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metaplastic_carcinoma

Metaplastic Carcinoma

Related Terms: metaplastic breast cancer, reast neoplasms, metaplastic carcinoma, fibromatosis, immunohistochemical stains, diagnosis, breast radiography, lymphedema, arm lymphedema, arm swelling, cancer, breast neoplasm, sonography, mammography, MRI , osseous differentiation, invasive ductal carcinoma, invasive lobular carcinoma, breast, prognosis, triple-negative breast cancer, prognosis, adjuvant chemotherapy

Described as a rare type of breast cancer that often is confused with other entities, noth benign and malignant. It describes a cancer that begins in one type of cell and changes into another tpe of cell. Most cases of metaplastic breast cancer start in the epithelial cells, then change into squamous (nonglandular cells). (1)

It can spread to the lymph nodes and thus can spread easily to other areas of the body.

Risk Ractors

Unknown at the present time.

Symptoms

Can manifest as either a well circumscribed mass or an irregular or spiculated mass. Other symptoms can include nipple tenderness, discharge or changes; skinn irritation or changes such as puckers, dimples, scaliness or new creases; war, red swollen breasts with a rash resembling the skin of an orange (peau d'organge) and finally a pain in the breast.

Diagnosis:

A biopsy of the suspect lump will be taken and depending on the results from that, other tests maybe ordered by the oncologist. A doctor will also include age and medical condition of the patients, the type of cancer suspects, severity of any symptoms and any previous test result when formulating a diagnostic workup.

There are several “types” pf biopsies that might be performed. These include

A fine needle or small needle biopsy aspiration biopsy (FNAB) uses a small needle to remove a small sample of cells.

A core needle biopsy uses a larger needle to remove a larger sample of tissue. This is usually the preferred biopsy technique for determining whether a physical exam or imaging finding is cancer. A vacuum-assisted biopsy removes multiple large cores of tissue.

A surgical biopsy removes the largest amount of tissue. This biopsy may be incisional (removal of part of the lump) or excisional (removal of the entire lump). Because it’s best to plan curative surgery after a cancer diagnosis has been made, a surgical biopsy is usually not the recommended approach to determining whether an abnormality is cancerous. If a surgical biopsy confirms cancer, then further surgery is usually required to remove remaining cancer in the breast and evaluate the lymph nodes. Therefore, in order to keep surgery to one operation, it is best when a patient receives a core biopsy to diagnose the cancer, followed by the type of cancer surgery with the best chance at removing all of the disease, as determined by the doctor.

Image-guided biopsy is used when a distinct lump can't be felt, but an abnormality is seen on a radiologic image, such as a mammogram. During this procedure, a needle is guided to the area of concern with the help of mammography, ultrasound, or MRI. A stereotactic biopsy is performed with mammography guidance. A small metal clip may be put into the breast to mark the site of biopsy, in case the sample tissue proves cancerous and additional surgery is required. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy, depending on the amount of tissue being removed. (1)

Lymph nodes may be removed as well to determine if the cancer has spread into the lymphatics. The basic types of node biopsy includes the sentinel node biopsy and/or the axillary node biopsy.

Finally, other tests could include a simple chest xray, a bone scan a computed tomography (CT or CAT), or a positron emission tomography (PET scan.) These test are painless and can be tremendously helpful in determining whether or not the cancer has spread and if so where.

Radiological or imaging tests that might be used include diagnostic mammography, ultrasound and magnetic resonance imaging (MRI).

Treatment

The treatment program will be determined by the stage or grade of the tumor, the patient's age and overall health, the patient's menopausal status and the presence of known mutations in inherited breast cancer genes (BRCA1 or BRCA2).

Surgery will be performed to remove the tumor from the breast and to evaluate the surroounding axillary lymph nodes.

The two basic types of surgery is (1) a lumpectomy in which the tumor and a small margin of surrounding tissue is taken. Secondly, a mastectomy to remove the entire breast.

Other treatments may include radiation therapy, which includes partial breast irradiation and intensity-modulated radiation therapy. The Cancer.net page Understanding Radiation Therapy is quite helpful in understand the radiation therapy.

Chemotherapy may be used. This is the use of drugs to kill cancer cells. This treatment appears to be controversial in the treatment of metaplastic carcinoma. In one study released in Novembe 2011, “A total of 46 MCB cases were identified from 8,695 breast tumor patients who underwent biopsy or resection. About 11 of 25 patients with initial bulky disease (T3-4) received neoadjuvant chemotherapy before surgery, and 2 (18.2%) exhibited a partial response. About 12 of 18 patients who developed distant metastasis received palliative systemic chemotherapy. Of them, only 1 (8.3%), 1 (10%), and none (0%) responded to first-, second-, or third- and beyond line chemotherapy, respectively. None of the patients who received anthracyline- (n = 13), vinorelbine- (n = 7), or cyclophosphamide-based (n = 18) chemotherapy responded, whereas 3 (17.6%) of 17 patients who received taxane-based chemotherapy exhibited a partial response. Tumor response to systemic chemotherapy remains generally poor for MCB patients. Taxanes may have modest activity, but need to be validated in further studies.” (2)

Complications

One major complication of metaplastic carcinoma, and indeed in all cancers is a condition called lymphedema. Please see arm lymphedema and/or leg lymphedema for detailed information regarding it. Initially, with lymphedema you may feel a “strange” change going on in the arm, unusual pain, a needles and pin feeling, or a feeling of heaviness. Other symptoms include difficulty in moving the arm, or a stiffness, weakness, or numbness of the arm.

