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Conti M, Morciano F, Amodeo S, Gori E, Romanucci G, Belli P, Tommasini O, Fornasa F, Rella R. Special Types of Breast Cancer: Clinical Behavior and Radiological Appearance. J Imaging 2024; 10:182. [PMID: 39194971 DOI: 10.3390/jimaging10080182] [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: 05/22/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Breast cancer is a complex disease that includes entities with different characteristics, behaviors, and responses to treatment. Breast cancers are categorized into subgroups based on histological type and grade, and these subgroups affect clinical presentation and oncological outcomes. The subgroup of "special types" encompasses all those breast cancers with insufficient features to belong to the subgroup "invasive ductal carcinoma not otherwise specified". These cancers account for around 25% of all cases, some of them having a relatively good prognosis despite high histological grade. The purpose of this paper is to review and illustrate the radiological appearance of each special type, highlighting insights and pitfalls to guide breast radiologists in their routine work.
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Affiliation(s)
- Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Silvia Amodeo
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Elisabetta Gori
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi 1, 37142 Verona, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Oscar Tommasini
- UOC Diagnostica per Immagini, Dipartimento Emergenza e Accettazione, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
| | - Francesca Fornasa
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi 1, 37142 Verona, Italy
| | - Rossella Rella
- UOC Diagnostica per Immagini, Dipartimento Emergenza e Accettazione, Ospedale G.B. Grassi, Via Gian Carlo Passeroni, 28, 00122 Rome, Italy
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Tomey V, Ashwini Kumar RK, Nikhade P, Akulwar A. Carcinosarcoma of breast - A chimera among breast neoplasms. J Family Med Prim Care 2024; 13:2149-2151. [PMID: 38948622 PMCID: PMC11213368 DOI: 10.4103/jfmpc.jfmpc_983_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 07/02/2024] Open
Abstract
Malignant phyllodes, along with ductal carcinoma, is known as metaplastic cancer of the breast. This tumor is additionally known as breast carcinosarcoma. Malignant phyllodes in conjunction with ductal carcinoma is a rare finding in routine clinical practice. We describe the case report of a 47-year-old female patient who arrived with a large right breast mass. A core biopsy was performed, and histopathological examination indicated that the tumor was a malignant phyllodes tumor. A positron emission tomography (PET) scan revealed hyper-metabolic and hypo-metabolic tumors with perilesional stranding and satellite nodularity. There were a few metastatic right axillary nodes visible. There was no indication of distant metastases. Due to the presence of both components, a modified radical mastectomy surgery with axillary dissection was undertaken for this patient. Histopathological analysis of paraffin sections revealed ductal carcinoma in situ (DCIS) comedo-epithelial component and spindle-shaped cells with hyper-chromatic oval nuclei and scanty cytoplasm.
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Affiliation(s)
- Vandana Tomey
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Wanadongri, Nagpur, Maharashtra, India
| | - Raj Kumar Ashwini Kumar
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Wanadongri, Nagpur, Maharashtra, India
| | - Pravin Nikhade
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Wanadongri, Nagpur, Maharashtra, India
| | - Anil Akulwar
- Department of Surgery, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Wanadongri, Nagpur, Maharashtra, India
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Yao M, Luo S, Li L, Wang Y, Zhu W, Liu Y, Liang C. Sonographic and clinicopathologic features of metaplastic breast carcinoma and infiltrating ductal carcinoma: a comparative single-center cohort study. Quant Imaging Med Surg 2024; 14:909-919. [PMID: 38223107 PMCID: PMC10784059 DOI: 10.21037/qims-23-1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024]
Abstract
Background The rarity of metaplastic breast carcinoma (MBC) has resulted in limited sonographic data. Given the inferior prognosis of MBC compared to invasive ductal carcinoma (IDC), accurate preoperative differentiation between the two is imperative for effective treatment planning and prognostic prediction. The objective of this study was to assess the diagnostic accuracy of MBC and differentiate it from IDC by analyzing sonographic and clinicopathologic features. Methods In this retrospective cohort study, 197 women comprising 200 IDC lesions were enrolled between January 2012 and December 2021 and 20 women comprising 20 pure MBC lesions were enrolled between January 2019 and December 2019. A comparison was made between the sonographic and clinicopathologic characteristics of MBC and IDC. Results The results indicated that patients with MBC had a higher proportion of tumor grade 3 (95.0% vs. 32.5%; P<0.001), high Ki-67 expression (100.0% vs. 75.0%; P<0.001), and the triple-negative subtype (90.0% vs. 13.0%; P<0.001) as compared to those with IDC. On ultrasound (US) findings, MBC lesions tended to have a larger size (≥5 cm: 45.0% vs. 1.5%; P<0.001), regular shape (45.0% vs. 1.5%, P<0.001), circumscribed margin (40.0% vs. 0.5%, P<0.001), a complex cystic and solid echo pattern (50.0% vs. 3.5%; P<0.001), and posterior acoustic enhancement (95.0% vs. 14.5%; P<0.001). Additionally, MBC was more likely to be misinterpreted as a benign lesion by sonographers than was IDC (30.0% vs. 4.5%; P<0.001). Multilayer perceptron analysis revealed posterior acoustic enhancement, circumscribed margins, and size as distinguishing factors between these two tumor types. The estimated rates of local recurrence, distant metastasis, and 5-year overall survival in 19 cases with MBC were found to be 10.5%, 31.6%, and 65.0%, respectively. Conclusions MBC typically presents as a large breast mass with more benign US features in older women, findings which may facilitate its accurate diagnosis and differentiation from other breast masses.
