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Leng L, Hua X, Liu W, Jian W. Hormone receptor expression in low-grade adenosquamous carcinoma of the breast progressing to high-grade metaplastic carcinoma: A case report. Medicine (Baltimore) 2024; 103:e39131. [PMID: 39058816 PMCID: PMC11272229 DOI: 10.1097/md.0000000000039131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Breast low-grade adenosquamous carcinoma is an uncommon cancer that has been neglected in genetic and pathophysiological research. Consequently, medical practitioners face challenges in the effective diagnosis and treatment of this condition. PATIENT CONCERNS We present the case of a 57-year-old Asian female patient who presented with bilateral breast masses on physical examination. Ultrasound and an MRI revealed a highly suspicious malignant mass in her right breast that was completely removed surgically. DIAGNOSES After pathological analysis, the diagnosis was low-grade adenosquamous carcinoma with local high-grade transformation, and some of the tumor components were estrogen receptor positive. INTERVENTIONS The patient underwent appropriate postoperative chemotherapy and achieved a favorable outcome. OUTCOMES During the follow-up period after surgical resection, the patient did not experience any local recurrence or distant metastasis. LESSONS Owing to the rare combination of estrogen receptor positivity and high-grade progression, this patient also required adjuvant chemotherapy. This enhances the essential foundation for diagnosing and treating this rare disease, and facilitates the implementation of treatment plans.
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Affiliation(s)
- Lei Leng
- Department of Pathology, Guangzhou Red Cross Hospital affiliated to Jinan University Guangzhou, Guangdong Province, China
| | - Xin Hua
- Department of Pathology, Guangzhou Red Cross Hospital affiliated to Jinan University Guangzhou, Guangdong Province, China
| | - Wei Liu
- Department of Breast Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Wu Jian
- Department of Otorhinolaryngology—Head and Neck Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, China
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Papatheodoridi A, Papamattheou E, Marinopoulos S, Ntanasis-Stathopoulos I, Dimitrakakis C, Giannos A, Kaparelou M, Liontos M, Dimopoulos MA, Zagouri F. Metaplastic Carcinoma of the Breast: Case Series of a Single Institute and Review of the Literature. Med Sci (Basel) 2023; 11:medsci11020035. [PMID: 37218987 DOI: 10.3390/medsci11020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
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.
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Affiliation(s)
- Alkistis Papatheodoridi
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
- Department of Physiology, Medical School of National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Eleni Papamattheou
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, Medical School, University of Athens, 115 28 Athens, Greece
| | - Spyridon Marinopoulos
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, Medical School, University of Athens, 115 28 Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
| | - Constantine Dimitrakakis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, Medical School, University of Athens, 115 28 Athens, Greece
| | - Aris Giannos
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, Medical School, University of Athens, 115 28 Athens, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Medical School of National and Kapodistrian University of Athens, "Alexandra" General Hospital of Athens, 115 28 Athens, Greece
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Lewis G, Fong N, Gjeorgjievski SG, Li XB, Li Z, Wei S, Sturgis CD, Wang C, Komforti M, Zhang H, Downs E, Cui X, McIntire P, Hoda RS, Rowe JJ, Sciallis A, Zhang G. Low-grade adenosquamous carcinoma of the breast: a clinical, morphological and immunohistochemical analysis of 25 patients. Histopathology 2023. [PMID: 37067767 DOI: 10.1111/his.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/26/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
AIMS Due to its rarity and non-specific clinical and pathological features, low-grade adenosquamous carcinoma (LGASC) of the breast continues to pose diagnostic challenges. Unlike other triple-negative breast carcinomas, LGASC tends to have an indolent clinical behaviour. It is essential to recognise this lesion for accurate diagnosis and appropriate management. METHODS AND RESULTS Twenty-five cases of LGASC were identified in our archives and collaborating institutes. Cases of LGASC with dominant coexisting other type carcinomas were excluded. We studied the clinical presentation, morphological features, patterns of the commonly used immunohistochemical stains and follow-up. In our cohort, LGASC was commonly located at the outer aspect of the breast and associated with intraductal papilloma. The morphology of LGASC is characterised by infiltrating small glands and nests with variable squamous differentiation. We also found cuffing desmoplastic (fibrolamellar) stromal change in 75% of patients and peripheral lymphocytic aggregates in 87.5% of patients. P63 and smooth muscle myosin (SMM) were the most common myoepithelial markers used to assist in diagnosis. P63 often stained peripheral tumour cells surrounding invasive glands (circumferential staining in 80% of the cases), mimicking myoepithelial cells. It also stained the small nests with squamous differentiation. However, SMM was negative in 63% of the cases. The vast majority of our cases were triple-negative; only a few had focal and weak expressions of ER and PR. One patient who did not have excision developed lymph node metastasis. Most patients underwent excision or mastectomy with negative margins as surgical treatment; there were no recurrences or metastases in these patients with clinical follow-ups up to 108 months. CONCLUSIONS LGASC has some unique, although not entirely specific, morphological features and immunohistochemical staining patterns. Fibrolamellar stromal change, peripheral lymphocytic aggregates and variable staining of p63 and SMM are valuable features to facilitate the diagnosis.
