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Wu WP, Lin J, Huang YL, Chen ST, Chou CT, Chen DR. Magnetic resonance imaging characteristics and survival outcomes of metaplastic breast carcinoma. PLoS One 2025; 20:e0323541. [PMID: 40367244 PMCID: PMC12077782 DOI: 10.1371/journal.pone.0323541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 04/09/2025] [Indexed: 05/16/2025] Open
Abstract
OBJECTIVE Metaplastic breast carcinoma is a rare type of breast carcinoma, and there are limited data about the magnetic resonance imaging (MRI) findings of metaplastic carcinoma. This study evaluates the MRI characteristics and prognostic outcomes across metaplastic carcinoma subtypes. MATERIALS AND METHODS In this retrospective cohort study, a total of 29 patients with histologically confirmed metaplastic carcinoma from 2011 to 2019 were enrolled. Clinical, pathological, and follow-up data, focusing on disease-free (DFS) and overall survival (OS), are recorded. Breast MRI findings were analyzed and categorized based on BI-RADS 5th edition. RESULT Among the participants, 19 had squamous carcinoma, 8 had metaplastic carcinoma with mesenchymal differentiation, and 2 had unclassified subtypes. The most common findings were a solitary mass (75.8%), high T2 signal (51.7%), and heterogenous enhancement (65.5%) with a washout kinetic curve (86.2%). The apparent diffusion coefficient (ADC) values in the metaplastic carcinoma with mesenchymal differentiation group were significantly higher (mean 1.83 +/- 0.50 x 10-3 mm2/s) in comparison with the squamous carcinoma group (mean 1.12 +/- 0.21 x 10-3 mm2/s). The cut-off point of the ADC value was 1.53x10-3 mm2/s, with a sensitivity of 71.4% and a specificity of 100% (AUC = 0.937). The five-year DFS and OS rates were 63% and 79% across the board, 78% and 89.5% in the squamous group, and 50% and 53% in the mesenchymal differentiation group, respectively. CONCLUSION Metaplastic breast carcinoma is a diverse and aggressive malignancy with variable prognosis. Our findings indicate that mesenchymal differentiation is characterized by higher ADC values and correlates with a worse prognosis.
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Affiliation(s)
- Wen-Pei Wu
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Joseph Lin
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan
| | - Yu-Len Huang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Te Chou
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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Matusz-Fisher A, Chen A, Donahue EE, Schepel CR, Wallander ML, Livasy CA, White RL, Tan AR, Hadzikadic-Gusic L. Clinical outcomes by histologic pattern of early-stage metaplastic breast cancer: A single-institution retrospective study. Clin Breast Cancer 2025:S1526-8209(25)00113-2. [PMID: 40425384 DOI: 10.1016/j.clbc.2025.04.022] [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: 02/17/2025] [Revised: 04/08/2025] [Accepted: 04/29/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE Metaplastic breast cancer (MpBC) is a rare, aggressive type of breast cancer composed of several histologic patterns. This study evaluated outcomes among the MpBC histologic patterns, which include spindle cell/sarcomatous, squamous, heterologous mesenchymal, and mixed. PATIENTS AND METHODS A retrospective chart review identified patients with early-stage MpBC diagnosed between January 1, 2010, and September 1, 2021. A matched control patient cohort with nonmetaplastic triple-negative breast cancer (TNBC) was selected. Associations between MpBC histologic patterns and disease characteristics were evaluated using chi-squared and Wilcoxon tests. Kaplan-Meier estimates and log rank tests assessed differences in recurrence-free survival (RFS) and overall survival (OS). RESULTS In the MpBC cohort (n = 106), histologic patterns included spindle cell/sarcomatous (34%), squamous (16%), heterologous mesenchymal (31%), mixed (18%), and other (1%). In patients with MpBC who received neoadjuvant chemotherapy (n = 32), residual cancer burden (RCB) was not found to be significantly different between the spindle cell/sarcomatous pattern versus other patterns (P = .81). In the entire MpBC cohort, patients with the spindle cell/sarcomatous pattern had inferior RFS (P = .02) and OS (P = .004) compared to patients with other patterns. There was no significant difference in RFS (P = .90) or OS (P = .90) between the MpBC and TNBC cohort. CONCLUSION RCB did not differ among the MpBC histologic patterns, but outcomes were inferior in patients with the spindle cell/sarcomatous pattern. Outcomes were also inferior in patients with MpBC receiving neoadjuvant versus adjuvant chemotherapy. Our study did not find a difference in outcomes between patients with MpBC versus nonmetaplastic TNBC. More investigation with larger sample sizes and biomarkers is warranted.
