Metaplastic sarcomatoid carcinoma of the breast with absent or minimal overt invasive carcinomatous component: a misnomer.
ABSTRACT 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.
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ABSTRACT: El carcinoma sarcomatoide de mama es una variante histológica del carcinoma metaplásico, compuesto predominantemente por células fusiformes. Presentamos el caso de un tumor en mujer de 54 años, en que las características clínicas y de imagen sugerían un tumor maligno, y finalmente la histología y la inmuno-histoquímica confirmaron el diagnóstico de carcinoma sarcomatoide monofásico. En esta variante no es posible identificar un componente epitelial claro, por lo que plantea problemas de diagnóstico diferencial con sarcomas y otras lesiones mesenquimatosas. La demostración mediante inmunohistoquímica de la naturaleza epitelial de las células fusiformes, resultó fundamental para establecer el diagnóstico.Revista Chilena de Obstetricia y Ginecologia 12/2010; 76(1):37-41. DOI:10.4067/S0717-75262011000100008
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ABSTRACT: Primary breast sarcomas represent less than 1% of all malignant breast neoplasias. The principal risk factor for these fast growing lesions is previous radiotherapy treatment. We present a case of a 55 year-old woman with a 4,5 cm tumour, which was diagnosed as a chondrosarcoma after excluding other possibilities, such as metaplastic carcinoma, malignant phyllodes tumour, stromal sarcoma (spindle cell) and osteosarcoma. Very few cases of this rare tumour have been reported in the literature.10/2013; 46(4):257–260. DOI:10.1016/j.patol.2012.11.002
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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