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Affiliation(s)
- Gloria Lewis
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nancy Fong
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Xiaoxian Bill Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Zaibo Li
- Department of Pathology and Laboratory Medicine, Ohio State University, Columbus, OH, USA
| | - Shi Wei
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles D Sturgis
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chunjie Wang
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Miglena Komforti
- Department of Pathology and Laboratory Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Huina Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
| | - Erinn Downs
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Xiaoyan Cui
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick McIntire
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raza S Hoda
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Jordi Rowe
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Sciallis
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gloria Zhang
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Priyadarshini S, Singh N, Ali H, Kasireddy V. Adenosquamous Carcinoma of the Breast: Case Report and Literature Review. Cureus 2022; 14:e25940. [PMID: 35711248 PMCID: PMC9197327 DOI: 10.7759/cureus.25940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Low-grade adenosquamous breast carcinoma (LGASC) is an atypical variant of metaplastic breast cancer. It differs from metaplastic carcinoma and has an indolent behavior. It usually presents as a palpable lump, unlike in our case, which had an incidental presentation. Because of its rarity, it often creates a clinical and diagnostic challenge. With the risk of local recurrence, the current management is aggressive with excision. Chemoradiation has been used in a few cases, but optimal management is unclear. Our manuscript aims to add to the existing knowledge on LGASC.
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Xu C, Gu Z, Liu J, Lin X, Wang C, Li J, Fu Y, Cheng X, Zhuang Z. Adenosquamous carcinoma of the breast: a population-based study. Breast Cancer 2021; 28:848-858. [PMID: 33580464 PMCID: PMC8213591 DOI: 10.1007/s12282-021-01222-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Background To summarize the clinicopathological characteristics, prognosis, and management of breast adenosquamous carcinoma (ASC). Methods A population-based study was performed using retrospectively extracted data from the Surveillance, Epidemiology, and End Results database for breast cancer patients with histological diagnoses of ASC, infiltrating duct carcinoma (IDC) and squamous cell carcinoma (SCC) from 2004 to 2016. Results ASC presented similar tumor size but low histological grade and less lymph node metastasis compared to IDC. ASC expressed less positive rate of hormone receptors and barely HER2, which was similar with SCC. ASC patients underwent the similar surgical and systematic treatment as IDC, only with less radiotherapy. Median follow-up data of 78 months showed that the prognosis of IDC patients was better than that of ASC patients (all p < 0.05 for BCSM and OS). ASC was not an independent prognosis factor of breast cancer. After propensity score matching (PSM), no significant difference in BCSM nor OS was observed between ASC and IDC groups. In HR-negative patients, the prognosis of ASC was similar with that of IDC, and both were superior to SCC. In HR-positive patients, the 5-year survival rate of ASC was 63.5%, which was far less than that in ASC of HR-negative (81.0%). Multivariate analysis showed that older age (age > 60) and advanced AJCC-stage were independent factors of poor prognosis in ASC, breast-conserving surgery was also ideally suited for ASC. Conclusions ASC has unique clinicopathological characteristics and prognosis. It is imperative to focus on a more precise and personalized treatment management of ASC patients.
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Affiliation(s)
- Cheng Xu
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Zhangyuan Gu
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Juan Liu
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Xiaoyan Lin
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China
| | - Cheng Wang
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated To Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Jiejing Li
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Yun Fu
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Xiaolin Cheng
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Zhigang Zhuang
- Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China.
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Kashu N, Oura S, Yoshida H, Nishino E, Makimoto S. A Case of Squamous Cell Carcinoma of the Breast with Low-Grade Adenosquamous Carcinoma. Case Rep Oncol 2020; 13:1152-1157. [PMID: 33173478 PMCID: PMC7590783 DOI: 10.1159/000508181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/31/2023] Open
Abstract
A 68-year-old woman with a breast mass was referred to our hospital. Imaging studies showed an oval well-defined mass, 1.3 cm in size, in her left lower outer quadrant of the breast. Core needle biopsy with immunohistochemical staining showed atypical spindle cells forming solid nests with necrosis and papillary lesions, leading to the tentative and pre-operative diagnosis of invasive ductal carcinoma. Due to the absence of daughter nodules, extensive ductal spread, and lymphadenopathy on imaging evaluation, the patient underwent breast-conserving surgery and sentinel node biopsy, resulting in negative surgical margins and no lymph node involvement. Post-operative pathological examination showed triple negative atypical cells with squamous differentiation, squamous cell carcinoma (SCC), with cystic parts and a small amount of low-grade adenosquamous cell carcinoma (LGASC), both encompassing the cystic parts in a contiguous fashion. No cases with synchronous SCC and LGASC in the breast have been reported to date. An etiologic correlation between SCC and LGASC should be further evaluated.
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Affiliation(s)
- Nozomi Kashu
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shoji Oura
- Division of Breast Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | | | - Eisei Nishino
- Division of Pathology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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