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Mastoraki A, Schizas D, Giannakodimos I, Rebakos A, Margaris I, Katsaros I, Vagios I, Vassiliu P, Pikoulis E. Malignant melanoma of the breast: controversies in the diagnosis and therapeutic management of a rare nosologic entity. Int J Dermatol 2020; 59:1057-1064. [PMID: 32115682 DOI: 10.1111/ijd.14818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
Melanoma of the breast is an infrequent entity, presenting as either primary or metastatic from extramammary solid neoplasms. Depending on the involvement of the skin, primary malignant melanoma of the breast (PMMB) can be classified as cutaneous or noncutaneous. Cutaneous PMMB accounts for <5% of all melanomas and only 0.5% of all breast cancers. Furthermore, despite the rarity of metastatic breast neoplasms, melanoma comprises a frequent source of metastases. Metastatic potential of melanoma is associated with poor prognosis, and the majority of patients present more than one metastatic foci at the time of diagnosis. Diagnostic approach for both primary and metastatic melanomas of the breast is substantiated by fine needle aspiration (FNA) cytology along with immunohistochemistry. Nevertheless, verification of a metastatic mammary melanoma requires the discovery of a primary lesion. The mainstay of treatment for primary tumors is surgery, with radical local excision and axillary lymph node dissection or, on occasion, axillary sentinel node resection, while for metastatic tumors it depends on the specificities of the melanoma. Adjuvant therapy is always implemented. The aim of this survey is to meticulously review the literature of primary and metastatic malignant melanomas of the breast and report epidemiologic and clinicopathologic data for this rare entity. Clinical features, histogenesis, morphological, and immunochemical findings are discussed, while the role of current diagnostic and therapeutic management of this uncommon entity is emphasized.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Ilias Giannakodimos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Athanasios Rebakos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Ioannis Margaris
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Ioannis Katsaros
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Ilias Vagios
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Pantelis Vassiliu
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
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2
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Inouye CM, Cimino-Mathews A, Eisner D, Rosenthal DL, VandenBussche CJ. Fine-needle aspiration of metastatic melanoma presenting as bilateral breast cysts. Diagn Cytopathol 2017; 45:446-451. [PMID: 28322032 DOI: 10.1002/dc.23666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/08/2016] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
Abstract
Melanoma is the second most common non-hematopoietic malignancy after carcinomas to metastasize to the breast and often appears as a well-circumscribed, dense nodule on imaging. Although metastatic lesions presenting as bilateral cysts have been reported, this presentation is not common and may mimic benign breast cysts. We present a challenging case of metastatic melanoma presenting as bilateral breast cysts with spindled cytomorphology in a patient with a history of mammary carcinoma. Discordance between the spindled cytomorphology and the morphology of the core biopsy, which was similar to the patient's primary breast cancer, allowed for entertainment of other tumors and disease processes. Confirmatory immunostaining of the cytology material with HMB-45 was important to establish the diagnosis of metastatic melanoma. Diagn. Cytopathol. 2017;45:446-451. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Casey M Inouye
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Eisner
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorothy L Rosenthal
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Vergine M, Guy C, Taylor MR. Phyllodes Tumor of the Breast With Malignant Melanoma Component. Int J Surg Pathol 2015; 23:483-8. [DOI: 10.1177/1066896915592018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast display a wide variation in histological appearance and are classified into benign, borderline, and malignant categories based on a combination of histological parameters. These tumors may include a malignant heterologous component that is believed to originate through a process of multidirectional differentiation from a cancer stem cell. In these cases, the tumor is classified as a malignant phyllodes tumor. Among the heterologous elements that have been described in malignant phyllodes tumors are rhabdomyosarcoma, chondrosarcoma, osteosarcoma, liposarcoma and angiosarcoma. We present the first case of a phyllodes tumor with a malignant melanoma component in the breast of a 71-year-old lady, discussing the clinical implications of this diagnosis.
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Affiliation(s)
- Marco Vergine
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Catherine Guy
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Mark R. Taylor
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
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4
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Wang CH, Gao XJ, Liao SY, Feng JX, Luo B, Liu LX. Transcriptome analysis of human breast cancer cell lines MCF-7 and MDA-MB-435 by RNA-Seq. Mol Biol 2015. [DOI: 10.1134/s0026893315020144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kallel R, Bahri I, Abid N, Feki J, Mellouli M, Ayadi L, Boudawara T. [Mixed breast carcinoma with melanocytic differentiation in a man]. Ann Pathol 2014; 34:115-8. [PMID: 24703020 DOI: 10.1016/j.annpat.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/09/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Male breast cancer is rare; the lobular type is exceptional. Only one case of mixed ductal and lobular type is reported in the literature. This is the first report on a mixed ductal and lobular carcinoma with melanocytic differentiation in a man. The aim of our study is to describe the clinicopathological characteristics of this rare type of breast tumor and to discuss its histogenesis. CASE REPORT A 63-year-old man presented with cutaneous ulceration of the left breast. Ultrasound of the breast revealed a solid hypoechoic lesion, 13 mm in diameter. Microscopic evaluation of the biopsy showed an invasive ductal carcinoma. The patient received three cycles of chemotherapy and lost of view. Then consulted for increasing of the tumor size reaching 3 cm. Histological examination of the mastectomy specimen showed a mixed ductal and lobular carcinoma with melanocytic differentiation, confirmed by the immunohistochemical study. The patient received adjuvant chemotherapy and the evolution was favorable with an average follow-up of 9 months. CONCLUSION Breast carcinoma with melanocytic differentiation is extremely rare; only seven cases are reported in the literature and all occurs in females. Its histogenesis is unclear; tumors exhibiting this combination of cell types may occur as collision or composite tumors.