If you suspect this is occurring or if you have any of the symptoms, demand that your physician refer you to a certified lymphedema therapist for an examination and complete evluation. You may also want to familiarize yourself with our Warning Signs of Lymphedema page.

Prognosis

The rarity of metaplastic carcinoma and the low frequency of axillary metastses makes it difficult to study the morphologic features which would correspond with a prognosis.

How, when consider the pprognosis, this depends up the stage of the cancer, any co-morbidities and over all health of the patient. Studies that have been done indicate a 5-year disease free survival rate ranging from 38% up to 86%.

Staging Information

Cancer.Net

(1) Cancer.Net

(2) Lack of efficacy to systemic chemotherapy for treatment of metaplastic carcinoma of the breast in the modern era.

Abstracts and Studies

Metaplastic carcinoma of the breast: multimodality imaging and histopathologic assessment.

Nov 2011

Choi BB, Shu KS.

Source

Department of Radiology.

Correspondence to: Bo Bae Choi. Email: med20@hanmail.net

Abstract

BACKGROUND Metaplastic carcinomas are ductal carcinomas that display metaplastic transformation of the glandular epithelium to non-glandular mesenchymal tissue. Metaplastic carcinoma has a poorer prognosis than most other breast cancers, so the differential diagnosis is important. Although many clinical and pathologic findings have been reported, to our knowledge, few imaging findings related to metaplastic carcinoma have been reported.PurposeTo investigate whole-breast imaging findings, including mammography, sonography, MRI, and pathologic findings, including immunohistochemical studies of metaplastic carcinomas of the breast.

MATERIAL AND METHODS: We analyzed 33 cases of metaplastic carcinoma between January 2001 and January 2011. Mammography, ultrasonography, and MRI were recorded retrospectively using the American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) lexicon. Immunohistochemical studies of estrogen receptor (ER), progesterone receptor (PR), p53, and C-erbB-2 were performed.

RESULTS: The most common mammographic findings were oval shape (37%), circumscribed margin (59%), and high density (74%). The most common sonographic findings were irregular shape (59.4%), microlobulated margin (41%), complex echogenicity (81%), parallel orientation (97%), and posterior acoustic enhancement (50%). Axillary lymph node metastases were noted for 25% of the sonographic examinations. On MRI, the most common findings of margin and shape were irregularity (57% and 52.4%, respectively). High signal intensity was the most common finding on T2-weighted images (57%). Immunohistochemical profile was negative for ER (91%, 29/32) and PR (81%, 26/32).

CONCLUSION Metaplastic carcinomas might display more benign features and less axillary lymph node metastasis than IDC. High signal intensity on T2 MRI images and hormone receptor negativity would be helpful in differentiating this tumor from other breast cancers.

ACTA Radiologica

Metaplastic breast carcinoma: a case report and systematic review of the literature. Oct 2011

Toumi Z, Bullen C, Tang AC, Dalal N, Ellenbogen S.

Source

Department of General Surgery Pathology, Tameside General Hospital, Ashton-under-Lyne The University of Manchester, Manchester, UK. zahertoumi@btinternet.com

Abstract

Keywords: breast cancer; case report; matrix producing breast cancer; metaplastic breast cancer; systematic review

A 78-year-old retired woman was diagnosed with metaplastic breast carcinoma (MBC), a rare tumor, in our hospital. We reviewed 15 articles with a total of 1328 patients to determine the epidemiology, clinical features, biomarkers, histology, management and outcome of patients with this tumor. The mean age at presentation is 58.5 years (range 32-83).

Eighty-one percent of patients presented either with a breast mass or abnormal mammographic finding. Twenty-three percent of patients had a family history of breast cancer. Estrogen receptors were only found in 12%, progesterone receptors in 10% and HER2 in 6% of patients. The main method of treatment was mastectomy (66.9%) in combination with chemotherapy (57%) and radiotherapy (47%). Five-year disease-free survival ranged between 40% and 84% and 5-year overall survival ranged between 64 and 83%.

We have further reviewed the nature of this disease in the light of advancement in genetics, such as microarray gene expression profiling. The relationship of MBC with triple-negative tumor and basal-like tumor is discussed. It is hoped that advances in genetics and biomarkers will bring forward the era of personalized medicine in the treatment of breast carcinoma.

Wiley Online

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

Jul-Aug 2011

Lang R, Fan Y, Fu X, Fu L.

E-mail fulijyb@hotmail.com

Abstract

Key words: metaplastic breast carcinoma, osseous differentiation

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.

Full Text Article

Tumori

Metaplastic carcinoma of the breast with high grade spindle cell component with osteoid formation–a rare case report.

