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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]] | ||