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Affiliation(s)
- Ashley Matusz-Fisher
- Department of Solid Tumor Oncology and Investigational Therapeutics, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Wake Forest University School of Medicine, Charlotte, NC
| | - Annabel Chen
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Clinical Trials Office, Atrium Health Levine Cancer, Charlotte, NC
| | - Erin E Donahue
- Department of Biostatistics and Data Sciences, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Charlotte, NC
| | - Courtney R Schepel
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Clinical Trials Office, Atrium Health Levine Cancer, Charlotte, NC
| | - Michelle L Wallander
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Clinical Trials Office, Atrium Health Levine Cancer, Charlotte, NC
| | - Chad A Livasy
- Department of Pathology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Charlotte, NC
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Wake Forest University School of Medicine, Charlotte, NC
| | - Antoinette R Tan
- Department of Solid Tumor Oncology and Investigational Therapeutics, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Wake Forest University School of Medicine, Charlotte, NC
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Department of Surgery, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Atrium Health Levine Cancer, Wake Forest University School of Medicine, Charlotte, NC.
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Rogges E, Petrino MM, Firmani G, Sorotos M, Santanelli di Pompeo F, Di Napoli A. Metaplastic carcinoma of the breast mimicking breast implant-associated squamous cell carcinoma: a challenging differential diagnosis. Case Reports Plast Surg Hand Surg 2025; 12:2486239. [PMID: 40230815 PMCID: PMC11995762 DOI: 10.1080/23320885.2025.2486239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 03/23/2025] [Indexed: 04/16/2025]
Abstract
Metaplastic carcinoma of the breast (MBC) is an uncommon disease that accounts for 0.2-1% of all invasive breast carcinomas, comprising a heterogeneous group of diseases characterized by differentiation of the neoplastic epithelium to squamous cells and/or mesenchymal-looking elements. Breast implant-associated squamous cell carcinoma (BIA-SCC) is a rare complication of breast implantation, with 22 cases reported in the literature. Due to the histological overlap between MBC and BIA-SCC, the differential diagnosis may be challenging, especially in patients with an advanced cancer-bearing breast implant, in which assessing the tumor's primary site may be difficult. The limited amount of scientific data on BIA-SCC implies the absence of a standardized diagnostic method and of a specific staging system to guide patients' clinical management. Of the 22 BIA-SCC cases reported in the literature, 14 (64%) had squamous metaplasia of the inner surface of the capsule, whereas in 10 (45%), there was a histologically proven spread to the extracapsular tissues without a detailed description of the capsule infiltration. Herein, we describe the case of a peri-implant tumor mass with squamous histology in a patient treated with mastectomy and implant-based breast reconstruction for a microinvasive breast carcinoma, in which the absence of squamous metaplasia of the capsule and of its neoplastic infiltration favored a diagnosis of MBC likely originating from the peri-implant tissue. This case suggests that in patients with peri-implant cancers with squamous differentiation, the extension of the tumor throughout the capsule thickness and the presence of squamous metaplasia of the capsule are critical factors that should be considered in the differential diagnosis between BIA-SCC and MBC. In addition, even in cases with capsule-confined tumors, the depth of the capsular involvement can be used to stage the disease, similar to what is currently recommended for BIA-ALCL.
