A case of metaplastic breast cancer that showed a good response to platinum-based preoperative chemotherapy

Metaplastic breast carcinoma: Analysis of clinical and pathologic features, a five-year study

Background

Metaplastic carcinoma breast (MCB) is a rare tumor comprising of both glandular and non-glandular patterns with epithelial and or mesenchymal components. Due to their varied clinicomorphological features, diagnosis has been challenging.

Aim

To study the clinicopathological and histomorphology of cases of metaplastic carcinoma breast diagnosed in a tertiary care hospital along with literature review.

Materials and Methods

This is a retrospective study including data of 11 patients who were diagnosed with MCB either on trucut or mastectomy specimens conducted between January 2014 and December 2018.

Results

The study includes 11 patients, out of which 10 were diagnosed on mastectomy while one on trucut specimen. All the patients were women with the mean age of presentation being 43.8 years. The most common presentation was palpable breast lump with mean tumor size of 7.3 cm in greatest dimension. Skin involvement was seen in 36.3% of cases. While eight cases (72.7%) were classified as epithelial, three (27.2%) were classified as mixed. Amongst epithelial variety, in eight cases, squamous component was seen along with infiltrating ductal carcinoma (IDC) while one was pure squamous type. In mixed variety, one case showed spindled areas along with squamous areas and areas of IDC. Other two showed focal sarcomatous and cartilaginous areas in one and angiosarcomatous, bone and cartilage formation admixed with areas of IDC in other case.

Conclusion

MCB are rare breast tumors with aggressive course and are characterized by their large size and rapid growth rate. Recently, there has been an upsurge in the cases of MCB due to increase in recognition of this entity. It has to be distinguished from other tumors by the pathologists so as to guide proper treatment.

Metaplastic Breast Carcinoma Revisited; Subtypes Determine Outcomes: Comprehensive Pathologic, Clinical, and Molecular Review

Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.

Metaplastic Carcinoma of the Breast: Case Series of a Single Institute and Review of the Literature

Metaplastic carcinoma of the breast (MpBC) is a very rare and aggressive type of breast cancer. Data focusing on MpBC are limited. The aim of this study was to describe the clinicopathological features of MpBC and evaluate the prognosis of patients with MpBC. Eligible articles about MpBC were identified by searching CASES SERIES gov and the MEDLINE bibliographic database for the period of 1 January 2010 to 1 June 2021 with the keywords metaplastic breast cancer, mammary gland cancer, neoplasm, tumor, and metaplastic carcinoma. In this study, we also report 46 cases of MpBC stemming from our hospital. Survival rates, clinical behavior, and pathological characteristics were analyzed. Data from 205 patients were included for analysis. The mean age at diagnosis was 55 (14.7) years. The TNM stage at diagnosis was mostly stage II (58.5%) and most tumors were triple negative. The median overall survival was 66 (12-118) months, and the median disease-free survival was 56.8 (11-102) months. Multivariate Cox regression analysis revealed that surgical treatment was associated with decreased risk of death (hazard ratio 0.11, 95% confidence interval 0.02-0.54, p = 0.01) while advanced TNM stage was associated with increased risk of death (hazard ratio 1.5, 95% confidence interval 1.04-2.28, p = 0.03). Our results revealed that surgical treatment and TNM stage were the only independent risk factors related to patients' overall survival.

Metaplastic breast cancer with chondrosarcomatous differentiation combined with concurrent bilateral breast cancer: A case report

BACKGROUND

Metaplastic breast carcinoma (MBC) is a rare subtype of invasive breast cancer comprising malignant epithelial and mesenchymal cells. Compared with other invasive breast cancers, MBC is not only histologically distinctly heterogeneous but also has a rapid and aggressive growth pattern, which leads to a significant risk of recurrence and mortality.

CASE SUMMARY

In this study, we report the case of a patient with a large left breast mass diagnosed with bilateral invasive ductal carcinoma in both breasts after a preoperative core needle aspiration biopsy of the bilateral breast mass. The patient received neoadjuvant chemotherapy and underwent bilateral breast modified radical mastectomy. Postoperative pathology suggested carcinosarcoma with predominantly chondrosarcoma in the left breast and invasive ductal carcinoma (luminal B) in the right breast. As the patient did not achieve complete pathological remission after six cycles of neoadjuvant chemotherapy, we administered six months of intensive capecitabine treatment. Then the patient was switched to continuous treatment with endocrine therapy using letrozole + goserelin, and the patient is currently in stable condition. However, as MBC of the breast is concurrently diagnosed with chondrosarcoma differentiation, our case is sporadic.

CONCLUSION

Given the variety of immunohistochemical types of bilateral breast cancer, achieving effective chemotherapy should be a key research focus.

Metaplastic Breast Carcinoma Revisited; Subtypes Determine Outcomes: Comprehensive Pathologic, Clinical, and Molecular Review

Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.

