Abstract
Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer characterized by coexistence of carcinomatous and sarcomatous components. Snail is a nuclear transcription factor incriminated in the transition of epithelial to mesenchymal differentiation of breast cancer. Aberrant Snail expression results in lost expression of the cell adhesion molecule E-cadherin, an event associated with changes in epithelial architecture and invasive growth. We aimed to identify the utility of Snail, and of traditional immunohistochemical markers, in accurate MBC classification and to evaluate clinicopathologic characteristics and outcome.We retrospectively reviewed 34 MBC cases from January 1997 to September 2007. The control group contained 26 spindle cell lesions. Immunohistochemistry used Snail, p63, epidermal growth factor receptor (EGFR), OSCAR, and wide spectrum cytokeratin (WS-KER). Negative was a score less than 1%. We found that Snail and EGFR are sensitive (100%) markers with low specificity (3.8% and 19.2%) for detecting MBC. p63 and WS-KER are specific (100%), with moderate sensitivity (67.6% and 76.5%); OSCAR is sensitive (85.3%) and specific (92.3%). A combination of any 2 of the p63, OSCAR, and WS-KER markers increased sensitivity and specificity. MBCs tended to be high-grade (77%), triple negative (negative for estrogen receptor, progesterone receptor, and HER2) [27/33; 81.8%], and carcinomas with low incidence of axillary lymph node involvement (15%), and decreased disease-free [71% (95%CI: 54%, 94%) at 3 yrs.) and overall survival. A combination of p63, OSCAR and WS-KER are useful in its work-up. On the other hand, Snail is neither a diagnostic nor a prognostic marker for MBC.
Highlights
Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer characterized by carcinomatous and sarcomatous components
Transformation of the carcinomatous component into the sarcomatous component through epithelial-tomesenchymal transition could explain the origin of the MBC [4]
Not statistically significant (p = 0.828), mastectomy patients more frequently had high grade tumors (81%) compared with breast conservation therapy (BCT) patients (69%). Survival of these patients was not associated with age, tumor size, grade, axillary lymph node (ALN) status, hormone receptor and HER2 status, and type of treatment
Summary
Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer characterized by carcinomatous and sarcomatous components. The likelihood for recurrence of MBC is high, translating into a poor outcome. Transformation of the carcinomatous component into the sarcomatous component through epithelial-tomesenchymal transition could explain the origin of the MBC [4]. This transition is a physiologic program used in embryogenesis and activated during cancer invasion, progression and metastasis, in which cancer cells lose their adherent and polarity features and change into a mesenchymal phenotype with a more elongated cellular shape for increasing motility
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