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Affiliation(s)
- E. Rogges
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Italy
- PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - M. M. Petrino
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Italy
| | - G. Firmani
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health, and Sense Organs (NESMOS), Sant’ Andrea Hospital, Rome, Italy
| | - M. Sorotos
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health, and Sense Organs (NESMOS), Sant’ Andrea Hospital, Rome, Italy
| | - F. Santanelli di Pompeo
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Neuroscience, Mental Health, and Sense Organs (NESMOS), Sant’ Andrea Hospital, Rome, Italy
| | - A. Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Italy
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Ni P, Wang Y, Bai X, Yang Z, Wu T, Gao C, Cheng Y, Niu L, Yan Y, Zhou Y, Shi B, Ge G, Cheng YL, Ge Z, Jiang Y, Zhang R, Liu F, Wang B, Ren Y, Zhou C. TNMpBC-NeoBCSS model: a breast cancer specific survival prediction model for triple-negative metaplastic breast carcinoma patients with neoadjuvant therapy. Sci Rep 2025; 15:8351. [PMID: 40069218 PMCID: PMC11897303 DOI: 10.1038/s41598-025-91888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 02/24/2025] [Indexed: 03/15/2025] Open
Abstract
The breast cancer specific survival (BCSS) benefits of Neoadjuvant therapy (NeoAT) for triple-negative metaplastic breast cancer (TNMpBC) was uncertain. This study aimed to develop a prediction model for assessing the BCSS for TNMpBC patients with NeoAT. The primary cohort of 1163 patients with TNMpBC, from which a nomogram was established based on the results of a LASSO regression analysis, was derived from multi-centers data in China and the SEER database. This model was further validated by an independent cohort of 155 TNMpBC patients with NeoAT, with discrimination and calibration assessed. Totally 155 (13.3%) TNMpBC patients received NeoAT, with 45 (29.0%) cases demonstrating pathologic complete response (pCR), were enrolled. Subjects acquired pCR had superior BCSS. Four variables significantly associated with BCSS were incorporated in the establishment of model: age at diagnosis, T stage, N stage, and response to NeoAT. This model was well validated, with a C-index of 0.82, and area under the curves of 0.838, 0.866 in training cohort, respectively, for 3- years and 5-years BCSS. Based on the cutoff scores from the TNMpBC-NeoBCSS model and calculated by X-tile analysis, patients in high risk group had a inferior BCSS (HR = 6.77, P < 0.0001) when compared with those in low-risk group. TNMpBC-NeoBCSS model provides a favorable tool for assessing the BCSS for the TNMpBC patients with NeoAT and may help doctors and TNMpBC patients optimally make decision on the necessity of neoadjuvant therapy on the basis of individual BCSS.
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Affiliation(s)
- Peng Ni
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yu Wang
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Xiaorong Bai
- Department of Breast Surgery, Gansu Cancer Hospital, Lanzhou, Gansu Province, China
- Department of Mammary Gland, Gansu Cancer Hospital, No.2 Xiaoxihu East Street, Xihu Street, Qilihe District, 730050, Lanzhou Province, China
| | - Zejian Yang
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Tao Wu
- The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang, Xinjiang Key Laboratory of Oncology, the Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Chen Gao
- Department of Breast Surgery, Gansu Cancer Hospital, Lanzhou, Gansu Province, China
| | - Yuan Cheng
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Ligang Niu
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Yu Yan
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Yuhui Zhou
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Bohui Shi
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Guanqun Ge
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Yi Long Cheng
- School of Chemistry, Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Zhishen Ge
- School of Chemistry, Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Yina Jiang
- Department of Pathogenic Biology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science, Xi'an, China
| | - Ran Zhang
- The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang, Xinjiang Key Laboratory of Oncology, the Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Fan Liu
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China
| | - Bo Wang
- Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi, China.
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an, China.
| | - Yu Ren
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China.
| | - Can Zhou
- Department of Breast Surgery, First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, Xi'an, 710061, Shaanxi Province, China.