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Affiliation(s)
- Mengxia Yao
- Department of Ultrasound, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Siwei Luo
- Department of Ultrasound, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Lian Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yin Wang
- Department of Ultrasound, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wu Zhu
- Department of Ultrasound, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yu Liu
- Department of Ultrasound, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Püsküllüoğlu M, Świderska K, Konieczna A, Rudnicki W, Pacholczak-Madej R, Kunkiel M, Grela-Wojewoda A, Mucha-Małecka A, Mituś JW, Stobiecka E, Ryś J, Jarząb M, Ziobro M. Discrepancy between Tumor Size Assessed by Full-Field Digital Mammography or Ultrasonography (cT) and Pathology (pT) in a Multicenter Series of Breast Metaplastic Carcinoma Patients. Cancers (Basel) 2023; 16:188. [PMID: 38201615 PMCID: PMC10778481 DOI: 10.3390/cancers16010188] [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: 11/11/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Metaplastic breast cancer (BC-Mp) presents diagnostic and therapeutic complexities, with scant literature available. Correct assessment of tumor size by ultrasound (US) and full-field digital mammography (FFDM) is crucial for treatment planning. METHODS A retrospective cohort study was conducted on databases encompassing records of BC patients (2012-2022) at the National Research Institutes of Oncology (Warsaw, Gliwice and Krakow Branches). Inclusion criteria comprised confirmed diagnosis in postsurgical pathology reports with tumor size details (pT) and availability of tumor size from preoperative US and/or FFDM. Patients subjected to neoadjuvant systemic treatment were excluded. Demographics and clinicopathological data were gathered. RESULTS Forty-five females were included. A total of 86.7% were triple-negative. The median age was 66 years (range: 33-89). The median pT was 41.63 mm (6-130), and eight patients were N-positive. Median tumor size assessed by US and FFDM was 31.81 mm (9-100) and 34.14 mm (0-120), respectively. Neither technique demonstrated superiority (p > 0.05), but they both underestimated the tumor size (p = 0.002 for US and p = 0.018 for FFDM). Smaller tumors (pT1-2) were statistically more accurately assessed by any technique (p < 0.001). Only pT correlated with overall survival. CONCLUSION The risk of underestimation in tumor size assessment with US and FFDM has to be taken into consideration while planning surgical procedures for BC-Mp.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
| | - Katarzyna Świderska
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Konieczna
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Wojciech Rudnicki
- Department of Electroradiology, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008p Kraków, Poland; (R.P.-M.)
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
- Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Michał Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Jerzy W. Mituś
- Department of Anatomy, Jagiellonian University Medical College, 31-008p Kraków, Poland; (R.P.-M.)
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Ewa Stobiecka
- Department of Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland; (A.G.-W.); (M.Z.)
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Asare B, White MJ, Rossi J. Metaplastic carcinoma with osteosarcomatous differentiation in the breast: Case report. Radiol Case Rep 2023; 18:4272-4280. [PMID: 37771380 PMCID: PMC10522872 DOI: 10.1016/j.radcr.2023.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Metaplastic breast carcinoma is rare and may present as a highly aggressive subtype of breast cancer. In this case report of metastatic metaplastic breast carcinoma with osteosarcomatous differentiation in a female patient previously treated for invasive ductal carcinoma, we describe the new presentation of a palpable mass with associated calcifications on imaging near the site of prior partial mastectomy. This article will detail the clinical presentation, imaging findings, histopathology, and clinical course following treatment of our case. Knowledge of the clinical and imaging presentation of this rare subtype, which can present with benign features on mammography and ultrasound, can facilitate timely diagnosis as treatment paradigms evolve.
