Abstract
Carcinosarcoma of the breast, often referred to as metaplastic carcinoma of the breast, is a rare malignancy with two distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. Clinically, carcinosarcoma of the breast is an aggressive breast cancer. The prognosis for carcinosarcoma of the breast is less favorable compared to more common types of breast cancer such as infiltrating ductal or lobular carcinoma. Currently, the evaluation of breast carcinoma includes hormone receptor analysis of the tumor tissue, with those positive for estrogen or progesterone responding better to both hormonal and chemotherapy.Trastuzumab (Herceptin®) is available as an adjunct treatment for tumors which over-express the HER2/neu gene. Typically, metaplastic carcinomas of the breast do not express the estrogen or progesterone receptors and do not over-express the HER2/neu oncogene. As a result of this "triple negative" phenotype, such tumors tend to be more aggressive and are unlikely to respond to targeted therapy with Herceptin. The epidermal growth factor receptor HER-1/EGFR protein is expressed in the majority of metaplastic carcinomas and thus may serve as a potential therapeutic target for EGFR inhibitors such as gefitinib and cetuximab. The two cases we describe exemplify the aggressive nature of carcinosarcoma of the breast and support the findings that this tumor type does not express the common receptors found in other breast carcinomas. These case reports also emphasize the need for investigating the role for blockade of the HER-1/EGFR receptor with targeted therapies when found to be over-expressed in the primary tumor.
Highlights
Patient 1 This patient is a 48 year old female who was admitted with a large fungating right breast mass which measured 22 × 20 cm and elevated 12 cm above the skin surface (Figure 1)
Carcinosarcoma of the breast is an aggressive, rare neoplasm that has been reported to account for 0.08–0.2% of all breast malignancies [1,2,3]
The term carcinosarcoma was previously reserved for neoplasms where the demarcation between carcinomatous and sarcomatous components was distinct in all microscopic fields
Summary
Carcinosarcoma of the breast (metaplastic, biphasic metaplastic, metaplastic sarcomatoid carcinoma, sarcomatoid carcinoma) is an aggressive, rare neoplasm that has been reported to account for 0.08–0.2% of all breast malignancies [1,2,3]. Hennessy et al reported on 100 patients with biphasic metaplastic sarcomatoid carcinoma (MSC) and 98 patients with carcinosarcoma identified through the SEER database They compared clinical features and survival parameters for the two cancer types [9]. They conclude that both MSC and carcinosarcoma are aggressive, treatment-refractory tumors with shared clinical features and outcomes similar to poorly differentiated, receptornegative adenocarcinoma of the breast. In comparing these two entities, they found that the initial T-stage of the tumor had a very strong association with overall outcome. A recent review of 16 publications over a 21-year range (1984– 2005) addressing the clinical and pathologic characteris-
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
