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Journal of Cancer Research and Clinical... Jul 2023The prognostic and therapeutic power of special histological subtypes in breast cancer in pure form or in combination with other histological subtypes is still not...
PURPOSE
The prognostic and therapeutic power of special histological subtypes in breast cancer in pure form or in combination with other histological subtypes is still not established, and diagnostic guidelines are cautious regarding prognostic power based on the histological subtype alone. Therapy decisions are guided in most cases independently of the histological subtype and are directed by biomarkers and tumor stage. In this study, we analyzed a comprehensive large retrospective breast cancer cohort with a special focus on histological subtype (other than ductal non-special type or lobular carcinoma) and correlated pure or mixed histological forms with pathological tumor stage and overall disease-free survival.
MATERIALS AND METHODS
A total of 827 breast cancer cases with pure or mixed special histological types were retrospectively analyzed. Survival information was available in 645 of 827 cases.
RESULTS
A total of 293 cases had pure forms, and 534 cases had mixed histological subtypes. The most common pure special types were mucinous (23.9%), micropapillary (21.2%), high-grade metaplastic (13%), male breast cancer (8.2%), cribriform (6.8%), metastases (6.1%), apocrine and papillary (each 5.46%), NST with medullary and clear cell pattern (up to 3.4%) and high-grade neuroendocrine carcinomas (2.7%). Mixed forms were most frequently encountered in NST carcinomas with micropapillary components (41.8%), followed by mucinous (9.93%) and cribriform (6.74%) mixed patterns. In univariate analysis, no pure form had prognostic relevance compared with any mixed form with the basic pure element. Pooling pure histological subtypes with tumor stage and age in a linear random-effects model, the cribriform subtype had the most favorable prognosis, while male breast cancer showed the poorest outcome (p < 0.001). All other frequent pure forms had intermediate prognostic power (p < 0.001).
CONCLUSION
Our results show that the analyzed special histological breast cancer subtypes (other than ductal and lobular carcinomas) do not carry prognostic information alone, either in pure form or in any combination with other subtypes. Prognostic groups including special subtypes, however, can strongly stratify breast cancer if tumor stage, age and biomarkers are included in the prognostic measurements.
Topics: Male; Humans; Prognosis; Retrospective Studies; Breast Neoplasms, Male; Breast Neoplasms; Carcinoma, Lobular; Disease-Free Survival; Carcinoma, Ductal, Breast
PubMed: 36310301
DOI: 10.1007/s00432-022-04443-x -
Discover Oncology Apr 2024Squamous cell carcinoma (SCC) of the breast is a rare variant of invasive breast cancer that has been classified as metaplastic carcinoma. When a tumor is composed of...
INTRODUCTION
Squamous cell carcinoma (SCC) of the breast is a rare variant of invasive breast cancer that has been classified as metaplastic carcinoma. When a tumor is composed of spindle cells, diagnosis is challenging.
CASE REPORT
A 42-year-old woman with a large mass in the right breast underwent modified radical mastectomy. A pathological examination revealed a tumor with central necrosis in it. The tumor had a sarcomatoid growth pattern and the cells were spindle-shaped with severe atypicality. Immunohistochemical staining showed that P63, P53, vimentin, and CKpan were positive, whereas estrogen receptor and C-erbB-2 were negative. Ki-67 proliferation index was as high as 90%. Therefore, a diagnosis of SCC of the right breast was made. The patient received eight cycles of postoperative chemotherapy with paclitaxel and carboplatin, followed by seven cycles of radiotherapy. During follow-up, the patient also had a left thyroid tumor, and postoperative pathology suggested microinvasive follicular carcinoma. Since breast surgery, the patient has remained disease-free for more than four years.
CONCLUSION
SCC of the breast with spindle cell and sarcomatoid features is rare. The diagnosis of such tumors requires exclusion of tumors with similar histological morphologies.
PubMed: 38558111
DOI: 10.1007/s12672-024-00958-6 -
Cureus Dec 2023Metaplastic breast carcinoma represents a diverse category of invasive breast cancers distinguished by the transformation of neoplastic epithelial cells into squamous...
Metaplastic breast carcinoma represents a diverse category of invasive breast cancers distinguished by the transformation of neoplastic epithelial cells into squamous cells or cells with mesenchymal appearance. Matrix-producing breast carcinoma is a variant of metaplastic breast carcinoma, an exceedingly uncommon malignancy accounting for less than 1% of all breast tumors. The precise origin of this tumor remains elusive; some molecular research points to a potential derivation from myoepithelial cells, while other studies emphasize the possibility of neoplastic transformation originating from multipotent stem cells. We report a case of recurrent matrix-producing breast carcinoma. The patient presented with a breast mass. The tumor cells displayed a lack of reactivity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2), and exhibited a Ki-67 proliferation index of approximately 40%. Additionally, the tumor cells demonstrated significant reactivity for cytokeratins and S100. The patient underwent surgery, radiation, and chemotherapy and then developed metastasis to the lower lobe of her left lung, seven years after primary diagnosis. Diagnosis of metastasis was confirmed by comparing the metastasis to the primary tumor and staining with a panel of immunohistochemical stains. The patient is currently undergoing chemotherapy and immunotherapy.