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Affiliation(s)
- Belinda Asare
- Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
| | - Marissa Janine White
- Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
| | - Joanna Rossi
- Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
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Huang C, Tian H, Xu J, Tong F, Fang D. Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review. Open Life Sci 2023; 18:20220640. [PMID: 37528884 PMCID: PMC10389674 DOI: 10.1515/biol-2022-0640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
Metaplastic matrix-producing breast carcinoma is a type of metaplastic breast carcinoma (MBC), which is a rare malignancy, accounting for 0.2-1% of breast carcinomas. A 52-year-old female visited a hospital because of a palpable painless mass in the right breast and was diagnosed with Breast Imaging Reporting and Data System (BI-RADS) category 4A via ultrasound (US) with a suspected positive lymph node at the right axillary region. Excision of the breast mass was performed and histopathologically confirmed that it was MBC with osseous differentiation. No distant metastasis was revealed before a modified radical mastectomy; however, metastasis to a lymph node of the right axillary region was observed (1/22). She received six cycles of TEC scheme chemotherapy (docetaxel, epirubicin, and cyclophosphamide, 21 days) and 5 weeks of radiotherapy (48 Gy/25 f/5 days a week), but without any follow-up examinations since radiotherapy. Twenty-four months after surgery, distant metastases to lungs and liver were confirmed and died 3 months later. This case provides valuable information for clinicians on MBC and suggests that further examination or biopsy should be performed to US BI-RADS 4A masses before surgery. In addition, regular postoperative follow-up plays important roles in detecting metastases early and improving prognosis.
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Affiliation(s)
- Cong Huang
- Department of General Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
- Chongqing Institute of Minimally Invasive Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
| | - Haibo Tian
- Chongqing Institute of Minimally Invasive Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
- Department of Pathology, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
| | - Jinming Xu
- Department of General Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
- Chongqing Institute of Minimally Invasive Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
| | - Fuyun Tong
- Chongqing Institute of Minimally Invasive Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
- Department of Thyroid and Breast Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
| | - Dengyang Fang
- Department of General Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
- Chongqing Institute of Minimally Invasive Surgery, Chongqing University Fuling Hospital, Chongqing, 408000, P. R. China
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Corso G, Criscitiello C, Nicosia L, Pesapane F, Vicini E, Magnoni F, Sibilio A, Zanzottera C, De Scalzi AM, Mannucci S, Marabelli M, Calvello M, Feroce I, Zagami P, Porta FM, Toesca A, Tarantino P, Nicolò E, Mazzarol G, La Vecchia C, Bonanni B, Leonardi MC, Veronesi P, Fusco N. Metaplastic breast cancer: an all-round multidisciplinary consensus. Eur J Cancer Prev 2023; 32:348-363. [PMID: 37021548 DOI: 10.1097/cej.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Metaplastic breast cancer (MpBC) is a rare and aggressive histologic subtype of breast cancer (BC) characterized by the presence of at least two cellular types, commonly epithelial and mesenchymal components. Despite growing evidence that MpBC is a unique entity, it has long been treated as a variant of nonspecial type (NST) BC. MpBC typically shows the phenotype of triple-negative breast cancer (TNBC), but compared to NST-TNBC, it is a relatively chemorefractory tumor associated with worse outcomes. Therefore, there is an urgent need to develop management guidelines specifically for MpBC to improve the prognosis of patients with early MpBC. This expert consensus aims to guide diagnosis and standardize clinical management of early MpBC among treating physicians. We provide guidance on the challenging radiological and pathological diagnosis of MpBC. Evidence on the involvement of genetic predisposition in the development of MpBC is also explored. We emphasize the importance of a multidisciplinary approach for the treatment of patients with early MpBC. The optimal surgery and radiotherapy approach is presented, as well as the opportunity offered by novel therapeutic approaches to increase treatment response in this chemoresistant subtype. Appropriate management of patients with MpBC is critical to reduce the high risk of local and distant recurrence that characterizes this disease.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
- European Cancer Prevention Organization (ECP)
| | - Carmen Criscitiello
- Department of Oncology and Hemato-Oncology, University of Milan
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Luca Nicosia
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Elisa Vicini