Jul-Aug 2011

Singal R, Singh P, Sahu P, Mittal A, Naredi B, Gupta S.

Source

Department of Surgery, M.M. Institute of Medical Sciences and Research, Mullana (Distt - Ambala), Haryana, India. singalrikki@yahoo.com

Abstract

Metaplastic carcinoma breast is rare entity with incidence of 0.02% of all breast malignancies. The ranges of age at diagnosis as well as clinical symptoms do not differ from that of conventional invasive ductal breast cancer. We are reporting a rare case diagnosed as metaplastic breast carcinoma on ultrasonography and confirmed histopathologically. The case merits presentation because of its rarity, low frequency of axillary metastasis and difficulty in interpreting the morphological features which correspond with prognosis.

PubMed

The prognoses of metaplastic breast cancer patients compared to those of triple-negative breast cancer patients.

Apr 2011

Bae SY, Lee SK, Koo MY, Hur SM, Choi MY, Cho DH, Kim S, Choe JH, Lee JE, Kim JH, Kim JS, Nam SJ, Yang JH.

Source

Keywords: Metaplastic breast cancer, Invasive ductal carcinoma, Triple-negative breast cancer, Prognosis, Adjuvant chemotherapy

Department of Surgery, Division of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.

Abstract

Metaplastic breast carcinoma (MBC) is a rare, heterogeneous breast cancer characterized by admixture of adenocarcinoma with metaplastic elements, low hormone receptor expression, and poor outcomes. The authors retrospectively reviewed the medical records of 47 MBC patients and 1,346 invasive ductal carcinoma (IDC) patients. Two hundred eighteen of the IDC patients were triple-negative (TN-IDC) for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 (ER-/PR-/HER2-). Patients were surgically treated at the Samsung Medical Center between 2005 and 2009. The MBC patients presented with a larger tumor size, lower lymph node involvement, higher histological and nuclear grades, higher triple negativity (ER-/PR-/HER2-) and higher p53, CK5/6, and EGFR expressions compared with those of the IDC group. However, there were no significant differences in clinicopathological characteristics between MBC and TN-IDC.

During the follow-up period (median duration of 30.3 months, range 2.6-56.3 months), seven (14.9%) MBC patients, and 98 (7.1%) IDC patients had disease recurrence. The three-year disease-free survival (DFS) rate was 78.1% in the MBC group and 91.1% in IDC group (P < 0.001). The three-year DFS rate was not significantly different between the MBC and TN-IDC groups (78.1 vs. 84.9%, P = 0.114). However, in patients with lymph node metastasis who underwent adjuvant chemotherapy, the three-year DFS rate was 44.4% in the MBC group and 72.5% in the TN-IDC group (P = 0.025).

The authors found that MBC had a poorer clinical outcome than did IDC. In breast cancer patients with nodal metastasis, MBC had a poorer prognosis than did TN-IDC, despite adjuvant chemotherapy.

Springerlink

Metaplastic carcinoma of the breast.

July 2010

Okada N, Hasebe T, Iwasaki M, Tamura N, Akashi-Tanaka S, Hojo T, Shibata T, Sasajima Y, Kanai Y, Kinoshita T.

Source

Pathology Consultation Service, Clinical Trials and Practice Support Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo 104-0045, Japan. naookada@ncc.go.jp

Keywords: Metaplastic carcinoma, Invasive ductal carcinoma, Invasive lobular carcinoma, Breast, Prognosis

Abstract

The purposes of this study were to investigate whether the biological characteristics or outcomes of patients with metaplastic carcinoma, invasive ductal carcinoma, or invasive lobular carcinoma of the breast differ; to determine whether the metaplastic carcinoma subtypes have similar malignant potentials; and to identify accurate predictors of outcome in patients with metaplastic carcinoma.

The subject comprised 6137 invasive ductal carcinoma patients, 301 invasive lobular carcinoma patients, and 46 metaplastic carcinoma patients of the breast. The metaplastic carcinomas were classified according to the World Health Organization classification. Multivariate analyses clearly demonstrated that the metaplastic carcinoma patients had a significantly poorer outcome than the invasive ductal carcinoma patients or the invasive lobular carcinoma patients independent of the nodal status or age not exceeding 39 years, whereas patients with triple-negative metaplastic carcinomas or triple-negative invasive lobular carcinomas had a poorer outcome than those with triple-negative invasive ductal carcinomas. Although no significant differences in clinical outcome were observed among the metaplastic carcinoma subtypes in multivariate analyses, an age not exceeding 39 years, the presence of skin invasion, and the presence of a squamous cell carcinoma component in nodal tumors were significant outcome predictors for metaplastic carcinoma patients.

In conclusion, the results of this study clearly demonstrated that metaplastic carcinoma is more aggressive than invasive ductal carcinoma or invasive lobular carcinoma. Although the metaplastic carcinoma subtypes had no prognostic significance, an age not exceeding 39 years, the presence of skin invasion, and the presence of a squamous cell carcinoma component in nodal tumors were significant predictors of outcome among metaplastic carcinoma patients.

Human Pathology

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metaplastic_carcinoma.txt · Last modified: 2012/10/16 14:40 (external edit)