Spindle cell (sarcomatoid) carcinoma of the breast: a clinicopathologic and immunohistochemical analysis of 29 cases.
ABSTRACT Spindle cell (sarcomatoid) carcinoma of the breast is a rare variant of breast cancer that has been classified under the broad rubric of metaplastic carcinoma. Because the term "metaplastic carcinoma" comprises a heterogeneous group of tumors, it has been difficult to reliably predict biologic potential or to determine optimal therapy. To better characterize the spindle cell subset of metaplastic breast carcinomas, we reviewed 29 cases. All patients were adult females ranging from 40 to 96 years of age (median, 68 years). Tumor size ranged from 1.5 to 15 cm (median, 4 cm). Treatment was by excision and/or mastectomy with axillary node evaluation in most cases, often combined with postoperative radiation and/or chemotherapy. All cases were clinically of breast origin, showed >or=80% spindled/sarcomatoid morphology, and demonstrated keratin positivity and/or close association with ductal carcinoma in situ. Immunohistochemical studies showed evidence suggesting myoepithelial differentiation as exhibited by immunoreactivity for smooth muscle actin, cytokeratin 14, and p63 in a subset of cases (39%). Twenty-seven cases exhibited pure spindled or sarcomatoid morphology of variable appearance and nuclear grade, whereas 2 contained high-grade invasive ductal carcinoma comprising <or=20% of the tumor mass. Two cases exhibited heterologous elements (1 rhabdomyosarcoma and 1 with both chondrosarcoma and osteosarcoma) and 4 were associated with ductal carcinoma in situ. Follow-up data were available on 24 of 29 patients (range, 1-120 months; median, 20 months). Of 20 cases in which axillary nodes were biopsied, definitive nodal metastases were identified in only 1 (5%), and this was in a case with a significant component of invasive ductal carcinoma. Three patients developed local recurrences. Extranodal metastases occurred in 11 of 24 patients (46%), most commonly to the lungs. Ten of 24 patients (42%) died of disease at a median interval of 11.5 months (range, 1-46 months) and 3 patients were alive with metastatic disease. Eight patients were alive with no evidence of recurrent or metastatic disease (median, 29.5 months). Based on this series, spindle cell/sarcomatoid carcinoma of the breast is a highly aggressive neoplasm with a high rate of extranodal metastases. Purely spindled/sarcomatoid tumors have a significantly lower rate of nodal metastases than conventional ductal and lobular breast carcinomas.
SourceAvailable from: Farooq Wani[Show abstract] [Hide abstract]
ABSTRACT: Metaplastic breast cancer is a rare subtype of breast cancer that is histologically heterogeneous, being composed of both sarcomatous and epithelial components. It presents as rapidly growing palpable masses. Incidence of nodal metastasis is low, as compared to intraductal carcinoma, but it has a high metastatic potential and more chances of local recurrence. Many different pathological classifications are available, the most popular being "Wargotz and Norris classification". Imaging features mimic those of intraductal carcinoma. Immunohistochemically, these tumors show a basal/myoepithelial phenotype with positivity for cytokeratins, AE1/AE3, smooth muscle actin, p63, alpha B-crystallin, etc. These tumors show no or very low positivity for hormone receptors or HER-2 over expression. Therefore, they are often called triple negative carcinomas. They are aggressive tumors with suboptimal response to standard chemotherapy regimens. Overall prognosis of the patients with metaplastic breast cancer is worse than the patients with intraductal breast carcinoma. Further research is needed for formulating targeted therapies for this aggressive tumor.
[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this paper is to establish criteria that could guide the diagnosis, prognosis and treatment of canine mammary neoplasias. It was elaborated during the Mammary Pathology Meeting: Diagnosis, Prognosis and Treatment of the Canine Mammary Neoplasia, held on November 6th and 7th, 2010 in Belo Horizonte – MG, Brazil. Academics from several regions of Brazil were present and contributed to this work. After three years, a new discussion was found necessary in order to address important questions: 1 - Have Brazilian DVMs applied the consensus? 2 - What were the main difficulties in applying the consensus? 3 - What were the obtained results? 4 - What were the main differences among the various oncology services/groups? 5 - How could the criteria be improved and uniformed? A spreadsheet that allowed data collection and an abstract was submitted by each oncology service/group from various parts of the country. Based on the abstracts we identified the main differences in diagnosis and therapeutic conducts among the groups. These differences have guided the discussions of the II Mammary Pathology Meeting and the publication of a second consensus that has been revised and updated. The II Mammary Pathology Meeting: Diagnosis, Prognosis and Treatment of the Canine mamary Neoplasia, was held on December 9th, 10thand 11th, 2013 in Belo Horizonte – MG, sponsored by the Laboratory of Comparative Pathology of the Federal University of Minas Gerais (UFMG), with the support of the Brazilian Association of Veterinary Pathology (ABPV) and Brazilian Association of Veterinary Oncology (ABROVET). Academics from several regions of Brazil were present and contributed to this work.
[Show abstract] [Hide abstract]
ABSTRACT: Spindle cell carcinoma of the breast is a rare tumor. This tumor can proliferate rapidly and cause cystic changes because of internal tissue necrosis. We evaluated a 54-year-old woman with right breast lump. Mammography showed a category four mass with a diameter of 2.5 cm. Ultrasonography (US) revealed a complex cystic lesion, and fine-needle aspiration (FNA) cytology demonstrated bloody fluid and malignant cells. Partial breast resection and sentinel lymph node biopsy were performed. Immunohistology revealed spindle cells with positive results for cytokeratin (AE1/AE3) and vimentin, partially positive results for s-100, and negative results for desmin and α-actin. The pathological stage was IIA, and biochemical characterization showed that the tumor was triple negative. Six courses of FEC-100 chemotherapy (5-fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2), and cyclophosphamide 500 mg/m(2)) were administered. Radiotherapy was performed. This case is discussed with reference to the literature.