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Andrea Sibilio
- Division of Breast Surgery Forlì (Ravenna), AUSL Romagna, Ravenna
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Sara Mannucci
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Monica Marabelli
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
- Division of Hematology, Clinica Moncucco, Lugano, Switzerland
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Paola Zagami
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Department of Biomedical, Surgical and Dental Sciences
| | | | - Antonio Toesca
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Paolo Tarantino
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Division of Breast Oncology, Dana-Farber Cancer Institute, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eleonora Nicolò
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Giovanni Mazzarol
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, and
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan
- Harvard Medical School, Boston, MA, USA
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8
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Chaudhary D, Balhara K, Mandal S, Mallya V, Tomar R, Khurana N, Bains L. Metaplastic breast carcinoma: Analysis of clinical and pathologic features, a five-year study. J Cancer Res Ther 2023; 19:1226-1230. [PMID: 37787287 DOI: 10.4103/jcrt.jcrt_1229_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/09/2022] [Indexed: 10/04/2023]
Abstract
BACKGROUND Metaplastic carcinoma breast (MCB) is a rare tumor comprising of both glandular and non-glandular patterns with epithelial and or mesenchymal components. Due to their varied clinicomorphological features, diagnosis has been challenging. AIM To study the clinicopathological and histomorphology of cases of metaplastic carcinoma breast diagnosed in a tertiary care hospital along with literature review. MATERIALS AND METHODS This is a retrospective study including data of 11 patients who were diagnosed with MCB either on trucut or mastectomy specimens conducted between January 2014 and December 2018. RESULTS The study includes 11 patients, out of which 10 were diagnosed on mastectomy while one on trucut specimen. All the patients were women with the mean age of presentation being 43.8 years. The most common presentation was palpable breast lump with mean tumor size of 7.3 cm in greatest dimension. Skin involvement was seen in 36.3% of cases. While eight cases (72.7%) were classified as epithelial, three (27.2%) were classified as mixed. Amongst epithelial variety, in eight cases, squamous component was seen along with infiltrating ductal carcinoma (IDC) while one was pure squamous type. In mixed variety, one case showed spindled areas along with squamous areas and areas of IDC. Other two showed focal sarcomatous and cartilaginous areas in one and angiosarcomatous, bone and cartilage formation admixed with areas of IDC in other case. CONCLUSION MCB are rare breast tumors with aggressive course and are characterized by their large size and rapid growth rate. Recently, there has been an upsurge in the cases of MCB due to increase in recognition of this entity. It has to be distinguished from other tumors by the pathologists so as to guide proper treatment.
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Affiliation(s)
- Dimple Chaudhary
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Kirti Balhara
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Shramana Mandal
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Varuna Mallya
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Reena Tomar
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Nita Khurana
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Lovnish Bains
- Department of Pathology and Surgery, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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9
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Luo QQ, Luo NN. Case report and literature review on a large MBC with ulceration. Medicine (Baltimore) 2023; 102:e33131. [PMID: 36862895 PMCID: PMC9981360 DOI: 10.1097/md.0000000000033131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Metaplastic breast cancer (MBC) is a rare tumor of the breast, and skin ulceration of breast tumors is a difficult clinical problem that reduces the patient's quality of life. PATIENT CONCERNS There are currently no Standard Treatment Guidelines for MBC at present, and the treatment for the skin ulceration of breast tumors is limited in clinics. DIAGNOSIS Here, we report the case of a patient with a large MBC and skin ulceration, accompanied by exudation and odor. INTERVENTION The combined treatment of albumin paclitaxel and carrelizumab (anti-PD-1 immunotherapy) was effective in reducing the tumor, but it increased the severity of the skin ulceration. After taking traditional Chinese medicine, the skin ulceration healed completely. Then the patient underwent a mastectomy and radiotherapy. OUTCOMES The patient has a high quality of life and was in good condition after the comprehensive treatment. LESSONS This suggests that traditional Chinese medicine may have a good auxiliary therapeutic effect on the skin ulceration of MBC.
