Case Of Metaplastic Breast Carcinoma Research Articles

Significance of Estrogen/Progesterone Receptor Expression in Metaplastic Breast Carcinoma.

Metaplastic breast carcinoma (MBC) is a rare subgroup of breast neoplasms associated with adverse outcomes because of its aggressive nature. Typically, MBCs show triple-negative hormone receptor (HR) status. Determining the HR status of breast cancer is an integral part because it is an important prognostic factor and helps in the treatment course of the disease. This study aimed to determine the HR status of MBC, its significance, and its association with various clinicopathological parameters. This was a retrospective study conducted at the Department of Histopathology, Liaquat National Hospital. A total of 140 biopsy-proven cases of MBC were enrolled in the study. Clinical and pathological data were retrieved from the institutes' archives. Immunohistochemical studies were conducted to determine the estrogen receptor (ER) and progesterone receptor (PR) status. The mean age of MBC in our population was found to be 52.18 ± 12.19 years. The HR positivity rate in our population was found to be 32.9%. A significant association was found between HR status and tumor laterality, tumor size, tumor grade, tumor stage, and recurrence. ER/PR-negative MBCs were most probably associated with higher grade and higher tumor stage and were larger in size (6.62 ± 3.43 cm) than ER/PR-positive MBCs (4.20 ± 1.88 cm). Moreover, ER/PR-positive MBCs showed a higher recurrence rate than ER/PR-negative MBCs (43.5% vs. 25.5%, respectively). No statistically significant relationship was found between HR status and patient age, histological subtype, or survival rate. MBC is a rare breast neoplasm. MBC was found to be triple negative in most cases, but a significant percentage were HR (ER/PR) positive. Moreover, we found an association between HR status and various clinicopathological features, indicating that HR status is a significant predictor of MBC prognosis.

METAPLASTIC CARCINOMA BREAST: A CASE SERIES

Introduction: Metaplastic breast carcinoma is a distinct histological type of breast cancer and comprises of two components ofboth epithelial & mesenchymal type in a single tumor. It includes adenosquamous, squamous cell carcinoma (SCC), spindle cell carcinoma, metaplastic carcinoma with mesenchymal differentiation, mixed carcinoma and myoepithelial carcinoma. Materials and Methods: The study comprises of 5 cases of Metaplastic Breast carcinoma and was conducted in the Department of Pathology in Western part of India. Discussion: MBC is characterized by adenocarcinoma admixed with spindle cells, squamous cells and mesenchymal differentiation. Among the five cases in the present series, two cases showed lymph nodes metastasis. Commonlyimmunohistochemistry (IHC) markers in cases of MBC shows triple negative for estrogen receptor (ER), progesterone receptor (PR) and HER2-neu. Conclusion: The MBC has a poor prognosis and have a diverse clinical behavior, variable histology and different regime of treatment.

Metaplastic Breast Carcinoma: Clinicopathologic Features and Recurrence Score Results From a Population-based Database.

Metaplastic breast carcinoma (MBC) is a rare, aggressive form of cancer comprising epithelial and mesenchymal elements. The purpose of this study was to use population-based data to review the clinicopathologic, molecular features, and outcomes of MBC. Surveillance, Epidemiology, and End Results Program (SEER) data were used to identify MBC and invasive ductal carcinoma (IDC), no special type (NOS) between 2004 and 2015. Results from Oncotype DX's 21-gene assay linked to SEER registries were included for hormone receptor (HR)-positive tumors. χ 2 analysis was performed to determine the differences between MBC and IDC. Kaplan-Meier curves and multivariate Cox proportional hazards models were used for breast cancer specific death (BCSD). Compared with IDC, NOS (n=509,864), MBC (n=3876) were more likely to present at an older age, be black, have negative lymph nodes, be >2cm, grade 3, and triple negative (TN). All subtypes [HR-positive/human epidermal growth receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and TN] had higher BCSD than IDC, NOS. 22.3% of MBC cases were HR-positive. HR-positive MBCs tested for a recurrence score (RS) 65% were high-risk compared with 16.8% of IDC, NOS. Within the MBC cohort, no significant differences in BCSD were identified with respect to different molecular subtypes. In a fully adjusted model, TN or HER2-positive status did not adversely affect BCSD compared with HR-positive MBC. All molecular subtypes of MBC had a poorer prognosis compared with IDC, NOS. The different molecular subtypes of MBC did not affect the BCSD. HR-positive MBC patients had a significantly higher high-risk RS than IDC, NOS patients.