PubMed: 38196420
DOI: 10.7759/cureus.50265 -
Case Reports in Oncology 2023Metaplastic breast carcinoma (MBC) is a rare histologic subtype of breast carcinoma, which is usually negative for estrogen receptor, progesterone receptor, and HER2....
INTRODUCTION
Metaplastic breast carcinoma (MBC) is a rare histologic subtype of breast carcinoma, which is usually negative for estrogen receptor, progesterone receptor, and HER2. HER2-positive MBC is therefore extremely rare. Most MBCs have poor response to chemotherapy. HER2-targeted neoadjuvant chemotherapy (NAC) is widely performed and has high efficacy in treating HER2-positive breast cancer. We report an atypical case of HER2-positive breast cancer that had poor response to NAC and was diagnosed with MBC after the surgery.
CASE PRESENTATION
A 73-year-old woman noticed a mass in her right breast and visited our hospital. The mass was diagnosed as hormone receptor-negative, HER2-positive invasive ductal carcinoma, T2N0M0 stage IIA. She received HER2-targeted NAC comprising trastuzumab + pertuzumab + docetaxel. Despite three courses, we observed disease progression. The next NAC regimen was composed of two courses of epirubicin + cyclophosphamide, but the cancer continued to grow. She stopped receiving NAC and underwent a unilateral mastectomy and sentinel lymph node biopsy. Although the preoperative pathological result of core needle biopsy specimen showed invasive ductal carcinoma, the postoperative pathological result of the surgical specimen was MBC.
CONCLUSION
In this case, when the patient had undergone three courses of trastuzumab + pertuzumab + docetaxel, it would have been appropriate to review the result of the core needle biopsy with pathologists or to perform vacuum-assisted breast biopsy. This case suggests the importance of considering the possibility of special histologic subtypes such as MBC when a tumor with the diagnosis of invasive ductal carcinoma is resistant to NAC.
PubMed: 38028581
DOI: 10.1159/000534847 -
Medical Archives (Sarajevo, Bosnia and... 2024Metaplastic breast cancer is a clinically rare subtype of breast carcinomas, accounting for less than 1% of all breast neoplasms, and was not officially recognized till... (Review)
Review
BACKGROUND
Metaplastic breast cancer is a clinically rare subtype of breast carcinomas, accounting for less than 1% of all breast neoplasms, and was not officially recognized till the end of the 20th century as an independent pathological diagnosis.
OBJECTIVE
In this paper, we report a case of metaplastic breast cancer with squamous differentiation in a 51-year-old female, with a succinct review of the literature.
CASE REPORT
The patient presented to our outpatient department with a complaint of left breast mass for 2 months duration with a diagnostic workup found to be grade three metaplastic carcinoma with squamous differentiation. The management decision was to proceed with neoadjuvant chemotherapy, followed by surgical intervention based on the tumor cell response to neoadjuvant therapy.
CONCLUSION
Metaplastic breast cancer represents a rare clinical entity, encountered in a minority of patients. The clinical presentation of metaplastic carcinomas in general is similar to other breast cancers, however, metaplastic breast cancer tend to present in later stages as a rapidly growing mass with poor prognosis. The recognized poor prognosis along with rarity necessities having a high index of suspicion for early detection and appropriate management of metaplastic breast cancer.
Topics: Female; Humans; Middle Aged; Breast Neoplasms; Metaplasia; Neoadjuvant Therapy; Carcinoma, Squamous Cell
PubMed: 38481595
DOI: 10.5455/medarh.2024.78.75-77 -
Discover Oncology Apr 2024Metaplastic breast carcinoma (MBC), a category of breast cancer, includes different histological types, which are occasionally mixed and heterogeneous. Considering the...
Immunohistochemical and molecular profiles of heterogeneous components of metaplastic breast cancer: a squamous cell carcinomatous component was distinct from a spindle cell carcinomatous component.
Metaplastic breast carcinoma (MBC), a category of breast cancer, includes different histological types, which are occasionally mixed and heterogeneous. Considering the heterogeneity of cancer cells in a tumour mass has become highly significant, not only from a biological aspect but also for clinical management of recurrence. This study aimed to analyse the immunohistochemical and molecular profiles of each MBC component of a tumour mass. Twenty-five MBC tumours were histologically evaluated, and the most frequent MBC component (c) was squamous cell carcinoma (SCC), followed by spindle cell carcinoma (SpCC). A total of 69 components of MBC and non-MBC in formalin-fixed paraffin-embedded sections were examined for 7 markers by immunohistochemistry. SCC(c) were significantly PTEN negative and CK14 positive, and SpCC(c) were significantly E-cadherin negative and vimentin positive. Multivariate analyses revealed that immunohistochemical profiles of normal/intraductal (IC)(c), no special type (NST)(c), and MBC(c) differed; moreover, SCC(c) and SpCC(c) were distinctly grouped. PTEN gene mutation was detected only in SCC(c) (2/7), but not in SpCC(c). Next-generation sequence analyses for 2 cases with tumours containing SCC(c) demonstrated that PTEN gene mutation increased progressively from IC(c) to NST(c) to SCC(c). In conclusion, the immunohistochemical and molecular profiles of the SCC(c) of MBC are distinct from those of the SpCC(c).