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Affiliation(s)
- Qin-Qin Luo
- Traditional Chinese Medicine Department of Wuhan No.1 Hospital, China
| | - Na-Na Luo
- Traditional Chinese Medicine Department of Wuhan No.1 Hospital, China
- * Correspondence: Na-Na Luo, Nuclear Medicine Department of Hubei Cancer Hospital, China (e-mail: )
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10
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Çelik H, Başara Akın I, Durak MG, Balcı P. Multimodality imaging and histopathology of metaplastic breast cancer. Diagn Interv Radiol 2023; 29:59-67. [PMID: 36959869 PMCID: PMC10679585 DOI: 10.4274/dir.2022.221363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/08/2022] [Indexed: 03/25/2023]
Abstract
Metaplastic breast cancer (MBC) is a rare subtype of invasive breast cancer characterized by mixed epithelial and mesenchymal differentiation. Commonly seen subtypes include squamous cell carcinoma, spindle cell carcinoma, and metaplastic carcinoma with heterologous mesenchymal differentiation. MBC tends to have a more aggressive clinical presentation, higher metastatic potential, higher rates of local recurrence, and a worse prognosis compared with invasive breast carcinoma of no special type. Most MBCs are triple-negative breast cancers, which explains their resistance to most systemic therapies. Therefore, accurately diagnosing MBC early is crucial for deciding the treatment strategy and predicting the prognosis. In this pictorial essay, the imaging findings of MBC in different modalities and the histopathologic features of its subtypes are reviewed.
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Affiliation(s)
- Hakkı Çelik
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Merih Güray Durak
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Pınar Balcı
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Alhaidary AA, Arabi H, Elessawy M, Alkushi A. Metaplastic breast carcinoma: an overview of the radio-pathologic features in retrospective cohort tertiary hospital. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00761-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Metaplastic breast carcinoma (MBC) is a rare type of breast carcinoma. It accounts for 0.2–1% of all invasive breast carcinoma. The aim of this study is to investigate the radiological features of this tumor and correlate them with the pathological findings.
Results
Of the 22 patients with pathology-proven metaplastic cancers, 18 patients (81.82%) presented with a palpable mass. The majority of the mammogram findings were masses with irregular shapes (n = 12, 63.16%) and indistinct margins (n = 11, 57.89%). Similarly, the majority of the ultrasound studies showed masses with irregular shapes (n = 16, 72.73%) and indistinct margins (n = 8, 36.36%). Most of the echopatterns were complex or with heterogeneous textures, each presented in eight cases (36.36%). More than half of the cases had a posterior acoustic enhancement (n = 12, 54.55%). Most of the cases tested negative for estrogen receptors, progesterone receptors and HER2 protein, and they were high-grade tumors with a high proliferative index (Ki-67%) of > 15%.
Conclusion
MBC is a rare and distinct aggressive breast cancer with no definite characteristic imaging compared to other breast cancer. It shows a mass with irregular shape and indistinct margins in both mammogram and ultrasound. Additionally, it reveals posterior acoustic enhancement and rarely contains microcalcifications. The correlation with the pathological findings is crucial for the diagnosis and subsequent appropriate treatment.
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Kim JY, Kim SH, Jeong MJ, Lee JH, Kang MJ, Gwak G, Yoo SH. Imaging Findings of Metaplastic Breast Carcinoma with Chondroid Differentiation: A Case Reports. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1385-1393. [PMID: 36545426 PMCID: PMC9748460 DOI: 10.3348/jksr.2022.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/29/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
Metaplastic carcinoma of the breast is a heterogeneous group of neoplasms with mixed epithelial and mesenchymal differentiation. Metaplastic carcinoma of the breast is a rare and aggressive malignancy, with high recurrence and metastasis. Metaplastic carcinoma with chondroid differentiation is an uncommon subtype that tends to have a relatively good prognosis than that of other subtypes. We report the imaging features of three cases of pathologically proven metaplastic carcinoma with chondroid differentiation as follows: a high-density mass with amorphous or coarse heterogeneous calcifications on mammography; a microlobulated or partially indistinct, complex cystic, and solid mass on sonography; and a relatively circumscribed or partially indistinct, irregular mass with heterogeneous T2 high-signal intensity and heterogeneous or rim enhancement with initial fast enhance ment and delayed washout on MRI.
