Iranian Journal of Pathology

Revisiting Metaplastic Carcinoma of Breast: An Emphasis on the Clinico-pathological and Immunohistochemical Variables Analyzed at a Tertiary Cancer Centre in South India

Document Type : Original Research

Authors

Geetha V Patil Okaly1 1
Akshatha C 1
Sandhya N 1
Akina Prakash 1
M N Suma 1
Ashwini Nargund 1
Shankar Anand 1
C Ramachandra 2
Libin Babu Cherian 1

1 Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, India

2 Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India

https://doi.org/10.30699/ijp.2022.541798.2757
Abstract
Background & Objective: Metaplastic carcinoma is a diverse variant of invasive breast carcinomas (IBC) characterized by dedifferentiation of malignant cells towards squamous and/or mesenchymal elements. It accounts for 0.3-1.2% of all IBC. These tumors are typically triple-negative by hormonal profiling with a high proliferation index and a dismal prognosis. Lymph node metastasis is an unusual feature in metaplastic carcinoma.
Methods: The present study analyses 30 cases (26 cases of modified radical mastectomy and 4 cases of lumpectomy) of metaplastic carcinoma over 2018-2020 (3 years). Four oncopathologists reviewed routine histopathologic and immunohistochemical-stained slides. The clinical details were collected from the Medical Records Department of the Cancer Institute.
Results: A total of 20 (66.67%) cases were patients >50 years of age, 21(70%) out of which were diagnosed as invasive carcinoma, grade 3 according to the Nottingham histological score. Five (16.7%) cases presented with lymph node metastasis. While immunohistochemically 28 (93.3%) cases were triple-negativeCK5/6, P63, EGFR, and Ki-67 (more than 40%) positivity was noted in 25 (83.3%) , 26 (86,7%) , 20 (66.7%), and 25 (83.3%) cases, respectively.
Conclusion: Metaplastic carcinoma is characteristically triple-negative breast malignancies (TNBC) exhibiting a high Ki-67 index and a lower rate of lymph node metastasis. CK5/6, p63, and EGFR are pertinent immunohistochemical markers that may aid in diagnosis. However, those markers are non-specific for the disease and morphologic features are always the key to the diagnosis of the process.

Keywords

CK: cytokeratin
EGFR: epidermal growth factor receptor
IBC: Invasive breast carcinoma
IHC: immunohistochemistry
NST: No special type
MC: Metaplastic carcinoma

