Metaplastic breast carcinoma

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Metaplastic breast carcinoma, also (less specifically) metaplastic carcinoma, is rare form of invasive breast cancer.

Metaplastic breast carcinoma
Diagnosis in short

Metaplastic breast carcinoma. H&E stain.
LM either (1) or (2): (1) malignant mesenchymal elements - either: (a) spindle cells or (b) osseous, chondroid or rhabdoid differentiation, (2) malignant squamous component - non-skin
LM DDx fibromatosis, malignant phyllodes tumour, primary mammary sarcoma, mammary myofibroblastoma,nodular fasciitis. squamous cell carcinoma of the skin, malignant melanoma (desmoplastic)
IHC S-100 -ve, AE1/AE3 +ve (epithelial elements only), CK7 +ve (epithelial elements only), p63 +ve (epithelial elements only), vimentin +ve, desmin -ve
Grossing notes breast grossing
Staging breast cancer staging
Site breast - see invasive breast cancer
Prevalence uncommon
Prognosis poor
Clin. DDx other breast tumours

General

Microscopic

Features - one of the following:[1][2]

  1. Malignant mesenchymal elements - either:
    1. Spindle cells.
    2. Osseous, chondroid or rhabdoid differentiation.
  2. Squamous component.

Notes:

  • Calcifications are uncommon.
  • Cytology may be very bland, i.e. it may look very benign.
  • May have minimal mitotic activity.

DDx:

Images

  • Breast- Metaplastic Carcinoma- FibromatosisType- LP (SKB)

  • Breast- Metaplastic Carcinoma- FibromatosisType- LP (SKB)

  • Breast- Metaplastic Carcinoma- FibromatosisType- MP (SKB)

  • Breast- Metaplastic Carcinoma- FibromatosisType- MP (SKB)

  • Breast- Metaplastic Carcinoma- FibromatosisType- HP (SKB)

  • Breast- Metaplastic Carcinoma- FibromatosisType- HP (SKB)

  • Breast- Metaplastic Carcinoma- HP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- HP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- LP (SKB)

  • Breast- Metaplastic Carcinoma- LP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma- LP (SKB)

  • Breast- Metaplastic Carcinoma- MP (SKB)

  • Breast- Metaplastic Carcinoma - Not a great photo but shows a chondroid-like area (SKB)

  • Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)

  • Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)

  • Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)

  • Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like HP (SKB)

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]
    1. Matrix-producing carcinoma:[4]
      • Features: cartilaginous and/or osseous stromal matrix; no osteoclastic giant cells.
    2. Spindle cell carcinoma:[5]
      • Features: (non-malignant) spindle cells.
      • Prognosis: better prognosis than other metaplastic carcinomas.
    3. Carcinosarcoma:[6]
      • Features: malignant mesenchymal element.
      • Prognosis: survival worse when compared to other metaplastic carcinomas.
    4. Squamous cell carcinoma of ductal origin:[7]
      • Features: purely squamous; metastases are squamous cell carcinoma.
    5. Metaplastic carcinoma with osteoclastic giant cells:[8]
    • The WHO subclassifies as follows:[9]
    1. Epithelial - includes: squamous cell carcinoma, adenocarcinoma with spindle cell differentiation, adenosquamous carcinoma.
    2. 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. (???)
  • Almost invariably TRIPLE NEGATIVE for ER, PR and HER2

See also

References

  1. ↑ 1.0 1.1 URL: http://www.breastpathology.info/Case_of_the_month/2007/COTM_0807%20discussion.html. Accessed on: 28 November 2010.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Wargotz, ES.; Norris, HJ. (Jul 1989). "Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma.". Hum Pathol 20 (7): 628-35. PMID 2544506.
  5. ↑ 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.
  6. ↑ Wargotz, ES.; Norris, HJ. (Oct 1989). "Metaplastic carcinomas of the breast. III. Carcinosarcoma.". Cancer 64 (7): 1490-9. PMID 2776108.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
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