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Differences of Clinicopathological Features between Metaplastic Breast Carcinoma and Nonspecific Invasive Breast Carcinoma and Prognostic Profile of Metaplastic Breast Carcinoma. Breast J 2022; 2022:2500594. [PMID: 36051469 PMCID: PMC9424033 DOI: 10.1155/2022/2500594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Introduction Metaplastic breast carcinoma is a rare special type of breast cancer, which has distinguished clinical characteristics. We aimed to evaluate the clinicopathological features of metaplastic breast carcinoma compared with nonspecific invasive breast carcinoma and study the prognosis of metaplastic breast carcinoma. Methods We reviewed metaplastic breast carcinoma cases (n = 37) from January 2000 to December 2021 and nonspecific invasive breast carcinoma cases (n = 433) from January 2019 to December 2020 extracted from our institution retrospectively. The following variables were recorded, including the patients' general information, complications, T stage, expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, molecular subtyping, lymph node status, skin or chest wall involvement, vessel carcinoma embolus, therapy modality (surgical treatments, chemotherapy, and radiotherapy), and survival. Results Patients with metaplastic breast carcinoma had more advanced disease than patients with nonspecific invasive breast carcinoma (T stage: P=0.0011). A greater proportion of metaplastic breast carcinoma presented with triple-negative breast cancer than nonspecific invasive breast carcinoma (79.41% vs. 12.47%, P ≤ 0.001). Our study showed that the skin or chest wall invasion was more frequent in metaplastic breast carcinoma patients (11.76% vs. 1.62%, P=0.005). The 5-year survival rate for metaplastic breast carcinoma patients was 57.66% (95% CI: 0.3195∼0.7667). No local recurrence was observed while distant metastasis occurred in 33.33% of patients with metaplastic breast carcinoma. Death due to disease occurred in 24.24% of patients with metaplastic breast carcinoma. Conclusion The majority of metaplastic breast carcinoma patients had more advanced disease and triple-negative disease than nonspecific invasive breast carcinoma patients. Also, metaplastic breast carcinoma patients had frequent skin or chest wall invasion and a high rate of distant metastasis and mortality.
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Kherbek H, Deeb I, Ali H, Halloum M, Alshehabi Z, Ali W. A huge metaplastic breast carcinoma with chest wall invasion and pulmonary metastasis: a rare case report. Oxf Med Case Reports 2022; 2022:omac027. [PMID: 35316995 PMCID: PMC8931821 DOI: 10.1093/omcr/omac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/03/2022] Open
Abstract
Metaplastic breast carcinoma (MBC) is a diverse group of invasive breast carcinoma, in which the neoplastic epithelium differentiates toward squamous cells or mesenchymal looking elements, including but not restricted to spindle, osseous and chondroid cells. MBC was formally considered a distinct pathological pattern by WHO classification of breast tumors in 2000. We report the case of a 49-year-old Syrian female who presented to our hospital due to a painful huge mass in her right breast. Radiographic and clinical findings were highly indicative of breast carcinoma. Therefore, a core needle biopsy was performed, and surprisingly, microscopic examination suggested the diagnosis of soft tissue sarcoma, whereas immune stains confirmed the diagnosis of metaplastic carcinoma. We aim to introduce a challenging case that clarifies the rarity of this tumor, and the methods we used in diagnosing, examining and treating this malignancy.
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Affiliation(s)
| | - Ismaeel Deeb
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Haya Ali
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Mais Halloum
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Zuheir Alshehabi
- Department of Pathology, Cancer Research Center, Tishreen University, Latakia, Syria
| | - Wassim Ali
- Department of Thoracic Surgery, Tishreen University Hospital, Latakia, Syria
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Meng L, Zhao X, Lu L, Xing Q, Wang K, Guo Y, Shang H, Chen Y, Huang M, Sun Y, Zhang X. A Comparative Assessment of MR BI-RADS 4 Breast Lesions With Kaiser Score and Apparent Diffusion Coefficient Value. Front Oncol 2021; 11:779642. [PMID: 34926290 PMCID: PMC8675081 DOI: 10.3389/fonc.2021.779642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the diagnostic performance of the Kaiser score and apparent diffusion coefficient (ADC) to differentiate Breast Imaging Reporting and Data System (BI-RADS) Category 4 lesions at dynamic contrast-enhanced (DCE) MRI. Methods This was a single-institution retrospective study of patients who underwent breast MRI from March 2020 to June 2021. All image data were acquired with a 3-T MRI system. Kaiser score of each lesion was assigned by an experienced breast radiologist. Kaiser score+ was determined by combining ADC and Kaiser score. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of Kaiser score+, Kaiser score, and ADC. The area under the curve (AUC) values were calculated and compared by using the Delong test. The differences in sensitivity and specificity between different indicators were determined by the McNemar test. Results The study involved 243 women (mean age, 43.1 years; age range, 18-67 years) with 268 MR BI-RADS 4 lesions. Overall diagnostic performance for Kaiser score (AUC, 0.902) was significantly higher than for ADC (AUC, 0.81; p = 0.004). There were no significant differences in AUCs between Kaiser score and Kaiser score+ (p = 0.134). The Kaiser score was superior to ADC in avoiding unnecessary biopsies (p < 0.001). Compared with the Kaiser score alone, the specificity of Kaiser score+ increased by 7.82%, however, at the price of a lower sensitivity. Conclusion For MR BI-RADS category 4 breast lesions, the Kaiser score was superior to ADC mapping regarding the potential to avoid unnecessary biopsies. However, the combination of both indicators did not significantly contribute to breast cancer diagnosis of this subgroup.