Subjects

  1. Günhan-Bilgen I, Memiş A, Üstün EE, Zekioglu O, Özdemir N. Metaplastic carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation. AJR Am J. 2002;178(6):1421-5. [DOI:10.2214/ajr.178.6.1781421] [PMID]
  2. Park JM, Han BK, Moon WK, Choe YH, Ahn SH, Gong G. Metaplastic carcinoma of the breast: mammographic and sonographic findings. J Clin Ultrasound. 2000;28(4):179-86. [DOI:10.1002/(SICI)1097-0096(200005)28:43.0.CO;2-Y]
  3. Massuet A, Fernández S, Rimola J, Andreu FJ, Tortajada L, Sentís M. Carcinoma metaplásico de mama: resonancia magnética y correlación radiopatológica. Radiología 2006;48:155-163. [DOI:10.1016/S0033-8338(06)73146-0]
  4. Amillano Párraga K, Elorriaga Barandiaran K, Alberro Aduriz JA, Martín López A, Rezola Solaun R, Plazaola Alcibar A. Carcinoma metaplásico de mama: Revisión a propósito de un caso. Oncología (Barc.) 2004;27(9):42-6. [DOI:10.4321/S0378-48352004000900006]
  5. Kuo SH, Chen CL, Huang CS, Cheng AL. Metaplastic carcinoma of the breast: analysis of eight Asian patients with special emphasis on two unusual cases presenting with inflammatory-type breast cancer. Anticancer Res. 2000;20(3B):2219-22.
  6. Bellino R, Arisio R, D'Addato F, Attini R, Durando A, Danese S, Bertone E, Grio R, Massobrio M. Metaplastic breast carcinoma: pathology and clinical outcome. Anticancer Res. 2003;23(18):669-3.
  7. Moreno J, Urquijo E, González-Lopera S, Díez J, Burgos J, Luján S, Rodríguez-Escudero FJ. Carcinoma metaplásico de mama: estudio clínico-histológico de siete casos. Clín Invest Ginecol Obstet. 2003;30(7):222-31. [DOI:10.1016/S0210-573X(03)77264-5]
  8. Smith DM, Rongaus VA, Wehmann TW, Agarwal PJ, Classen GJ Metaplastic breast carcinoma. J Am Osteopath Assoc 1996;96:419-21. [DOI:10.7556/jaoa.1996.96.7.419]
  9. Patterson SK, Tworek JA, Roubidoux MA, Helvie MA, Oberman HA. Metaplastic carcinoma of the breast: mammographic appearance with pathologic correlation. AJR Am J. 1997;169(3): 709-12. [DOI:10.2214/ajr.169.3.9275883] [PMID]
  10. Rayson D, Adjei AA, Suman VJ, Wold LE, Ingle JN. Metaplastic breast cancer: prognosis and response to systemic therapy. Ann Oncol. 1999;10(4):413-9. [DOI:10.1023/A:1008329910362] [PMID]
  11. Kurian KM, Al‐Nafussi A. Sarcomatoid/ metaplastic carcinoma of the breast: a clinic-pathological study of 12 cases. Histopathology. 2002;40(1):58-64. [PMID] [DOI:10.1046/j.1365-2559.2002.01319.x]
  12. Wargotz ES, Does PH, Norris HJ. Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol. 1989;20(8):732-40. [DOI:10.1016/0046-8177(89)90065-8]
  13. Johnson TL, Kini SR. Metaplastic breast carcinoma: a cytohistologic and clinical study of 10 cases. Cytopathology. 1996;14(3):226-32. [DOI:10.1002/(SICI)1097-0339(199604)14:33.0.CO;2-F]
  14. Khan HN, Wyld L, Dunne B, Lee AH, Pinder SE, Evans AJ, Robertson JF. Spindle cell carcinoma of the breast: a case series of a rare histological subtype. Eur J Surg Oncol. 2003;29(7):600-3. [DOI:10.1016/S0748-7983(03)00107-0]
  15. Fisher ER, Palekar AS, Gregorio RM, Paulson JD. Mucoepidermoid and squamous cell carcinomas of breast with reference to squamous metaplasia and giant cell tumors. Am. J. Surg. Pathol. 1983;7(1):15-27. [DOI:10.1097/00000478-198301000-00002] [PMID]
  16. Kaufman MW, Marti JR, Gallager HS, Hoehn JL. Carcinoma of the breast with pseudosarcomatous metaplasia. Cancer. 1984;53(9):1908-17. [DOI:10.1002/1097-0142(19840501)53:93.0.CO;2-F]
  17. Denley H, Pinder SE, Tan PH, Sim CS, Brown R, Barker T, Gearty J, Elston CW, Ellis IO. Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases. Histopathology. 2000;36(3):203-9.