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Affiliation(s)
- Rim Kallel
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - Ibticem Bahri
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - Najla Abid
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie.
| | - Jihène Feki
- Service de carcinologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - Manel Mellouli
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - Lobna Ayadi
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - Tahya Boudawara
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib Bourguiba, 3029 Sfax, Tunisie
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6
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Biswas A, Goyal S, Jain A, Suri V, Mathur S, Julka PK, Rath GK. Primary amelanotic melanoma of the breast: combating a rare cancer. Breast Cancer 2014; 21:236-40. [PMID: 20978954 DOI: 10.1007/s12282-010-0231-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 09/16/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Malignant melanoma is the foremost cause of metastasis to the breast from extramammary solid neoplasm. However primary melanoma of the breast is a distinct rarity. Primary melanoma involves the skin and less commonly the glandular parenchyma of the breast. METHOD We herein describe a case of primary amelanotic melanoma of the breast parenchyma in a 32-year-old female managed with a combination of surgery, adjuvant radiotherapy and immunotherapy. CONCLUSION This case report aims to increase awareness of unusual neoplasms of the breast which might require a different surgical and adjuvant therapeutic approach.
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Affiliation(s)
- Ahitagni Biswas
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India,
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Gauchotte G, Gauchotte É, Bressenot A, Verhaeghe JL, Guillemin F, Leroux A, Genin P. Les carcinomes métaplasiques du sein : une étude morphologique et immunohistochimique. Ann Pathol 2011; 31:18-27. [DOI: 10.1016/j.annpat.2010.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Abstract
Metaplastic carcinoma of the breast is a rare heterogeneous malignancy, accounting for <1% of all invasive breast carcinomas, in which adenocarcinoma is found to coexist with an admixture of spindle, squamous, chondroid or bone-forming neoplastic cells. Metaplastic breast carcinoma composed of both epithelial and melanocytic elements is rare, and only seven cases have been reported so far. Reported herein is the case of a 38-year-old woman with a nodular mass in her left breast suspicious of malignancy, discovered during routine ultrasound examination. After histological and immunohistochemical examination of the resected tumor mass, initial diagnosis was collision tumor: ductal invasive carcinoma and metastatic melanoma. The patient underwent quadrantectomy, chemotherapy and radiotherapy. At 6 years follow up the patient was alive and healthy, without local recurrence or metastases. After revising slides and the literature, in addition to patient follow up, it was concluded that this case represents metaplastic carcinoma with melanocytic differentiation.
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Affiliation(s)
- Antonia Bendic
- Department of Pathology, Forensic Medicine and Cytology, Clinical Hospital Center Split, Spinceva, 21000 Split, Croatia.
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9
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Abstract
A controversy has arisen over the past several years about the true origin of the human MDA-MB-435 cell line. Originally described as a human breast cancer cell line, subsequent expression array studies instead suggested a gene expression profile consistent with a melanoma origin. Subsequent karyotype and comparative genomic hybridization studies supported the idea that current stocks of both MDA-MB-435 cells and M14 melanoma cells must be identical cell lines, and the conclusion was drawn that both cell lines were in fact M14 melanoma cells. However, an alternate conclusion based on these data is that both cell lines are indeed identical, but are in fact MDA-MB-435 breast cancer cells. There is evidence that many cell lines can display "lineage infidelity" and that assignment to tissue type is unreliably made based on expression patterns. Evidence from the literature is presented here that is inconsistent with both lines being of M14 melanoma origin, but rather is consistent with both cell lines being of MDA-MB-435 breast cancer origin.
