63 years lady with well circumscribed breast mass. Trucut biopsy

Dr. Kandukuri Mahesh Kumar

Pathology

63 years lady with well circumscribed breast mass. Trucut biopsy done . Images attached, Diagnosis ??

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Dr. Mohit Rajpal

Pathology

Sections examined show a biphasic neoplasm composed of both epithelial and mesenchymal elements. The epithelial component is composed of infiltrating cords and tubules of epithelial cells. The mesenchymal component is composed of osteoid( image2), adipocytic elements and fibroblastic proliferation Impression - Trucut Biopsy Breast - Metaplastic Carcinoma Breast Differential Diagnosis - Phyllodes Tumor with Metaplasia - Infiltrating Ductal Carcinoma Breast exhibiting Metaplasia -Primary Sarcoma breast Since the Tumor is well circumscribed and with this morphology ; findings more in favour of Metaplastic carcinoma breast IHC for Confirmation Correlation with Clinical and Mammography Findings

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Dr. Kandukuri Mahesh Kumar

Pathology

Hello dear Curofians, Yes ,it is a case of Metaplastic Carcinoma breast.. Some Literature of Metaplastic Carcinoma ----Metaplastic carcinoma of the breast is a rare tumor in which the predominant component is not epithelial or glandular. It is also called sarcomatoid carcinoma, carcinosarcoma or spindle cell carcinoma. Distinction from invasive ductal carcinoma NOS is important because patients have shorter disease free survival, and metastases tend to be hematogenous, not nodal. Metaplastic carcinoma has been classified into three categories – (a) carcinoma with an abundant matrix but without a spindle cell component, (b) spindle cell carcinoma with a lesser amount of carcinoma, and (c) a biphasic pattern of malignant glandular and spindle elements (carcinosarcoma). The name “metaplastic” is due to the transformation of epithelial component into a nonglandular component, such as spindle cells, squamous cells or heterologous elements. Morphologically, the sarcomatous component may resemble low grade fibromatosis, or high grade fibrosarcoma, malignant fibrous histiocytoma, chondrosarcoma, osteosarcoma, rhabdomyosarcoma, angiosarcoma or a combination. The epithelial component may be glandular or squamous. Immunohistochemical stains are notable for keratin staining of the spindle cells. A broad spectrum keratin cocktail or high molecular weight cytokeratin (34 beta E12) is recommended, and is usually positive. Other keratin antibodies are less sensitive, as is S100. A recent report concluded that p63, with strong, diffuse nuclear staining, is a good marker to distinguish spindle cell metaplastic carcinomas from other mesenchymal neoplasms, with 87% sensitivity and 99% specificity . The tumor in this case was not tested for p63. Most metaplastic carcinomas are negative for ER and PR (as in this case), and negative for HER2 overexpression. The epithelial and sarcomatoid components are derived from the same clone in most cases analyzed. The differential diagnosis includes phyllodes tumor, nodular fasciitis, myofibroblastic tumor or primary breast sarcoma. A fibromatosis-like variant of metaplastic carcinoma has also been described. Thanks for participating