METAPLASTIC BREAST CARCINOMA: ACASE REPORT

Metaplastic breast carcinoma is defined as a heterogeneous group of invasive breast cancercharacterized by differentiation of the neoplastic epithelium into squamous or mesenchymalcells with differentiation into spindle, chondroid, bone or other cells. It is a rare malignanttumor that represents lessthan 1% of breast cancers. It is an aggressive tumor, with a poorprognosis and resistant to chemotherapy.We report a case of metaplastic breast carcinoma, in order to discuss the epidemiological,clinical and histopathological particularities with a review of the literature.This caseconcerned a52-year-old woman with a nodule in the upper outer quadrant of the right breast,with a history of excision of a cystic papilloma on the same site, classified ACR4 onmammography. Histological and immunohistochemical examinationhad concludedametaplastic carcinoma.

Metaplastic breast cancer: A case report and literature review

Introduction: Breast cancer is the second most common cancer among women in the United States. Metaplastic breast cancer is characterized by two or more poorly differentiated cellular types, with epithelial or mesenchymal components. Metaplastic breast carcinoma is a rare and aggressive entity, accounting for less than 1% of invasive breast cancers. Hence, there is insignificant literature and research. Few cases are described in the literature. We report a rare case of metaplastic breast carcinoma with squamous and spindle cell differentiation. Case Report: An 82-year-old female was diagnosed with metaplastic breast cancer with squamous and spindled differentiation based on histological appearance. She underwent mastectomy, and we track her radiation follow-up. Conclusion: The report reviews and corroborates existing literature regarding clinical features, histologic characteristics, and treatment methods, and explores genetic components and clinical trials underway.

Metaplastic Breast Carcinoma: A Case Series with Three Different Presentations

Metaplastic Breast Carcinoma (MBC) is one among the rare types of breast carcinoma. MBC was recognised as a separate entity by World Health Organisation (WHO) in 2020. According to WHO, metaplastic carcinoma is classified into six types based on the histology which includes: low grade adenosquamous carcinoma; fibromatosis like metaplastic carcinoma; squamous cell carcinoma; spindle cell carcinoma; carcinoma with heterologous mesenchymal differentiation; and mixed metaplastic carcinomas. This rare type of tumour shows both epithelial and/or mesenchymal elements within the same lesion. The management of these patients remains an enigma due to the rarity of the tumour and the treatment responses between patients following therapy. In the present case series, five cases of MBC and their follow-up have been described. All patients were females within the age group of 50-65 years. All five patients underwent modified radical mastectomy. Lymph node involvement was noted in one case. Among the five cases, two patients had adenosquamous carcinoma, two patients had metaplastic carcinoma with heterologous mesenchymal differentiation and one patient had mixed metaplastic carcinoma.

Metaplastic carcinoma of the breast: a case report

Metaplastic carcinoma is a rare but heterogeneous group of neoplasm of breast, accounting for about 1% of all breast carcinomas. Metaplastic carcinomas may be either low-grade tumors (e.g., adenosquamous carcinoma or spindle cell carcinoma), or high-grade tumors (e.g., squamous cell carcinoma, or spindle cell carcinoma). We report a case of metaplastic breast carcinoma in a 72-year-old lady. The clinical, radiological and histological characteristics are discussed.