Synchronous metaplastic breast carcinoma and lung adenocarcinoma: a rare case and review of the literature

Synchronous primary cancers occur in 1.7% of breast cancer cases and metaplastic breast cancer (MBC) occurs in less than 1% of breast cancer cases. We present a previously healthy 66-year-old woman diagnosed with MBC after surgical resection of a presumed cyst. A second primary cancer, multifocal lung adenocarcinoma, was discovered during the staging process for her MBC. Remarkably she had not experienced pulmonary or constitutional symptoms at the time of diagnosis. She received chemotherapy with paclitaxel and carboplatin, followed by immunotherapy with nivolumab. At 24 months of follow-up after her initial diagnosis, she was breast cancer-free with stable pulmonary nodules. This case highlights that rather than assuming multifocal lesions represent metastasis, biopsies should be considered as clinical management could be significantly altered in the presence of a synchronous cancer. Furthermore, platinum-based chemotherapy agents have potential to be considered in the treatment of MBC.

Therapeutic landscape of metaplastic breast cancer

Metaplastic breast carcinomas (MPBC) are rare, aggressive and relatively chemorefractory tumors with a high unmet need. While most are "triple negative" and lack expression of estrogen, progesterone and HER2 receptors, MPBC are associated with worse outcomes compared to conventional triple negative invasive tumors. MPBCs are genetically heterogeneous and harbor somatic mutations, most frequently in TP53, PIK3CA and PTEN, with emerging studies suggesting a role for novel targeted therapies. These tumors have also been associated with overexpression of PD-L1 and tumor-infiltrating lymphocytes suggesting an endogenous immune response and therefore a rationale for treatment with immunotherapies. Here, we focus on therapeutic options for this difficult to treat breast cancer subtype and encourage physicians to consider targeted therapies/immunotherapies as part of ongoing clinical trials.

Metaplastic breast carcinoma: Current therapeutic approaches and novel targeted therapies

Metaplastic breast carcinoma (MBC) is a rare subtype of invasive breast cancer consisting of various combinations of malignant epithelial and mesenchymal cells. Its aggressive growth pattern combined with its histological heterogeneity account for MBC's characteristic resistance to systemic therapies, which subsequently leads to increased risk of recurrence and breast cancer mortality compared with other invasive mammary carcinomas. The aim of this review is to discuss the current therapeutic approaches, both in loco-regional as well as in systemic management of MBC. With the accumulation of knowledge from histopathologic assessment and the increasing identification of underlying molecular aberrations, emerging, novel targeted therapies will enable physicians to implement a more individualized and efficacious therapeutic strategy, leading hopefully to an improvement in the poor prognosis of MBC.

Metaplastic Carcinoma Breast: A Clinical Analysis of Nine Cases

Metaplastic Breast Carcinoma (MBC) is a rare heterogeneous group of primary breast malignancies with different subgroups; exhibits a variety of histopathologic patterns and appears to be both epithelial and mesenchymal in origin. The ideal treatment for MBC remains unknown, due to its low incidence and pathological variability. Owing to its rarity, MBC has been treated as a variant of Invasive Duct Carcinoma (IDC). But it has poorer prognosis as compared to IDC. This is a case series to evaluate clinicopathologic characteristics and the multi-disciplinary treatment of nine MBC patients treated in a single institute.

Clinicopathological characteristics and prognosis of metaplastic carcinoma of the breast

Metaplastic carcinoma of the breast (MBC) is a rare and heterogeneous type of neoplasm. Knowledge about its clinical characteristics, prognostic significance and optimal treatment modalities is fragmentary and controversial. The present retrospective study aimed to investigate the prognostic value of the clinicopathological features and different therapeutic strategies in MBC. For this purpose, the medical records of 69 MBC patients subjected to surgical resection for MBC at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China) were reviewed. A total of 69 MBC cases were followed up for 9–139 months. The 5-year disease-free survival (DFS) rate was 52.2% and the overall survival (OS) rate was 60.2%. Survival analysis revealed that large tumor size and lymph node (LN) metastases were correlated with shortened 5-year DFS and OS rates. In addition, chemotherapy significantly improved the prognosis of patients with LN metastasis, while radiation therapy (RT) significantly improved the 5-year OS and DFS rates of MBC patients with tumors ≥5 cm or with >4 metastatic LNs. In conclusion, MBC is a clinically aggressive subtype of breast cancer associated with a large tumor size. Chemotherapy may be recommended for certain subtypes of MBC with LN positivity, and RT may be a component of multimodality therapy for some MBC patients.

Metaplastic breast carcinomas - analysis of prognostic factors in a case series

Aim of the study

Metaplastic breast carcinomas (MBC) are a rare group of cancers, accounting for about 1% of all breast cancers. The study presents a case series of MBC patients diagnosed, treated and followed up in one healthcare center.

Material and methods

The study group comprised 18 women at the median age of 63 years. The most common carcinoma type in the study group was MBC with squamous epithelial differentiation (56%). Estrogen receptor expression was identified in one patient. No steroid or HER2 receptor expression was found in the remaining patients. We analyzed recurrence and survival rates in relation to clinical and therapeutic factors by using the Kaplan-Meier method.

Results

A significantly longer overall survival time was noted among patients treated with adjuvant radiation therapy, p = 0.018. No other factors had a significant influence on survival. Because of the small size of the study group, results obtained in the study should be treated with caution.