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Sağdıç MF, Özaslan C. Rare Histological Types of Breast Cancer: A Single-Center Experience. Breast J 2025; 2025:1179914. [PMID: 40224949 PMCID: PMC11991780 DOI: 10.1155/tbj/1179914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 02/21/2025] [Indexed: 04/15/2025]
Abstract
Background: Breast carcinoma is divided into at least 21 separate histologies, according to the 2019 World Health Organization (WHO) classification. The present study is dedicated to a 5% or rarer group of all breast cancer cases. Method: In this study, we retrospectively considered the data of 4550 patients operated on for breast carcinoma at the Ankara Oncology Training and Research Hospital of the University of Health Sciences between January 2018 and February 2024. Of those cases, 401 were discovered to have rare breast cancer types. We also explored the cases by clinicopathological features, overall survival (OS), and disease-free survival (DFS). Results: Our findings revealed a total of 10 rare breast cancer types in patients explored: mucinous carcinoma, micropapillary carcinoma, papillary group carcinomas, metaplastic carcinoma, neuroendocrine carcinoma, tubular carcinoma, cribriform carcinoma, apocrine carcinoma, acinic cell carcinoma, and secretory carcinoma. While mucinous, tubular, cribriform, papillary group carcinomas, micropapillary, and secretory carcinomas are described as types associated with good prognosis, metaplastic, neuroendocrine, apocrine, and carcinomas are described as types associated with relatively poor prognosis. Conclusion: Scrutinizing the clinicopathological features of rare breast cancer types altogether may be the distinct contribution of this paper to the relevant literature and future research.
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Affiliation(s)
| | - Cihangir Özaslan
- Department of Surgical Oncology, University of Health Sciences Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Xing X, Li J, Fan Y, Wang Y, Wang Y, Liao D, Zhang S. A case of high-grade adenosquamous carcinoma of the breast: case report and literature review. Front Oncol 2025; 15:1548036. [PMID: 40104510 PMCID: PMC11915217 DOI: 10.3389/fonc.2025.1548036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 02/13/2025] [Indexed: 03/20/2025] Open
Abstract
High-grade adenosquamous carcinoma (HGASC) is a rare and aggressive subtype of metaplastic breast cancer (MpBC). This article reports a case of HGASC (pT2N0M0 Stage IIA) in a 43-year-old female and reviews the relevant literature, with a specific focus on distinguishing HGASC from other MpBC subtypes, particularly low-grade adenosquamous carcinoma (LGASC). The patient underwent a skin-sparing mastectomy with abdominal rectus myocutaneous flap reconstruction. Histopathology confirmed HGASC with metaplastic features. Postoperative adjuvant chemotherapy with capecitabine was administered. The case highlights the unique clinical, imaging, and pathological characteristics of HGASC, its therapeutic challenges, and the need for individualized treatment strategies. A five-month follow-up showed no signs of recurrence or metastasis.
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Affiliation(s)
- Xiaoxiao Xing
- Department of Surgery, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Junyi Li
- Department of Surgery, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yangyang Fan
- Department of Radiology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun Wang
- Department of Pathology, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Wang
- Department of Surgery, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Daixiang Liao
- Department of Surgery, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyun Zhang
- Department of Surgery, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Zhang Y, An W, Wang C, Liu X, Zhang Q, Zhang Y, Cheng S. Novel models based on machine learning to predict the prognosis of metaplastic breast cancer. Breast 2025; 79:103858. [PMID: 39675092 PMCID: PMC11699302 DOI: 10.1016/j.breast.2024.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND Metaplastic breast cancer (MBC) is a rare and highly aggressive histological subtype of breast cancer. There remains a significant lack of precise predictive models available for use in clinical practice. METHODS This study utilized patient data from the SEER database (2010-2018) for data analysis. We utilized prognostic factors to develop a novel machine learning model (CatBoost) for predicting patient survival rates. Simultaneously, our hospital's cohort of MBC patients was utilized to validate our model. We compared the benefits of radiotherapy among the three groups of patients. RESULTS The CatBoost model we developed exhibits high accuracy and correctness, making it the best-performing model for predicting survival outcomes in patients with MBC (1-year AUC = 0.833, 3-year AUC = 0.806; 5-year AUC = 0.810). Furthermore, the CatBoost model maintains strong performance in an external independent dataset, with AUC values of 0.937 for 1-year survival, 0.907 for 3-year survival, and 0.890 for 5-year survival, respectively. Radiotherapy is more suitable for patients undergoing breast-conserving surgery with M0 stage [group1: (OS:HR = 0.499, 95%CI 0.320-0.777 p < 0.001; BCSS: HR = 0.519, 95%CI 0.290-0.929 p = 0.008)] and those with T3-4/N2-3M0 stage undergoing mastectomy [group2: (OS:HR = 0.595, 95%CI 0.437-0.810 p < 0.001; BCSS: HR = 0.607, 95%CI 0.427-0.862 p = 0.003)], compared to patients with stage T1-2/N0-1M0 undergoing mastectomy [group3: (OS:HR = 1.090, 95%CI 0.673-1.750 p = 0.730; BCSS: HR = 1.909, 95%CI 1.036-3.515 p = 0.038)]. CONCLUSION We developed three machine learning prognostic models to predict survival rates in patients with MBC. Radiotherapy is considered more appropriate for patients who have undergone breast-conserving surgery with M0 stage as well as those in stage T3-4/N2-3M0 undergoing mastectomy.