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Affiliation(s)
- Lingsong Meng
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingna Xing
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- Magnetic Resonance (MR) Research China, General Electric (GE) Healthcare, Beijing, China
| | - Yafei Guo
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Honglei Shang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Chen
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengyue Huang
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongbing Sun
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Huayanay Espinoza JL, Mego Ramírez FN, Guerra Miller H, Guelfguat M. An Overview of Rare Breast Neoplasms with Radiologic-Pathologic Correlation. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Sanmugasiva V, Hamid MTR, Fadzli F, Ab Mumin N, Rahmat K. Spindle Cell Metaplastic Breast Carcinoma. Curr Med Imaging 2021; 18:684-688. [PMID: 34607549 DOI: 10.2174/1573405617666211004114041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Metaplastic breast carcinoma is an uncommon malignancy that constitutes < 5% of all breast cancers. There are 5 subtypes which are spindle cell, squamous cell, carcinosarcoma, matrix-producing and metaplastic with osteoclastic giant cells. Spindle cell carcinoma represents approximately <0.3% of invasive breast carcinomas. It is typically a triple-negative cancer with distinct pathological characteristics, but relatively a non-conclusive imaging findings. CASE REPORT An elderly lady presented with an enlarging painful left breast lump for 1 year. Palpable left breast lump noted on clinical examination. Mammography demonstrated a high density, oval lesion with a partially indistinct margin. Corresponding ultrasound showed a large irregular heterogeneous lesion with solid-cystic areas. Histopathology showed atypical spindle-shaped cells which stained positive for cytokeratins and negative for hormone and human epidermal growth factor receptors, which favours spindle cell metaplastic carcinoma. Left mastectomy and axillary dissection were performed, and the final diagnosis was consistent with metaplastic spindle cell carcinoma. CONCLUSION Spindle cell carcinoma of the breast is a rare aggressive histological type of carcinoma which may present with benign features on imaging. Tissue diagnosis is essential for prompt diagnosis with multidisciplinary team discussion to guide management and improve patient's outcome.
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Affiliation(s)
- Vithya Sanmugasiva
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur. Malaysia
| | | | - Farhana Fadzli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur. Malaysia
| | - Nazimah Ab Mumin
- Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Selangor. Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur. Malaysia
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Abada E, Daaboul F, Ebare K, Jang H, Fehmi Z, Kim S, Ali-Fehmi R, Bandyopadhyay S. Clinicopathologic Characteristics and Outcome Descriptors of Metaplastic Breast Carcinoma. Arch Pathol Lab Med 2021; 146:341-350. [PMID: 34237136 DOI: 10.5858/arpa.2020-0830-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Metaplastic breast carcinoma is an aggressive form of breast cancer that accounts for 0.5% to 3% of all breast cancers. OBJECTIVE.— To study the clinicopathologic characteristics and outcomes of this rare disease. DESIGN.— Retrospective study of patients with a diagnosis of metaplastic breast carcinoma between 2000 and 2019. Hematoxylin-eosin-stained slides were reviewed and additional clinical data were obtained from electronic medical records. Univariable and multivariable Cox proportional hazard regression analyses were used to determine associations between overall survival and several clinicopathologic variables. RESULTS.— Of the 125 patients with metaplastic breast carcinoma identified, only patients with high-grade disease (N = 115) were included in the data analysis. A total of 38 participants (33%) were white, 66 (57%) were African American, and 11 (10%) belonged to other ethnicities. The median age at diagnosis was 57 years. The median tumor size was 3 cm. Heterologous histology was seen in 30% of cases. Multivariable analyses showed that patients with a larger tumor size had worse overall survival (hazard ratio [HR], 1.25; 95% CI, 1.10-1.44; P < .001). Distant metastatic disease was also associated with worse overall survival on multivariable analysis (HR, 10.27; 95% CI, 2.03-55.54; P = .005). In addition to treatment with either partial or complete mastectomies, 84 patients (73%) received chemotherapy. Multivariable analyses showed that chemotherapy had no effect on overall survival (HR, 0.53; 95% CI, 0.09-6.05; P = .55). CONCLUSIONS.— A larger tumor size and distant metastatic disease are associated with worse overall survival in patients with metaplastic breast carcinoma. Additional studies are needed to further characterize our findings.