Rare Case of Metaplastic Breast Carcinoma with Squamous Differentiation in Young Female: A Case Report

Background. Metaplastic breast carcinoma is a very rare breast cancer, only about 0.2"‘1% of all invasive breast carcinomas. The prognosis of these cancer is poor and aggressive, reported to have lower response rates to conventional adjuvant chemotherapy and a worse clinical outcome after chemotherapy than other forms triple"‘negative breast carcinomas. Histopathologically, metaplastic breast carcinoma has distinct patterns with different outcomes. Among the types of metaplastic carcinoma, squamous cell, high grade spindle cell and high grade adenosquamous carcinoma are associated with the worst prognosis. We report one case of metaplastic breast carcinoma with squamous differentiation in young patient.
 Methods. We examined the breast tumor tissue of a female patient, evaluated the macroscopic and microscopic features and asked the patient about the clinical course of the disease. Inform consent was obtained from the patient for publication of this case report and accompanying images.
 Results. We reported a young female patient with final diagnosis of pathology Mixed Infiltrating Duct Carcinoma of No Special Type Grade 3 and Metaplastic Breast Carcinoma with Squamous Differentiation (30%) that has invaded fat tissue with Ductal Carcinoma Insitu of High Nuclear Grade 3 with basis of the operation is still positive for the tumor mass. Patients lost follow"‘up and did not continue therapy.
 Conclusion. Morphology of metaplastic breast carcinoma are important factors influencing patient outcome. Early diagnosis and wide local excision of the squamous"‘type metaplastic breast carcinoma mass can make a better prognosis.

Mutant Phenotype p53 Immunohistochemical Expression Is Associated With Poor Prognostic Parameters and Disease-Free Survival in Triple-Negative Metaplastic Breast Carcinoma.

IntroductionMetaplastic breast carcinoma (MBC) is a special type of breast cancer that is most commonly triple-negative and has the worst outcome compared to other breast tumors. p53 is a tumor suppressor gene that is frequently mutated in many human cancers. The association of mutant p53 immunohistochemical expression with clinical and prognostic parameters has not been widely studied in triple-negative MBC. Therefore, in this study, we evaluated the expression patterns of p53 in triple-negative MBC and its association with clinical and prognostic parameters.MethodsA retrospective observational study was conducted in the Department of Histopathology at Liaquat National Hospital and Medical College, Pakistan, for a duration of 11 years. A total of 101 cases of triple-negative MBCs were included in the study. p53 immunohistochemistry was performed on the representative tissue blocks. Cases with diffuse strong positive p53 expression were labeled mutant phenotype, while cases with weak patchy p53 expression were termed wild-type.ResultsThe mean age of the patients was 48.33±11.47 years, and the mean tumor size was 3.98±2.07 cm. The mean Ki67 index was 48.98±22.97%. The median disease-free survival of the patients was 24 (three to 68) months, with a median follow-up of 37 (13 to 77) months. Most of the cases were tumor (T)-stage II (51.5%). Axillary metastasis was present in 36.6% of cases, with the perinodal extension in 16.8% of cases. Most cases were non-basal subtype (91.1%), and the majority of cases were grade III (85.1%). Recurrence was observed in 17.8% of cases. Among 101 cases, 52.5% cases showed mutant phenotype p53 expression. A significant association of p53 expression was noted with tumor grade, Ki67 index and disease-free survival. Cases with mutant phenotype p53 expression had a higher tumor grade, higher Ki67 index, and poorer disease-free survival than cases with wild-type p53 expression.ConclusionA substantial proportion of triple-negative MBC expressed diffuse strong expression (mutant phenotype) of p53 in our study, signifying a potential role of p53 as a therapeutic target in triple-negative MBC. Moreover, association of p53 with poor prognostic parameters, such as higher tumor grade and Ki67, and poor disease-free survival underscores the prognostic significance of p53 in triple-negative MBC.

