Matrix-producing carcinoma of the breast: case report with radiographical and cytopathological features

Invasive Ductal Carcinoma of the Breast with a Large Central Acellular Zone Associated with Matrix-producing Carcinoma

Matrix-producing carcinoma is a variant of metaplastic carcinoma of the breast that consists of overt carcinoma with direct transition to a cartilagenous and osseous stromal matrix. A clinicopathological association between MPC and high-grade invasive ductal carcinoma with a large central acellular zone has been recently discussed. However, few reports have ever shown the radiological, pathological and immunohistochemical correlation of this unique tumor. We present a case of 27-year-old woman with matrix-producing carcinoma with a large central acellular zone, which was characterized by a large homogeneous hypodense center with well-marginated, ring-like enhancement on contrast enhanced computerized tomography.

Cytopathological features of matrix-producing carcinoma of the breast

Matrix producing carcinoma (MPC) of the breast is a very rare subtype of metaplastic carcinoma with heterelogous elements, which comprises <0.1% of invasive breast carcinomas. There are very few reports describing the cytological features of MPC. In this article, we aimed to discuss cytological, histopathological and immunohistochemical features of this rare entity in a 59-year-old woman.

Multifocal matrix-producing mammary carcinoma mimicking lobular carcinoma on core biopsy - A case with long survival reported

We report the clinico-pathologic features of a patient with extensive multifocal matrix-producing mammary carcinoma which mimicked invasive pleomorphic lobular carcinoma on biopsy. Neoplastic cells both in areas with and without matrix were positive for EMA and vimentin. Cytokeratin antibodies were negative, and there was no immunoreactivity for ER, PR, HER2, CD10, GCDF15, p63, or E-cadherin. The proliferative activity was low (<5%) in areas both with and without matrix production. Despite significant tumor volume and high-grade histologic features, an 8-year follow-up has been uneventful.

Matrix-producing carcinoma of the breast: an aggressive subtype of metaplastic carcinoma

Matrix-producing carcinoma (MPC) of the breast is a subtype of metaplastic carcinoma defined as an invasive breast carcinoma with a direct transition of carcinoma to cartilaginous or osseous matrix without an intervening spindle cell component. Our aims were (1) to evaluate specific histologic characteristics of MPC and correlate these with disease recurrence; and (2) to determine whether rates of locoregional and distant recurrence for MPC are significantly different from those of invasive ductal carcinoma. Thirty-two cases of MPC were identified. Fourteen patients (44%) were < or =50 years of age; 10 (31%) had tumors of size < or =2 cm, and 6 (19%) had tumors > or =5 cm. In this series, all tumors contained chondromyxoid or chondroid matrix, and 1 (3.1%) also contained focal (<5%) osseous matrix. High-grade matrix was present in 9 cases (28%), and low-grade matrix was present in 23 (72%). Matrix comprised < or =10% of the tumor in 14 cases (44%), >10% but <40% in 9 (28%), and > or =40% in 9 (28%). The carcinomatous component was high grade in 30 cases (94%), and 19 tumors (59%) had central necrosis. Seven patients (22%) had positive axillary lymph nodes, and 8 (25%) had lymphovascular space invasion (LVSI). LVSI was the only factor independently associated with locoregional recurrence-free survival in multivariate analysis (P=0.043). Although > or =40% matrix was associated with improved distant recurrence-free (DFS) survival in univariate analysis (P=0.044), only LVSI and tumor stage were independently associated with DFS survival in multivariate analysis (P=0.027 and P=0.001, respectively). Compared with matched controls with invasive ductal carcinoma, patients with MPC had decreased locoregional recurrence-free survival (P=0.001) and decreased DRF survival (P=0.001). In summary, MPC is an aggressive subtype of metaplastic carcinoma with a worse clinical outcome than invasive ductal carcinoma.

A case of matrix-producing carcinoma of the breast

BACKGROUND

Matrix-producing carcinoma (MPC) of the breast is one variant type of metaplastic carcinoma. The cellular origin of MPC remains unclear. It has been suggested the tumor cells in MPC have the combined characteristics of both epithelial cells and mesenchymal cells. Several reports suggested that the tumor cells in MPC might originate from the myoepithelial cells, but others suggested the origin was basal-like cells.

CASE PRESENTATION

The patient was a 42-year-old Japanese female. A tumor of about 2 cm in diameter was noted in the right breast. CT revealed the circumference of the tumor to have a ring-like structure, and fine needle aspiration cytology indicated suspicion for malignancy. Breast-conserving surgery was performed. Histopathological studies showed carcinoma cells, having cuboidal to oval-shaped nucleus, were proliferating in cord-like and sheet-like structures in the periphery. In the central areas of the tumor, myxoedematous area was observed with cartilaginous matrix and necrosis. The diagnosis was a matrix-producing carcinoma. Immunohistochemical findings showed the tumor cells had the characteristics of both epithelial cells and mesenchymal cells, while being negative for estrogen receptor, progesterone receptor, Her2, myoepithelial cell markers and basal cell markers.

CONCLUSION

The findings for our present patient and many of the other MPC patients reported in the published literature indicate that this breast cancer has the properties of both epithelial cells and mesenchymal cells. In addition, there is a possibility that matrix-producing tumor cells of our present patient may have a feature of undifferentiated cells.

Cytomorphology of Rare Malignant Tumors of the Breast

This article reviews cytomorphology of rare malignant tumors of the breast: squamous carcinoma, metaplastic carcinoma, adenoid cystic carcinoma, apocrine carcinoma, secretory carcinoma, lipid-rich carcinoma, and carcinoma with choriocarcinomatous features. It is important to bear in mind the cytomorphology and diagnosis of rare malignant tumors of the breast in analysis of breast fine needle aspiration smears. Although rare, these malignant tumors can be diagnosed by the cytomorphological characteristics, and should be included in the differential diagnoses of breast neoplasms.

Esophageal anthracosis: lesion mimicking malignant melanoma

A case of anthracosis of the esophagus is reported. The patient was a previously healthy 69-year-old Japanese woman. A black and slightly elevated lesion was detected in her esophagus by upper gastroesophageal fiberoscopic examination. Endoscopically, the lesion looked like malignant melanoma. Thoracic esophagotomy was then performed. Histological examination revealed a pigmented lesion beneath the mucosal epithelial layer. The lesion consisted of an aggregation of histiocytes containing an abundance of tiny black pigments. A few mature lymphocytes and plasma cells were also evident in the periphery of the lesion. Histologically, these findings looked like lymph nodes in the pulmonary hilus; however, no lymph nodal structure was evident in the esophageal wall. Traction diverticula were also noted in the pigmented lesion. The patient has remained well without disease for 9 months since the surgery. Although anthracosis is a rare condition in the esophagus, the present case gave warning to pathologists and clinicians that it does indeed occur. Endoscopists and pathologists should differentiate anthracosis from malignant melanoma because the treatment and outcome are quite different for each.

Breast cancer with choriocarcinomatous features: A case report with cytopathologic details

A case of breast cancer with choriocarcinomatous features (BCCF) is reported. The patient was a 38-year-old Japanese female with a long history of schizophrenia. Her nursing staff noticed a palpable mass in her right breast, which showed rapid growth. Following cytopathologic confirmation of a malignant breast tumor, she underwent mastectomy with ipsilateral axillary lymph node dissection. Histologic examination revealed BCCF, which was positive for placental alkaline phosphatase and human chorionic gonadotropin (HCG) by immunohistochemistry. The serum HCG level was high. She died 7 months postoperatively, with multiple metastases of BCCF to the chest wall, lung and liver.