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Affiliation(s)
- Yinghui Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wenxin An
- Department of Urology Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cong Wang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiaolei Liu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qihong Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yue Zhang
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China.
| | - Shaoqiang Cheng
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
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Liu H, Zhao G, Fan Z, Wu D, Qu F. Metaplastic carcinoma of the breast containing three histological components: a case report. Front Oncol 2024; 14:1470986. [PMID: 39749029 PMCID: PMC11693695 DOI: 10.3389/fonc.2024.1470986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 11/11/2024] [Indexed: 01/04/2025] Open
Abstract
Malignant breast tumors mainly arise from the ductal and lobular epithelium, whereas sarcomas, which originate from the stromal tissues of the breast, account for less than 5% of cases. Mostly, these tumors consist of a single tissue type, rendering malignant breast tumors with three distinct tissue types exceedingly rare. We report a unique case of a malignant breast tumor comprising three tissue types: squamous cell carcinoma (approximately 25%), invasive ductal carcinoma (approximately 5%), and fibrosarcoma (approximately 70%). Given the case's rarity, pre-operative imaging and tumor biopsy failed to yield definitive diagnostic information, we detail the patient's clinical and therapeutic process, providing insights for physicians on clinical diagnosis and treatment.
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Affiliation(s)
- Huan Liu
- Breast Surgery Department, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Breast Surgery Department, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Zhimin Fan
- Breast Surgery Department, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Di Wu
- Breast Surgery Department, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Fengjiang Qu
- Emergency Surgery Department, The First Hospital of Jilin University, Changchun, China
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Yit LFN, Quek ZHS, Tan TJ, Tan BF, Tan PH, Tan KTB, Sim Y, Wong FY. Curative Approaches for Metaplastic Breast Cancer: A Retrospective Cohort Outcome Review. Int J Radiat Oncol Biol Phys 2024; 120:1273-1283. [PMID: 38950711 DOI: 10.1016/j.ijrobp.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Metaplastic breast cancer (MBC) is a rare and heterogeneous breast cancer subtype, and there are critical gaps in our understanding of its long-term outcomes. This retrospective cohort study aimed to address these gaps by scrutinizing the pathologic and clinical aspects of MBC to enhance clinical decision-making and refine patient care strategies. METHODS AND MATERIALS This registry-based retrospective cohort study included women aged ≥21 years diagnosed with MBC or matrix-producing carcinoma. The data were obtained from January 2001 to August 2020 from the Joint Breast Cancer Registry of Singapore Health Services, which included 23,935 patients. Demographic and clinicopathologic characteristics, neoadjuvant chemotherapy responses, and survival outcomes were analyzed. Statistical assessments involved univariate and multivariate Cox proportional hazards models and Kaplan-Meier survival analyses. RESULTS This study enrolled 170 patients; 87.1% had non-metastatic disease, and 12.9% had metastatic disease. The age of patients at diagnosis ranged from 46 to 65 years (median, 56 years). The cohort's predominant characteristics were triple negative breast cancer (64%), advanced clinical stage (77.6%), node negativity (67.6%), and grade 3 disease (74.1%). In patients receiving neoadjuvant chemotherapy with curative intent treatment (17.6%), neoadjuvant chemotherapy yielded a pathologic complete response of 19.2% and a disease progression rate of 46.2%. Multivariate analysis showed that adjuvant radiation therapy significantly improved overall survival and disease-free survival, with hazard ratios of 0.29 (95% CI, 0.13-0.62; P < .005) and 0.23 (95% CI, 0.10-0.50; P < .005), respectively. Clinical T3 and T4 stages and nodal involvement were associated with poor outcomes. Stable disease after neoadjuvant chemotherapy was associated with poor overall survival and disease-free survival. CONCLUSIONS This study sheds light on the complex landscape of MBC and emphasizes the pivotal role of adjuvant radiation therapy in enhancing patient outcomes. Despite advancements, challenges persist that warrant continued research to refine neoadjuvant chemotherapy strategies and delve into the nuanced factors that influence treatment responses.