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Affiliation(s)
- Evi Abada
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Fayez Daaboul
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Kingsley Ebare
- the Department of Pathology, Baylor College of Medicine, Houston, Texas (Ebare)
| | - Hyejeong Jang
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Ziad Fehmi
- the Department of Biomolecular Science, University of Michigan, Ann Arbor (Fehmi)
| | - Seongho Kim
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Rouba Ali-Fehmi
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Sudeshna Bandyopadhyay
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
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Andreou S, Soule E, Long D, Jasra B, Sharma S. When Something Seems Amiss: Radiology-Pathology Correlation of Metaplastic Breast Cancer. Cureus 2020; 12:e8239. [PMID: 32582498 PMCID: PMC7306645 DOI: 10.7759/cureus.8239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Metaplastic breast cancer is difficult to diagnose, resistant to conventional treatment, and biologically aggressive. A suspicious timeline and discordance between imaging findings and histopathologic tissue diagnosis should trigger additional workup. New, large lesions or rapidly growing lesions with complex echogenicity on ultrasound warrant correlation with image-guided biopsy for a definitive diagnosis. Lesions that appear aggressive on imaging, with negative biopsy findings, may represent false negatives due to sampling bias from intratumoral heterogeneity. In such cases, it may be advisable to obtain an excisional biopsy. These tumors are known to progress even with neoadjuvant chemotherapy. Immunotherapy, however, may be effective even for metastatic disease. A multidisciplinary approach and a high index of suspicion may, therefore, confer survival benefits in circumstances where the imaging phenotype does not fit with the timeline or pathologic diagnosis. This report describes five cases of metaplastic breast cancer diagnosed at our institution to highlight the importance of a timely and accurate diagnosis of this rare but aggressive breast malignancy.
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Affiliation(s)
- Sonia Andreou
- Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Deidra Long
- Pathology, University of Florida College of Medicine, Jacksonville, USA
| | - Bharti Jasra
- Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Smita Sharma
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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Jia Y, He C, Liu L, Sun L, Chen Y, Luo Y, Yu T. A Retrospective Study of the Imaging and Pathological Features of Metaplastic Breast Carcinoma and Review of the Literature. Med Sci Monit 2019; 25:248-258. [PMID: 30618455 PMCID: PMC6338010 DOI: 10.12659/msm.912107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Metaplastic breast cancer (MBC) is a rare type of breast cancer, characterized histologically by the presence of two or more malignant cell types (epithelial and mesenchymal). This retrospective study aimed to review the imaging and histological features of MBC, with a review of the literature. Material/Methods Nineteen patients with MBC (age range, 28–75 years; mean, 55 years) underwent review of their clinical records, histopathology, immunohistochemistry, and imaging findings, which included mammography, sonography, and magnetic resonance imaging (MRI) with T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and diffusion restriction determined by the apparent diffusion coefficient (ADC) and a time-intensity curve (TIC) for signal intensity. Results The mammographic features of MBC were oval shaped (54.5%), with indistinct margin (45.5%), and high tumor density (72.7%), and on sonography, they were oval shaped (57.1%), with hypo-echogenic areas (85.8%). On MRI, MBC showed moderate hyper-intensity with a high signal intensity in the center of the tumor on T2WI (100%), an indistinct margin (75.0%), and rim enhancement (58.3%). Using a TIC, the early phase showed rapid enhancement, and the delay phase showed a signal plateau (91.7%). DWI showed diffusion restriction in all cases determined by the ADC. Immunohistochemistry showed negative expression of estrogen receptor (ER) (91.0%), progesterone receptor (PR) (81%), and HER2 (erbB-2) (80.0%). Conclusions Imaging features of MBC on mammography and ultrasound were benign. The use of T2WI MRI showed characteristic features of signal intensity using TIC curve and ADC analysis, which may support biopsy and histological analysis for definitive diagnosis.
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Affiliation(s)
- Yu Jia
- Department of Radiology, Liaoning Cancer Hospital, and Institute of Jinzhou Medical University Postgraduate Cultivation Base, Shenyang, Liaoning, China (mainland)
| | - Cuiju He
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
| | - Linan Liu
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
| | - Lili Sun
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
| | - Yanwei Chen
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
| | - Yahong Luo
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
| | - Tao Yu
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China (mainland)
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