A composite malignant tumour of the elderly female breast

Malignant adenomyoepithelioma of the breast with mixed osteogenic, spindle cell, and carcinomatous differentiation

A 50-year-old woman had a malignant tumor of the left breast, which recurred twice, metastasized, and caused death after 39 months. Histologically, the original neoplasm and the first recurrence comprised an adenomyoepithelioma, in addition to a sarcoma composed of trabeculae of mature and immature bone, osteoid, and partly calcified, dense collagenous tissue. The trabeculae were lined by alpha-smooth muscle actin-positive mononuclear tumor cells, which also extended into the stroma. Similarly, scattered osteoclastlike, multinucleate giant cells were present in the stroma and in the region of the trabeculae. This same pattern of adenomyoepithelioma and osteosarcoma also was seen in the last recurrence, together with a proliferation of undifferentiated malignant spindle-shaped cells. The last biopsy also contained a separate small focus of invasive ductal carcinoma of usual type. It was concluded that this, apparently unique, tumor probably represented an adenomyoepithelioma in which a metaplastic sarcoma of osteogenic and undifferentiated types developed from the myoepithelial element, and in which a carcinoma developed from the epithelial component.

Concomitant angiosarcoma and carcinoma of the breast: a case report

A case of concomitant angiosarcoma and carcinoma of the left breast in a forty-three year old woman is described. Following a diagnosis of angiosarcoma she was treated by simple mastectomy. Five months later, left axillary lymph node biopsy showed metastatic adenocarcinoma. Retrospective examination of the mastectomy specimen disclosed a concomitant but separate adenocarcinoma. The patient remains well after 3 years. The implications of this rare association are discussed and the long survival gives an opportunity to review the prognosis in breast angiosarcomas.

Carcinoma of the breast with pseudosarcomatous metaplasia

Twenty-six cases of breast carcinoma demonstrating pseudosarcomatous metaplasia are described, and their clinical and pathologic aspects are correlated. The metaplastic elements include mature and immature bone, cartilage, myxoid stroma, loose fibromyxoid and dense spindle-cell stroma, and anaplastic stroma with giant cell features. Light and electron microscopic examination demonstrated an orderly sequence of transformation and dedifferentiation of epithelial cells to become undifferentiated mesenchymal cells. These tumors are more aggressive than purely epithelial carcinomas. The overall survival rate was 44%. Five-year survival figures for TNM Stages I, II, and III lesions were 56%, 26%, and 18%, respectively. The incidence of lymph node metastasis was 25% despite the large size of many of these tumors. Systemic metastases replicated the range of metaplastic elements seen in the primary site. Patients with tumors composed predominantly of pseudosarcomatous elements had worse prognoses than those with predominantly epithelial components (28% versus 62%, 5-year survival).

Breast neoplasms containing bone and cartilage

A total of 307 breast neoplasms and tumour-like conditions were reviewed to assess the frequency with which bone and/or cartilage occurred. Of 90 fibroadenomas, 1 (1.1%) and 2 of 158 breast carcinomas (1.3%) contained bone, one benign mesenchymoma contained cartilage, and one benign "mixed" tumour (pleomorphic adenoma) displayed cartilage and bone. Twenty-two papillomas and 34 cases of gynaecomastia did not contain any cartilage or bone. This study confirms the impression that the occurrence of bone or cartilage in human breast neoplasms is rare. These lesions are briefly discussed with reference to the pertinent literature.

Breast ductal carcinoma with osseous metaplasia

The case of an elderly patient with one of the rarest forms of breast carcinoma is reported. Histomorphologic aspects and theories as to its origin are discussed.

Tubular carcinoma developing within a recurring cystosarcoma phyllodes of the breast

Malignant alteration in cystosarcoma phyllodes is uncommon and almost always confined to the stromal component. A rare case of recurring cystosarcoma is reported. In the first recurrence, lobular carcinoma in situ was present within the tumor and the second recurrence revealed tubular carcinoma within the cystosarcoma. Epithelial proliferation of various sorts is not uncommon in cystosarcomas but only two previous instances of infiltrating carcinoma have been observed within these tumors. The problem of mammary carcinoma coexisting with cystosarcoma is reviewed and comparisons are made with a closely related neoplasm, the fibroadenoma.

Carcinoma of the breast with metaplasia to chondrosarcoma: a light and electron microscopic study

Two carcinomas of the breast containing large areas of sarcomatous tissue were studied by light and electron microscopy. In one of these, the sarcomatous element was frankly cartilaginous and in the other, predominantly myxoid but with small cartilaginous-looking foci. By light microscopy, a highly suggestive metaplastic transition could be traced from cells within the epithelial nests to those within the sarcomatous lobules. Ultrastructurally, cells in the former region showed epithelial characteristics and those in the latter region, mesenchymal and/or cartilaginous features. The carcinomatous cells contained desmosomes and formed intercellular spaces lined by microvilli; a few cells showed prominent profiles of rough endoplasmic reticulum. In the first case, the cells in the immediate vicinity of the epithelial nests and those in the fully developed cartilaginous regions showed a progressive dilatation of their endoplasmic reticulum to form large sac-like structures filled with a finely granular and floccular material. The intercellular matrix was electron lucent and contained scattered dense particles, fibrillo-granular material and collagen fibres. Condensation of this material at some distance from the cell resulted in the formation of lacunae. In the second case, the cells in the myxoid areas also showed prominent dilatation of endoplasmic reticulum.