Abstract
BackgroundMetaplastic breast carcinoma is a rare entity of breast cancer expressing epithelial and/or mesenchymal tissue within the same tumor. The aim of this study is to evaluate the clinicopathological features of metaplastic breast carcinoma and to confirm the triple negative, basal-like and/or luminal phenotype of this type of tumor by using immunohistochemical staining.MethodsSeven cases of MBC were evaluated for clinico-pathological features including follow up data. Cases were studied immunohistochemically by CK-Pan, Vimentin, ER, PR, HER2, basal markers (CK5/6, p63, EGFR, SMA and S-100), luminal cytokeratins (CK8, CK18 and CK19), markers for syncytial cells (β-HCG and PLAP), as well as prognostic markers (p53, ki-67 and calretinin).ResultsThe mean age of the patients was 36 years. Three cases showed choriocarcinomatous features. All of our cases were negative for ER, PR and HER2. Six out of the 7 cases showed basal-like differentiation by demonstrating positivity with at least one of the basal/myoepithelial markers. Also 6 out of the 7 cases expressed luminal type cytokeratins (CK8, CK18 and/or CK19). P53 was positive in 3 cases, ki-67 was strongly expressed in only one case, while calretinin was expressed in 6 cases.ConclusionMetaplastic breast carcinoma presents in our population at a younger age group than other international studies. All cases are categorized immunohistochemically under the triple negative group of breast cancer and 86% of them exhibited basal-like and luminal phenotype. Majority of cases developed local recurrence and distant metastasis in a relatively short period of time.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1101289295115804
Highlights
Metaplastic breast carcinoma is a rare entity of breast cancer expressing epithelial and/or mesenchymal tissue within the same tumor
Hicks et al proposed an immunohistochemical panel to be used as a surrogate for molecular classification including; estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) [8]
Radiological examination for breast masses using ultrasound/mammogram with or without MRI was performed for all cases and revealed heterogeneous, hypo-echoic masses with irregular outlines in the majority of them
Summary
Metaplastic breast carcinoma is a rare entity of breast cancer expressing epithelial and/or mesenchymal tissue within the same tumor. Evidence from gene expression microarrays suggested the presence of multiple molecular subtypes of breast cancer: luminal, basal-like, normal breastlike and HER2 positive [7] These subtypes are associated with differences in risk factors, biological behavior, clinical outcome, histologic grades and response to therapy. Hicks et al proposed an immunohistochemical panel to be used as a surrogate for molecular classification including; estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) [8] It was widely accepted for use in identifying breast carcinomas with basal-like immunophenotype as defined by c-DNA microarrays and may help in categorizing MBC under one of these subtypes [7,8]. We conducted this study to evaluate the clinicopathological features of metaplastic breast carcinoma and to confirm the basal-like and/or luminal phenotype of this type of tumor by using immunohistochemical study
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