PubMed: 38564036
DOI: 10.1007/s12672-024-00950-0 -
Medicina (Kaunas, Lithuania) Aug 2023Cutaneous mixed tumor is a rare benign neoplasm that exhibits a wide range of metaplastic changes and differentiation in the epithelial, myoepithelial, and stromal... (Review)
Review
Cutaneous mixed tumor is a rare benign neoplasm that exhibits a wide range of metaplastic changes and differentiation in the epithelial, myoepithelial, and stromal components, which is often confused with various other skin lesions. We present an unusual case of a 58-year-old woman with a mixed tumor of the upper lip, previously misdiagnosed as adnexal carcinoma on a preoperative biopsy. The excision biopsy shows a well-circumscribed lesion composed of various cells and structures featuring folliculo-sebaceous differentiation embedded in a prominent chondromyxoid stroma. The immunohistochemical study proves the various lineages of differentiation and classifies the neoplasm as the less common eccrine subtype of cutaneous mixed tumor. The common embryologic origin of the folliculo-sebaceous apocrine complex leads to a great histological variety of cellular components of mixed tumors and the formation of structures that resemble established types of adnexal neoplasms, which could be a diagnostic pitfall, especially on a small incision biopsy.
Topics: Female; Humans; Middle Aged; Skin Neoplasms; Adenoma, Pleomorphic; Biopsy; Cell Differentiation; Confusion
PubMed: 37629755
DOI: 10.3390/medicina59081465 -
Cancers Aug 2023A better understanding of the mechanisms generating tumour heterogeneity will allow better targeting of current therapies, identify potential resistance mechanisms and...
A better understanding of the mechanisms generating tumour heterogeneity will allow better targeting of current therapies, identify potential resistance mechanisms and highlight new approaches for therapy. We have previously shown that in genetically modified mouse models carrying conditional oncogenic alleles, mammary tumour histotype varies depending on the combination of alleles, the cell type to which they are targeted and, in some cases, reproductive history. This suggests that tumour heterogeneity is not a purely stochastic process; rather, differential activation of signalling pathways leads to reproducible differences in tumour histotype. We propose the NOTCH signalling pathway as one such pathway. Here, we have crossed conditional knockout or alleles into an established mouse mammary tumour model. deletion had no effect on tumour-specific survival; however, loss of alleles resulted in a dose-dependent increase in metaplastic adenosquamous carcinomas (ASQCs). ASQCs and adenomyoepitheliomas (AMEs) also demonstrated a significant increase in AKT signalling independent of status. Therefore, the NOTCH pathway is a suppressor of the ASQC phenotype, while increased PI3K/AKT signalling is associated with ASQC and AME tumours. We propose a model in which PI3K/AKT and NOTCH signalling act interact to determine mouse mammary tumour histotype.
PubMed: 37686600
DOI: 10.3390/cancers15174324 -
Journal of Personalized Medicine Sep 2023Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of...
Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.
PubMed: 37888062
DOI: 10.3390/jpm13101451 -
Breast Disease 2024An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past...
An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past medical history of atrial fibrillation that was managed with an oral anticoagulant. Mammography demonstrated a dense mass in the upper outer quadrant of the left breast. Ultrasound showed an irregular, heterogeneous 4.7 cm lesion containing debris and cystic spaces with raised peripheral vascularity at the 2 o'clock position, 3 cm from nipple. No internal vascularity was detected. This was managed as a haematoma and rivaroxaban was withheld. Follow-up imaging 3-weeks later showed persistence of the lesion. Bedside needle aspiration yielded haemoserous fluid with immediate reduction in size of the lesion. However, 2 weeks after aspiration, there was recurrence of the 'haematoma'. Multidisciplinary review of the clinical history, examination and imaging was sought, and biopsy of the irregularly thickened areas with vascularity along the periphery of the lesion was recommended. Vacuum-assisted biopsy was performed, and histology returned as metaplastic carcinoma. A recurring 'haematoma' should always prompt a search for a secondary cause, with features such as irregular thickened walls and papillary/nodular components requiring further evaluation with biopsy for histopathological correlation.
Topics: Humans; Female; Hematoma; Breast Neoplasms; Aged, 80 and over; Diagnosis, Differential; Mammography; Metaplasia; Recurrence
PubMed: 38875024
DOI: 10.3233/BD-240006