pathol 20 (8): 732-40. PMID 2473024.
- ↑ Wargotz, ES.; Norris, HJ. (Oct 1989). "Metaplastic carcinomas of the breast. III. Carcinosarcoma.". Cancer 64 (7): 1490-9. PMID 2776108.
- ↑ Wargotz, ES.; Norris, HJ. (Jan 1990). "Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin.". Cancer 65 (2): 272-6. PMID 2153044.
- ↑ Wargotz, ES.; Norris, HJ. (Nov 1990). "Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells.". Hum Pathol 21 (11): 1142-50. PMID 2227922.
- ↑ O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 214. ISBN 978-0443066801.