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Affiliation(s)
| | | | - Tira J Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Boon Fei Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | | | - Yirong Sim
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
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Miao Z, Ba F, Wen Z, Chen K, Shen X, Gen F, Yang Y. Survival trends of patients with metaplastic breast carcinoma with different hormone receptor statuses: a SEER-based retrospective cohort study. BMC Womens Health 2024; 24:628. [PMID: 39593066 PMCID: PMC11590209 DOI: 10.1186/s12905-024-03470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Metaplastic breast carcinoma (MpBC) is a rare histological subtype of breast cancer, and its prognosis is relatively poor. The survival trend of MpBC with different hormone receptor statuses has remained unclear over the past two decades. METHODS MpBC patient data were collected from the Surveillance, Epidemiology, and End Results database from 2000 to 2019. Patients were divided into two groups according to their hormone receptor status (negative and positive). The survival probabilities were calculated via Kaplan‒Meier curves. Logistic regression analysis was used to obtain odds ratios for treatment and demographic characteristics. Multivariate Cox regression was used to identify prognostic factors. RESULTS A total of 3,076 patients were enrolled, and a significant improvement in survival was observed over the last 10 years. For HR-negative MpBC patients, both overall survival and breast cancer-specific survival improved, whereas no survival improvement was observed for HR-positive patients. Compared with those in the time period from 2000 to 2009, the proportion of negative nodes and the likelihood of receiving chemotherapy increased for HR-negative patients from 2010 to 2019. In the HR-negative subgroup, the survival of Whites improved significantly, whereas the survival of Blacks improved in the HR-positive subgroup. CONCLUSIONS The survival of HR-negative MpBC patients has improved significantly in the past 20 years, which may be related to early diagnosis, increased adjuvant therapy and medical development, but no trend towards improvement has been observed in HR-positive patients. Racial disparities in different HR statuses also need to be addressed.
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Affiliation(s)
- Zhiming Miao
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Futing Ba
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Zechao Wen
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Kai Chen
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Xiang Shen
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Feng Gen
- Department of Breast and Thyroid Surgery, Zhangjiagang Hospital Affiliated to Soochow University, Jiangsu, China
| | - Yinlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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11
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Püsküllüoğlu M, Konieczna A, Świderska K, Streb J, Pieniążek M, Grela-Wojewoda A, Pacholczak-Madej R, Mucha-Małecka A, Mituś JW, Szpor J, Kunkiel M, Rudzińska A, Jarząb M, Ziobro M. Treatment outcomes and prognostic factors in nonmetastatic metaplastic breast cancer patients: a multicenter retrospective cohort study. Acta Oncol 2024; 63:620-635. [PMID: 39099323 PMCID: PMC11332538 DOI: 10.2340/1651-226x.2024.40413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/28/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND PURPOSE Metaplastic breast carcinoma (BC-Mp) is an uncommon subtype that poses unique challenges. The limited information on patient prognosis and therapeutic strategies motivated our research initiative. We aimed to assess disease-free survival (DFS), overall survival (OS), and influential factors in patients with nonmetastatic BC-Mp. MATERIALS AND METHODS In this multicenter retrospective cohort study, clinicopathological data for nonmetastatic BC-Mp patients treated at four oncology units in Poland (2012-2022) were gathered. RESULTS Among 115 women (median age 61, range: 28-91), the median tumor size was 40 mm (range 20-130); 30% of patients exhibited positive local lymph nodes. The majority of patients presented with stage II (46%) and triple-negative breast cancer (TNBC) (84%). Radiotherapy was administered to 61% of patients. Surgical procedures included breast-conserving surgery in 31% of patients and mastectomy in 68%. Eighty-three per cent of patients received chemotherapy. The median estimated DFS and OS were 59 and 68 months, respectively. Multivariable analysis revealed that tumor size influenced DFS and OS (Hazard ratios [HR] = 1.02, 95%CI 0.01-0.03 for both endpoints) and taxanes application improved DFS (HR = 0.47, 95%CI 0.24-0.93), but other factors did not. For patients receiving neoadjuvant systemic therapy (N = 51), taxanes improved DFS and OS according to univariable analysis. INTERPRETATION Our findings highlight poor DFS and OS regardless of receiving optimal treatment, emphasizing the need for tailored therapeutic strategies for BC-Mp patients. Taxanes appear promising in a neoadjuvant setting, particularly within the current standard of care for the TNBC subtype.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland.