Metaplastic carcinoma of the breast and BRCA1 germline mutation: a case report and review

BackgroundMetaplastic carcinoma of the breast consists of both invasive ductal carcinoma and metaplastic carcinoma. This rare subtype of cancer has a poor prognosis. The development of metaplastic breast cancer and relationship with BRCA1 are not well known. Here, we report a rare case of germline BRCA1 mutation-positive breast cancer with chondroid metaplasia.Case presentationA 39-year-old Japanese woman with a family history of breast cancer in her mother and ovarian cancer in her maternal grandmother consulted at our hospital with a left breast mass. Needle biopsy for the mass was performed, leading to a diagnosis of invasive breast cancer with chondroid metaplasia. We performed left mastectomy + sentinel lymph node biopsy + tissue expander insertion and replaced with a silicone implant later. Pathological examination revealed that the patient had triple-negative breast cancer. Four courses of doxorubicin+ cyclophosphamide therapy were performed as adjuvant therapy after surgery. We performed genetic counseling and genetic testing, and the results suggested the germline BRCA1 mutation 307 T> A (L63*). She has currently lived without a relapse for 2 years post-surgery.ConclusionsThere have been only 6 cases of metaplastic breast carcinoma with germline BRCA1 mutations including our case. Patients with BRCA1 mutations may develop basal-like subtypes or M type of triple-negative breast cancer besides metaplastic breast cancers.

From breast to bone: a case of metaplastic breast carcinoma with osteosarcomatous differentiation

From breast to bone: a case of metaplastic breast carcinoma with osteosarcomatous differentiation

Histomorphological evaluation of Breast carcinoma – A study of 15 cases

Purpose/Objective: Breast cancer occurs in any of the cells of the mammary gland and exhibits a wide scope of morphological features, different immunohistochemical profiles, and unique histopathological subtypes that have specific clinical course and outcome. This study was conducted to assess various histomorphological variants of breast carcinoma. Material and Methods: Total of fifteen cases of modified radical mastectomy specimens were prospectively assessed from January 2019 to June 2019 in pathology department of Dr B.R. Ambedkar Medical college and hospital, Bangalore. Observation: Out of 15 cases, Invasive ductal carcinoma NOS was most common variant accounting for 10 cases (66.66%) followed by 1 cases of Invasive Lobular Carcinoma breast, 1 case of Invasive micropapillary carcinoma, 1 case of Medullary carcinoma, 1 case of Metaplastic breast carcinoma. The histological grading of breast carcinoma was done on the basis of Elston – Ellis modification of Scarff - Bloom - Richardson grading system. We found that Grade 2 tumours were more common accounting to 9 cases (60%) followed by Grade 1 tumour (26.66%). Conclusion: This study emphasizes on the importance of assessment of histopathological variants of breast carcinoma in not only in establishing the final diagnosis, but also in predicting the prognosis by histological typing, staging and grading of breast carcinoma. Keywords: Breast carcinoma, MRM, Histomorphology, WHO, Staging, Grading.

Survival outcomes of metaplastic breast carcinoma: An Indian tertiary care center data.

e12579 Background: Metaplastic breast carcinoma is a rare histological subtype that has basal like characteristics and is reported to have a poorer prognosis than no specific type/ductal carcinoma (ductal/NST). We aimed to investigate clinicopathological features and outcome from a single institution based registry. Methods: Clinical records of breast cancer patients treated during 2012-2019 were screened and 31 cases of metaplastic breast carcinoma were found. Descriptive analysis was done for patients’ demographics and clinicopathological features. Kaplan Meier method was used to assess survival outcomes. Results: The incidence of metaplastic breast cancer was 0.5% (31/6180) in our study out of which the most common histopathological differentiation was squamous (45.16%). The second most common was sarcomatoid histology (32.25%), followed by chondroid (9.68%) and mixed histology (12.9%). The median age at diagnosis was 60 years ranging from 28 to 82 years. 64.15% of patients were post-menopausal. At presentation, three (9.67%) patients had metastatic disease while the rest were diagnosed with early (51.61%) and locally advanced cancers (38.72%). Triple negative cancers (ER/PR/Her2 negative) constituted the vast majority with 22 cases (80.6%) while hormone receptor positive (ER/PR positive, Her-2 negative) and Her-2 neu positive (ER/PR negative) made up the rest with three patients (9.67%) each group respectively. The median overall survival was found to be 39 months (95% CI 25.46 - 52.53). Conclusions: After a thorough search in PubMed and Google Scholar, we could not find a larger case series from India with clinical outcomes for metaplastic breast carcinoma. Our results suggest that metaplastic breast carcinoma is a heterogenous disease. Outcomes of metaplastic breast carcinoma are relatively worse when compared with literature for triple negative breast cancer and breast cancer in general. Further biological understanding may offer valuable insights for newer targets and therapeutic approaches to metaplastic breast cancer.