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Affiliation(s)
- Ann F Chambers
- London Regional Cancer Program, Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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Mujat M, Ferguson RD, Hammer DX, Gittins C, Iftimia N. Automated algorithm for breast tissue differentiation in optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:034040. [PMID: 19566332 PMCID: PMC2990885 DOI: 10.1117/1.3156821] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
An automated algorithm for differentiating breast tissue types based on optical coherence tomography (OCT) data is presented. Eight parameters are derived from the OCT reflectivity profiles and their means and covariance matrices are calculated for each tissue type from a training set (48 samples) selected based on histological examination. A quadratic discrimination score is then used to assess the samples from a validation set. The algorithm results for a set of 89 breast tissue samples were correlated with the histological findings, yielding specificity and sensitivity of 0.88. If further perfected to work in real time and yield even higher sensitivity and specificity, this algorithm would be a valuable tool for biopsy guidance and could significantly increase procedure reliability by reducing both the number of nondiagnostic aspirates and the number of false negatives.
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Affiliation(s)
- Mircea Mujat
- Physical Sciences, Inc., 20 New England Business Center, Andover, Massachusetts 01810, USA.
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11
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Noske A, Schwabe M, Pahl S, Fallenberg E, Richter-Ehrenstein C, Dietel M, Kristiansen G. Report of a metaplastic carcinoma of the breast with multi-directional differentiation: an adenoid cystic carcinoma, a spindle cell carcinoma and melanoma. Virchows Arch 2008; 452:575-9. [PMID: 18283489 DOI: 10.1007/s00428-008-0588-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 01/21/2008] [Accepted: 01/22/2008] [Indexed: 11/27/2022]
Abstract
Metaplastic carcinoma of the breast is a heterogeneous neoplasia, generally composed of both epithelial and mesenchymal components. We report an unusual case of mammary metaplastic carcinoma in a 51-year-old female patient. Needle core biopsy from the tumour mass showed malignant epithelial and sarcomatous features. The resection specimen revealed a multi-directional tumour differentiation consisting predominantly of: firstly, a poorly differentiated basaloid epithelial cell type, consistent with an adenoid cystic carcinoma; secondly, areas of a spindle cell carcinoma; and, thirdly, areas with a melanocytic differentiation. This is the first report on a metaplastic carcinoma of the breast presenting as an admixture of an adenoid cystic carcinoma and melanoma.
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Affiliation(s)
- Aurelia Noske
- Institute of Pathology, Charité University Hospital Berlin, Campus Mitte, Charitéplatz 1, Berlin 10117, Germany.
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12
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Setaluri V. The Melanosome: Dark Pigment Granule Shines Bright Light on Vesicle Biogenesis and More. J Invest Dermatol 2003; 121:650-60. [PMID: 14632178 DOI: 10.1046/j.1523-1747.2003.12500.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Vijayasaradhi Setaluri
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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13
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Yang GCH, Yee HT, Waisman J. Metaplastic carcinoma of the breast with rhabdomyosarcomatous element: aspiration cytology with histological, immunohistochemical, and ultrastructural correlations. Diagn Cytopathol 2003; 28:153-8. [PMID: 12619098 DOI: 10.1002/dc.10243] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We studied a metaplastic breast carcinoma with a rhabdomyosarcomatous element from a 62-yr-old woman. In the fine-needle aspirates processed by Ultrafast Papanicolaou stain, there were small undifferentiated cells with scanty cytoplasm and differentiated cells with red macronucleoli and abundant cytoplasm. Some differentiated cells contained a brown inclusion with a blue rim. Ultrastructurally, the brown inclusion correlated to a central aggregate of sarcomeres and the blue rim correlated to actin filaments surrounding the sarcomeres. The differentiated cells without cytoplasmic inclusions expressed cytokeratin and contained tonofilaments. A transitional cell type containing both sacromeres and tonofilaments was absent. Immunohistochemically, the small undifferentiated cells expressed vimentin diffusely and showed >90% MIB-1 proliferating index, whereas the differentiated cells expressed cytokeratin, actin, or myoglobin and had virtually absent MIB-1 nuclear labeling. Histologically, the small cells were more concentrated along the capsule and the large cells were more concentrated in the center of the tumor. These findings suggest the bidirectional differentiation of the small undifferentiated cells into carcinoma cells and rhabdomyosarcoma cells in this tumor.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology, New York University School of Medicine, New York, New York, USA.
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14
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Ribeiro-Silva A, Luzzatto F, Chang D, Zucoloto S. Limitations of fine-needle aspiration cytology to diagnose metaplastic carcinoma of the breast. Pathol Oncol Res 2002; 7:298-300. [PMID: 11882910 DOI: 10.1007/bf03032387] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metaplastic carcinoma is a very rare breast neoplasm that is often confused with benign and others malignant entities on both clinical and conventional histopathologic basis. Three cases of metaplastic carcinoma of breast are presented. The difficulties found on fine needle aspiration cytology and the limitations of this procedure are discussed as well the main features of this tumor.
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Affiliation(s)
- A Ribeiro-Silva
- University of Sao Paulo (FMRP/USP), Department of Pathology of Faculty of Medicine of Ribeirao Preto Av. Bandeirantes, s/n Campus Universitário Monte Alegre., Sao Paulo, 14048-900, Brazil.
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