| | - Aleksandra Konieczna
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Katarzyna Świderska
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland; Department of Oncology, University Hospital, 30-688 Krakow, Poland
| | - Małgorzata Pieniążek
- Department of Oncology, Wrocław Medical University, 50-367 Wrocław, Poland; Lower Silesian Comprehensive Cancer Center, 53-413 Wrocław, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland; Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland; Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Jerzy W Mituś
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland; Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Joanna Szpor
- Department of Pathomorphology, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Michał Kunkiel
- Department of Oncology. Grochowski Hospital, 04-073 Warsaw, Poland
| | - Agnieszka Rudzińska
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Jarząb
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
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12
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Yao MX, Li L, Ye WT, Liu Y, Wang Y, Zhu W, Liang CH. Multimodal Imaging Features and Prognosis of Metaplastic Breast Carcinoma. Acad Radiol 2024; 31:2205-2213. [PMID: 38030514 DOI: 10.1016/j.acra.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
RATIONALE AND OBJECTIVES Metaplastic breast carcinoma (MBC) is an infrequent malignancy with an unfavorable prognosis, and there is a paucity of research on the multimodal imaging features of MBC. This study aimed to provide a comprehensive analysis of the multimodal imaging features, clinicopathological characteristics, and prognosis of MBC. MATERIALS AND METHODS A total of 36 patients with histologically confirmed MBC from 2012 to 2021 were included in the study. We analyzed the pre-treatment multimodal imaging features, including mammography, ultrasonography (US), and magnetic resonance imaging (MRI), as well as clinicopathology and prognosis of MBC. Follow-up data included local recurrence, distant metastasis, and overall survival (OS) rate. RESULTS MBC patients had a median age of 51 years at diagnosis. The most common histologic subtype was squamous cell carcinoma, with 86.1% of MBC being histological grade 3 and triple negative. The most common mammographic findings were irregular shape, non-calcification, and high density. The predominant US findings included irregular shape, parallel orientation, posterior acoustic enhancement, and hypoecho. On MRI, most masses exhibited irregular shape, spiculate margin, heterogeneous enhancement, Type II time intensity curve, and diffusion restriction on diffusion weighted images determined by apparent diffusion coefficient. According to breast imaging reporting and data system, mammography suggested malignancy in 50% of cases, US indicated a moderate to high suspicion of malignancy in 77.8% of cases, MRI revealed malignancy in all cases. At a median follow-up time of 48 months (range, 8-122 months) for 35 MBC patients, the local recurrence, distant metastasis, and OS rates were 11.4%, 28.6%, and 67.4%, respectively. CONCLUSION The benign features of MBC on mammography and US may cause misinterpretation. However, the inclusion of malignant features observed on MRI can improve diagnostic accuracy.
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Affiliation(s)
- Meng-Xia Yao
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Lian Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Baiyun District, Guangzhou, 510515, China (L.L.)
| | - Wei-Tao Ye
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China (W.T.Y., C.H.L.)
| | - Yu Liu
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Yin Wang
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Wu Zhu
- Department of Ultrasound, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Yuexiu District, Guangzhou, 510080, China (M.X.Y., Y.L., Y.W., W.Z.)
| | - Chang-Hong Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China (W.T.Y., C.H.L.).