Abstract P6-06-17: Assessment of TILs, PDL1 and FOXP3 expression in metaplastic breast cancer: A glimpse into its tumour microenvironment

Abstract BACKGROUND: Metaplastic breast carcinoma (MBC) encompasses a heterogeneous group of tumours that differentiate into squamous and/or spindle, chondroid, osseous or rhabdoid mesenchymal-looking elements.Tumour cells,among others in the tumour microenvironment express Program Death Ligand 1 (PD-L1); an emerging therapeutic target. Activation of PD-1/PD-L1 pathway in neoplastic cells results in dampening of immune response.FOXP3 is a transcriptional factor for regulatory T-cells associated with immunosuppression. AIMS:We aimed to evaluate the immunohistochemical expression of PD-L1, FOXP3 and tumour infiltrating lymphocytes (TILs) by assessing their expression in tumour and immune stromal cells and correlated this with patient outcome. METHODS:Quantification of TILs according to the 2014 working group was performed for a large cohort of MBC, and control Triple Negative breast cancer (TNBC) cohort. Expression of PD-L1 and FOXP3 was evaluated with immunohistochemistry. PD-L1 expression was recorded in the tumour cells and stromal TILS (sTILs). TILs in direct contact with malignant cells are classed intra-tumoural (iTILs),while sTILs are lymphocytes that do not interact directly with cancer cells. FOXP3 positive iTILs and sTILs were evaluated. Histologic score was calculated and findings compared with the TNBC cohort. RESULTS: No significant associations were found between TILs and World Health Organisation (WHO) MBC subtypes,or number and type of morphologies present in mixed MBCs. However, WHO MBC Types 1 and 4 tend to contain higher amounts of TILs, while WHO Type 6 presents with the least amount of infiltrate, suggesting a restricted immunogenic repertoire. Mixed MBC cases with more than 3 phenotypes present have fewer TILs. Low tumour and high sTILs PD-L1 expression displayed the best clinical outcome (without reaching significance in a Kaplan Meier survival analysis; p value= 0.5780) while FOXP3 iTILs is associated with adverse prognostic outcome (p value=0.0240). CONCLUSIONS: We identified a subset of patients that would likely respond to immunotherapeutics targeting the PD-1/PD-L1 checkpoint. We report the biological significance of FOXP3 and TILs in MBC; wherein, their presence establishes a potential prognostic value. Citation Format: Emarene Mationg Kalaw. Assessment of TILs, PDL1 and FOXP3 expression in metaplastic breast cancer: A glimpse into its tumour microenvironment [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-06-17.

Metaplastic Breast Carcinoma: A Rare Entity

Metaplastic Breast Carcinoma is a rare malignancy among invasive breast carcinoma. The patients usually present with large tumor size, axillary lymphnode metastasis and triple negative. The management of Metaplastic Breast carcinoma largely parallels that of Invasive Breast Carcinoma. In this case report, we found a case of metaplastic breast carcinoma with axillary lymphnode metastasis which is very rare.

