|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 381-383
Metaplastic carcinoma of the breast: A case report with review of literature
C Roy, KB Choudhury, A Saha, S Bag
Department of Radiotherapy, Institute of Post Graduate Medical Education and Research and S.S.K.M. Hospital, 244, A.J.C. Bose Road, Kolkata, West Bengal, India
|Date of Web Publication||10-Dec-2014|
Dr. A Saha
Department of Radiotherapy, Institute of Post Graduate Medical Education and Research and S.S.K.M. Hospital, 244, A.J.C. Bose Road, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy C, Choudhury K B, Saha A, Bag S. Metaplastic carcinoma of the breast: A case report with review of literature. Indian J Cancer 2014;51:381-3
A 52 years old female presented with right breast lump for eight months. On clinical examination a 4 × 4 cm firm, mobile, non-tender lump was identified in the inner-upper quadrant of her right breast. The nipple was retracted and the overlying skin of the breast showed peau d'orange skin change. The underlying muscles and the chest wall were free. There was no significant axillary or cervical lymphadenopathy (T4bN0MX). The other breast was normal. A fine needle aspiration biopsy (FNAB) of the right breast mass was highly suggestive of Intracystic Papillary Carcinoma of breast. X-ray of the chest, abdominal ultrasonography, whole-body bone scan revealed no evidence of metastasis. Her hematological and biochemical parameters were normal. Subsequently she underwent a modified radical mastectomy (MRM). Gross examination of specimen revealed a growth 5 × 5 × 4 cm, Skin and deep resection margins were free, Largest of the thirteen Lymph nodes (level I and II) found, measured 2.8 × 1.8 cm [Figure 1] and [Figure 2]. Microscopic examination revealed invasive metaplastic carcinoma with a high grade spindle cell type, Lymphovascular invasion or perineural invasion were absent and no metastatic deposits were seen in all the thirteen lymph nodes i.e., pt2N0 [Figure 3],[Figure 4] and [Figure 5]. On immunohistochemial examination the tumor cells were positive for pancytokeratin, epithelial membrane antigen and vimentin and negative for ER (Estrogen receptors) and PR (progesterone receptors) and cerB2 oncoprotein. The patient received, six cycles of FEC (Fluorouracil, Epirubicin, and Cyclophosphamide) combination chemotherapy and chest wall radiation therapy (TD 50 Gy, 25 fractions). She was in good condition at her latest follow up, 8 months post-operatively. The reported incidence of Metaplastic Breast Carcinoma (MBC) is 0.2% of all breast cancers.  MBC is generally considered to be high grade, with clinical presentations mimicking to those of infiltrating duct carcinoma (IDC), although it may rarely present as inflammatory carcinoma.  Metaplastic carcinoma is a rare tumor of breast consisting of intraductal or invasive carcinoma contigious or subtly merged with a highly cellular, mitotically active pleomorphic spindle cell stroma.  In MBC, carcinomas show extensive metaplastic change to squamous cells, spindle cells or heterologous mesenchymal elements. In the breast, the most popular theory regarding the histogenesis of the metaplastic components is through transformation of myoepitheleal cells.  In most tumors, areas of infiltrating duct carcinomas are present with transition to metaplastic elements. The sarcoma like component may resemble malignant fibrous histiocytoma, chondrosarcomas, osteosarcomas, rhabdomyosarcomas or a combination of these.  The diagnosis of epithelial - only subtype (adenosquamous or pure squmous cell carcinoma) can be based only on morphological assessment, but diagnosing the biphasic and monophasic types of metaplastic carcinoma requires the use of immunohistochemistry. Cytokeratin (AE1/AE3) remains the most widely used and the most sensitive marker, together with epithelial membrane antigen and vimentin, for defining the metaplastic spindle cells, particularly the monophasic subtype. As in the present case, most metaplastic carcinomas are negative for hormone receptors (oestrogen, progesterone) and expression of cerbB2 oncoprotein, in contrast with the high grade (grade-3) breast carcinomas where the cerbB2 positivity rate is about 35%. The treatment option for this tumor remains unclear. The absence of hormone receptors and cerbB2 oncoprotein expression limit oncological treatment options. Patients with metaplastic carcinomas tend to have poor outcomes with a high risk of recurrence after surgery. Aggressive presentation of this case recommended radical local and adjuvant treatment by radical mastectomy followed by radiation and chemotherapy, though the need for chemotherapy is unknown because of the absence of large series of randomized or observational data.  Sayed et al.  state that MBC is aggressive with a poor outcome., Tumor size has been postulated as passively the only relatively useful prognostic indicator and the mesenchymal elements involved, may also have some importance in prognosis.
| » Acknowledgment|| |
Authors acknowledge the cooperation of patient's husband for supplying the reports etc., for our study.
| » References|| |
Patrikar A, Maimoon S, Mahore S, Akhtar MA, Wilkinson A. Metaplastic carcinoma of breast (carcinosarcoma variant): A case report. Indian J Pathol Microbiol 2007;50:396-8.
Gogas J, Kouskos E, Markopoul C, Mantas D. Carcinosarcoma of the breast; report of two cases. Eur J Gynaecol Oncol 2003;24:93-5.
Kurian KM, AL-Nafussi A. Sarcomatoid/metaplastic carcinoma of the breast: A clinicopathological syudy of 12 cases. Histopathology 2002;40:58-64.
Ridolfi RL, Jamehdor MR, Arber JM. HER-2/new testing in breast carcinomas: A study on 942 cases. Breast Cancer Res Treat 1995;35:283-91.
Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast, clinical presentation, treatment results and prognosic factors. Acta Oncol 2006;45:188-95.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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