  18. Catroppo JF, Lara JF. Metastatic metaplastic carcinoma of the breast (MCB): an uncharacteristic pattern of presentation with clinicopathologic correlation. Cytopathology. 2001;25(5):285-91. [DOI:10.1002/dc.2056] [PMID]
  19. Goldhirsch A, Glick JH, Gelber RD, et al.: Meeting Highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. J Clin Oncol. 2001;19)18):3817-27. [DOI:10.1200/JCO.2001.19.18.3817] [PMID]
  20. Gary M Tse, Puay-Hoon Tan, Benjaporn Chaiwun, Thomas C Putti, Philip C W Lui, Alex K H Tsang, Fiona C L Wong, Anthony W I Lo. p63 is useful in the diagnosis of mammary metaplastic carcinomas. Natl Libr Med. 2006:38 (1):16-22 [DOI:10.1080/00313020500444625] [PMID]
  21. Lai HW, Tseng LM, Chang TW, Kuo YL, Hsieh CM, Chen ST, Kuo SJ, Su CC, Chen DR. The prognostic significance of metaplastic carcinoma of the breast (MCB)–a case controlled comparison study with infiltrating ductal carcinoma. The Breast. 2013;22(5):968-73. [DOI:10.1016/j.breast.2013.05.010] [PMID]
  22. Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast clinical presentation, treatment results and prognostic factors. Ann Oncol 2006;45(2):188-95. [DOI:10.1080/02841860500513235] [PMID]
  23. Kiran A, Veena M, Hasan H, Ghazala M. An usual case of metaplastic breast carcinoma (sarcomatoid variant) Indian J Surg. 2003;65:377-78.
  24. Pitts WC, Rojas VA, Gaffey MJ, Rouse RV, Esteban J, Frierson HF, Kempson RL, Weiss LM. Carcinomas with metaplasia and sarcomas of the breast. Am J Clin Pathol. 1991;95(5):623-32. [DOI:10.1093/ajcp/95.5.623] [PMID]
  25. Takuwa H, Ueno T, Ishiguro H, Mikami Y, Kanao S, Takada M, Sugie T, Toi M. A case of metaplastic breast cancer that showed a good response to platinum-based preoperative chemotherapy. Breast Cancer. 2014;21(4):504-7. [DOI:10.1007/s12282-011-0269-2] [PMID]
  26. Hennessy BT, Giordano S, Broglio K, Duan Z, Trent J, Buchholz TA, Babiera G, Hortobagyi GN, Valero V. Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol. 2006;17(4): 605-13. [DOI:10.1093/annonc/mdl006] [PMID]
  27. Tseng WH, Martinez SR. Metaplastic breast cancer: to radiate or not to radiate? Ann Surg Oncol. 2011;18(1):94-103. [DOI:10.1245/s10434-010-1198-6] [PMID] [PMCID]
  28. Gültekin M, Eren G, Babacan TA, Yazici G, Hurmuz P, Yildiz F, Altundag K, Guler N, Ozisik Y, Gurkaynak M. Metaplastic breast carcinoma: A heterogeneous disease. Asian Pac J Cancer Prev. 2014;15(6):2851-56 [DOI:10.7314/APJCP.2014.15.6.2851] [PMID]
  29. Bae SY, Lee SK, Koo MY, Hur SM, Choi MY, Cho DH, Kim S, Choe JH, Lee JE, Kim JH, Kim JS. The prognoses of metaplastic breast cancer patients compared to those of triple-negative breast cancer patients. Breast Cancer Res Treat. 2011;126(2):471-8. [DOI:10.1007/s10549-011-1359-8] [PMID]
  30. Song Y, Liu X, Zhang G, Song H, Ren Y, He X, Wang Y, Zhang J, Zhang Y, Sun S, Liang X. Unique clinicopathological features of metaplastic breast carcinoma compared with invasive ductal carcinoma and poor prognostic indicators. World J Surg Oncol. 2013;11(1):1-9. [DOI:10.1186/1477-7819-11-129] [PMID] [PMCID]
  31. Altaf FJ, Mokhtar GA, Emam E, Bokhary RY, Mahfouz NB, Al Amoudi S, Al-Gaithy ZK. Metaplastic carcinoma of the breast: an immunohistochemical study. Diagnostic Pathol. 2014;9(1):1-0. [DOI:10.1186/1746-1596-9-139] [PMID] [PMCID]
  32. Gary MT, Puay-Hoon T, Chaiwun B, Putti TC, Lui PC, Tsang AK, Wong FC, Lo AW. p63 is useful in the diagnosis of mammary metaplastic carcinomas. Pathology. 2006;38(1):16-20. [DOI:10.1080/00313020500444625] [PMID]
Iranian Journal of Pathology
Volume 17, Issue 3
Summer 2022
Pages 268-274

  • Receive Date 15 November 2021
  • Revise Date 20 February 2022
  • Accept Date 11 July 2022

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