Metaplastic breast carcinoma: a clinical-pathologic study of 97 cases with subset analysis of response to neoadjuvant chemotherapy

Metaplastic breast carcinoma is a rare heterogeneous category of breast cancer, often associated with a poor prognosis. Clinical-pathologic studies with respect to varied morphologic subtypes are lacking. There is also a dearth of studies assessing the response of metaplastic breast carcinoma to neoadjuvant chemotherapy. Cases of metaplastic breast carcinoma diagnosed between 2007 and 2017 were identified. Various clinical-pathologic variables were tested for association with survival. Patients who underwent neoadjuvant chemotherapy were assessed for pathologic response. Median age at diagnosis with metaplastic breast carcinoma was 64 years. With a median follow-up of 39 months, 26 patients (27%) recurred (24 distant and 2 loco-regional). The overall survival rate of the cohort was 66% (64/97). A number of variables were associated with survival in univariable analysis; however, in multivariable analysis, only lymph node status and tumor size (pT3 vs. pT1/2) were significantly associated with all survival endpoints: recurrence-free survival, distant recurrence-free survival, overall survival and breast cancer-specific survival. Twenty-nine of 97 (30%) patients with metaplastic breast carcinoma received neoadjuvant chemotherapy. Five (17%) patients achieved pathologic complete response. Matrix-producing morphology was associated with higher probability of achieving pathologic complete response (p = 0.027). Similar to other breast cancer subtypes, tumor size and lymph node status are prognostic in metaplastic carcinomas. The pathologic complete response rate of metaplastic breast carcinoma in our cohort was 17%, higher than previously reported. Although the matrix-producing subtype was associated with pathologic complete response, there was no survival difference with respect to tumor subtypes.

Metaplastic carcinoma breast (IDC and chondrosarcoma): a rare entity

Metaplastic breast carcinoma is very rare neoplasm. Authors report a case of metaplastic breast carcinoma containing characteristic features of infiltrating ductal carcinoma and chondrosarcoma. A 62-year-old female presented with complaint of a lump in the right breast for the last 2 years. FNAC was suggestive of mucinous tumour. Tru-cut biopsy had been performed outside the institution, which was suggestive of a Ductal carcinoma with mucinous component. Modified radical mastectomy of the right breast was performed and histopathology was suggestive of infiltrating ductal carcinoma and chondrosarcoma of the right breast. All resected lymph nodes were free of metastasis. Immunohistochemistry was suggestive of a metaplastic carcinoma with components of ductal carcinoma and chondrosarcoma with moderately positive ER, negative PR, positive Pancytokeratin in ductal carcinoma component, positive S-100 and KI-67.

Metaplastic breast carcinoma with extensive osseous differentiation: a report of two cases and review of the literature.

Invasive breast cancer with osseous metaplasia is rare. Here we report two cases of metaplastic breast carcinoma with extensive osseous differentiation. Case 1: The patient was a 60-year-old woman with a right breast tumor, about 4 cm in diameter. Mammogram and ultrasound presented an irregular-shaped mass suspected for malignancy. Core needle biopsy confirmed invasive carcinoma and the patient underwent a modified radical mastectomy. Case 2: The patient was a 48-year-old woman with a left breast tumor, about 3 cm in diameter. Mammogram demonstrated a well-circumscribed mass with extensive dense calcifications. Frozen section biopsy confirmed invasive carcinoma and a modified radical mastectomy was performed. The two patients had no metastatic carcinoma in the axillary lymph nodes and remained free of recurrence and systemic metastases in a 13- and 4-month follow-up period, respectively. Histopathologically, patient 1 had an adenocarcinoma with prominent sarcomatous (osteosarcomatous) differentiation with intervening spindle cells. The sarcomatous areas showed high nuclear atypia, pleomorphism and a high Ki-67 index. In Case 2, the neoplasm consisted of invasive ductal carcinoma of no special type with an osseous metaplasia component and showed a direct transition from the carcinoma to the osseous elements. The distinction between the different types of metaplastic carcinomas, specifically the distinction between benign and malignant metaplastic (osteoid) elements, should be taken into consideration.

A case of metaplastic breast carcinoma - an aggressive malignant tumour

A case of metaplastic breast carcinoma - an aggressive malignant tumour

Metaplastic breast carcinoma with chondroid differentiation: a rare variant of infiltrative carcinoma in a 38-year-old woman

Metaplastic breast carcinoma (MBC) is a rare type of invasive breast carcinoma, and chondroid differentiation is even rarer. Here we report a case of MBC with extensive chondroid differentiation in...