Metaplastic carcinomas of the breast are a heterogeneous group of neoplasms ranging from tumors with a predominant component of overt carcinoma and focal mesenchymal differentiation to keratin-positive tumors with pure sarcomatoid morphology. We examined the clinicopathologic features of 22 patients previously diagnosed at M.D. Anderson Cancer Center with metaplastic carcinoma of the breast with pure or almost pure sarcomatoid morphology. Patients were included in the study if their tumors had sarcomatoid morphology and: 1) an invasive carcinomatous component identifiable on hematoxylin and eosin stains comprising less than 5% of the invasive tumor; or 2) associated ductal carcinoma in situ; or 3) immunohistochemical expression of keratin in the sarcomatoid areas. Patients with low-grade fibromatosis-like metaplastic tumors and those who received neoadjuvant chemotherapy were excluded. Axillary lymph node dissection or limited axillary node excision was performed in 17 patients, including 1 patient who had a sentinel lymph node biopsy. Lymph node involvement occurred in only 1 patient and consisted of a single 3.5-mm metastasis. Clinical follow-up was available for 21 patients and ranged from 4 months to 155 months (median follow-up, 35 months). Ten patients experienced local relapse, including 7 of 11 patients treated with breast-conserving surgery, and 9 developed distant metastases, most frequently to the lungs. These findings suggest that metaplastic sarcomatoid carcinomas that lack or have only a minimal overt invasive carcinomatous component have a biologic behavior similar to that of sarcomas. In addition to systemic treatment, early aggressive local therapy is recommended, as these patients have a high rate of local relapse.
[Show abstract][Hide abstract] ABSTRACT: Fibromatosis-like spindle-cell metaplastic carcinoma (FLSpCC) is an atypical variant of spindle-cell carcinoma with a particular clinical behavior characterized by frequent local recurrence, very low potential for axillary lymph node metastasis, and uncommon distant metastases. Although it presents the typical immunoprofile of basal-like carcinomas, FLSpCC is associated with a favorable clinical outcome and conservative treatment is generally indicated. Because of the lack of specific clinical and radiological characteristics, the criteria for the differential diagnosis from other benign and malignant tumors are based only on histological findings and immunostaining. We report on two FLSpCC patients treated with wide local excision and mastectomy associated with axillary lymph node dissection. Although the biological behavior of this subtype of breast cancer has not been adequately evaluated, wide local excision or mastectomy with clear resection margins but no axillary dissection appears to be an adequate treatment approach.
[Show abstract][Hide abstract] ABSTRACT: Metaplastic breast cancer represents a spectrum of histologic subtypes with the common feature of divergent morphologic differentiation. Most of these subtypes are associated with chemotherapy resistance and an increased likelihood of developing distant metastatic disease, which has been associated with a poor prognosis. However, recent molecular characterization has indicated that some metaplastic cancers may respond to targeted therapy regimens currently undergoing evaluation in early phase clinical trials. In this review, the pathologic characteristics and epidemiology of metaplastic breast cancer are discussed along with novel therapeutic agents that may augment standard chemotherapy for this intriguing type of breast cancer.
Current Breast Cancer Reports 03/2012; 4(1). DOI:10.1007/s12609-011-0064-2
[Show abstract][Hide abstract] ABSTRACT: Primary osteosarcoma of the breast is a rare malignant tumour. We report such a case in a 77-year-old lady who presented with a hard lump which was clinically and mammographically indistinguishable from a calcified fibroadenoma. Wide local excision of the lesion was carried out. Detailed histological and immunohistochemical features of the tumour are described. Because there was no evidence of metastasis and adequate local excision, no further treatment was considered necessary and she remains disease free at 39 months.
The Breast 03/2003; 12(1):72-4. DOI:10.1016/S0960-9776(02)00274-6 · 2.38 Impact Factor
Maria E. Linnaus, Amylou C. Dueck, Heidi E. Kosiorek, Richard J. Gray, Nabil Wasif, Donald W. Northfelt, Karen S. Anderson, Ann E. McCullough, William W. Wong, Michele Y. Halyard, Samir H. Patel, Barbara A. Pockaj
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