Difference between revisions of "Metaplastic breast carcinoma"

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#redirect [[Invasive_breast_cancer#Metaplastic_breast_carcinoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Breast MetaplasticCarcinoma 2 MP4 CTR.jpg
| Width      =
| Caption    = Metaplastic breast carcinoma. [[H&E stain]].
| Synonyms  =
| Micro      = 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
| Subtypes  =
| LMDDx      = [[fibromatosis]], malignant [[phyllodes tumour]], primary mammary sarcoma, [[mammary myofibroblastoma]],[[nodular fasciitis]]. [[squamous cell carcinoma of the skin]], [[malignant melanoma]] (desmoplastic)
| Stains    =
| IHC        = S-100 -ve, AE1/AE3 +ve (epithelial elements only), CK7 +ve (epithelial elements only), p63 +ve (epithelial elements only), vimentin +ve, desmin -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  = [[breast grossing]]
| Staging    = [[breast cancer staging]]
| Site      = [[breast]] - see ''[[invasive breast cancer]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = poor
| Other      =
| ClinDDx    = other breast tumours
| Tx        =
}}
'''Metaplastic breast carcinoma''', also (less specifically) '''[[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]].
*[[Malignant melanoma]].
===Images===
<gallery>
Image:Breast MetaplasticCarcinoma FibromatosisType LP 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- LP (SKB)
Image:Breast MetaplasticCarcinoma FibromatosisType LP2 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- LP (SKB)
Image:Breast MetaplasticCarcinoma FibromatosisType MP 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- MP (SKB)
Image:Breast MetaplasticCarcinoma FibromatosisType MP2 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- MP (SKB)
Image:Breast MetaplasticCarcinoma FibromatosisType HP2 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- HP (SKB)
Image:Breast MetaplasticCarcinoma FibromatosisType HP 12BR***.jpg|Breast- Metaplastic Carcinoma- FibromatosisType- HP (SKB)
Image:Breast MetaplasticCarcinoma HP.jpg|Breast- Metaplastic Carcinoma- HP (SKB)
Image:Breast MetaplasticCarcinoma MP CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma HP CTR.jpg|Breast- Metaplastic Carcinoma- HP (SKB)
Image:Breast MetaplasticCarcinoma 2 MP CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma 2 MP2 CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma 2 MP3 CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma 2 MP4 CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma LP SNP.jpg|Breast- Metaplastic Carcinoma- LP (SKB)
Image:Breast MetaplasticCarcinoma LP CTR.jpg|Breast- Metaplastic Carcinoma- LP (SKB)
Image:Breast MetaplasticCarcinoma MP CTR (2).jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma MP2 CTR.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma LP PA (2).jpg|Breast- Metaplastic Carcinoma- LP (SKB)
Image:Breast MetaplasticCarcinoma MP PA.jpg|Breast- Metaplastic Carcinoma- MP (SKB)
Image:Breast MetaplasticCarcinoma PA.JPG|Breast- Metaplastic Carcinoma - Not a great photo but shows a chondroid-like area (SKB)
Image:Breast MetaplasticCarcinoma LP PA.JPG|Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)
Image:Breast MetaplasticCarcinoma LP3 PA.JPG|Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)
Image:Breast MetaplasticCarcinoma LP2 PA.JPG|Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like LP (SKB)
Image:Breast MetaplasticCarcinoma HP PA.JPG|Breast- Metaplastic Carcinoma- Spindled/fibromatosis-like HP (SKB)
</gallery>
*[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. (???)
*Almost invariably TRIPLE NEGATIVE for ER, PR and HER2
==See also==
*[[Invasive breast cancer]].
*[[Metaplastic carcinoma]].
==References==
{{Reflist|2}}
[[Category:Invasive breast cancer]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 11:37, 8 September 2016

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

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

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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