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13
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Turhan N, Memişoğlu E, Kökten ŞÇ, Güzel NT, Zarbaliyev E. Better Local Disease Control With Mastectomy in Metaplastic Breast Carcinoma: Findings of a Retrospective Cohort. Cureus 2024; 16:e61517. [PMID: 38957239 PMCID: PMC11217912 DOI: 10.7759/cureus.61517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Metaplastic breast cancer (MBC) is a rare type of breast carcinoma with clinicopathological differences. The prognosis and treatment strategies for MBC are usually conflicting. In this study, we aim to present the clinicopathologic features, treatment strategies, and prognosis of our MBC patients. MATERIAL AND METHODS In our retrospective study, 18 metaplastic breast cancer patients treated in our institution between January 2005 and December 2022 were evaluated. Demographic and clinicopathological characteristics, surgical and systemic treatment options, locoregional recurrences, distant metastases, and overall survival (OS) of the MBC patients were retrieved from the patient files. RESULTS All patients were female; the median age was 54.42 ± 12.37 years. Most of the patients (n = 15, 83.33%) presented with palpable masses. Tumors were mostly triple-negative, with a high grade and a high Ki‑67 proliferation index. Spindle cell carcinoma and MBC with mesenchymal differentiation were the most common subtypes. Most of the patients underwent mastectomy (n = 11, 61.11%); breast-conserving surgery (BCS) was performed on seven (38,88%) patients. Lymph node positivity was detected in six of 18 patients (33.33%). Fewer patients (n = 4, 22.22%) received neoadjuvant chemotherapy. While local recurrence developed in two out of seven patients (28.57%) who underwent BCS, there was no local recurrence in patients who had mastectomy. The OS time varied according to tumor size and the presence of lymph node metastases (p <0.001; p = 0.005). CONCLUSION Metaplastic breast cancer is genetically heterogeneous and resistant to conventional treatment strategies. Mastectomy is still the surgical treatment method that is performed more frequently and provides better local control for patients with metaplastic breast cancer.
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Affiliation(s)
- Nihan Turhan
- General Surgery, Martyr Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Istanbul, TUR
| | - Ecem Memişoğlu
- General Surgery, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, TUR
| | | | - Nalan Turan Güzel
- Pathology, Martyr Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Istanbul, TUR
| | - Elbrus Zarbaliyev
- General Surgery, Istanbul Yeni Yuzyıl University, Gaziosmanpasa Hospital, Istanbul, TUR
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14
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Püsküllüoğlu M, Swiderska K, Konieczna A, Streb J, Grela-Wojewoda A, Rudzinska A, Dobrzańska J, Pacholczak-Madej R, Mucha-Malecka A, Kunkiel M, Mitus JW, Jarząb M, Ziobro M. Clinical analysis of metaplastic breast carcinoma with distant metastases: A multi‑centre experience. Oncol Lett 2024; 27:198. [PMID: 38516685 PMCID: PMC10955678 DOI: 10.3892/ol.2024.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/23/2024] Open
Abstract
Metaplastic breast cancer (BC-Mp), which includes a range of epithelial and mixed epithelial-mesenchymal tumours, are rare malignancies with an unfavourable prognosis. The limited literature on BC-Mp focuses mainly on retrospective data for radically treated patients. Notably absent are studies dedicated to the palliative treatment of BC-Mp with distant metastases. The present retrospective study investigated treatment modalities and prognosis in a multi-centre cohort of 31 female participants diagnosed with distant metastatic BC-Mp, including 7 patients with de novo metastatic disease. The median age of the patients was 61 years (range, 33-87 years), with 38.7% presenting local lymph node involvement. Lungs were the most common site for the metastatic disease (61.3%). Median Ki-67 index was 50% (range, 35-70%), and 80.7% of cases were classified as grade 3. Human epidermal growth factor receptor 2 (HER2)+ and estrogen receptor+ were detected in 12.9 and 6.5% of cases, respectively. A total of 62.4% of patients received first-line palliative systemic treatment. The 1- and 2-year overall survival (OS) were 38.5 and 19.2%, respectively. Receiving ≥1 line of palliative treatment was significantly associated with improved OS (P<0.001). Factors such as age, Ki-67 index, HER2 or hormonal status, presence of specific epithelial or mesenchymal components, location of metastases or chemotherapy regimen type did not influence OS. The present study provided insights into the clinicopathological profile, systemic treatment experience, prognostic factors and OS data of BC-Mp with distant metastases, emphasizing the imperative for clinical trials in this population.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Katarzyna Swiderska
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Konieczna
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Oncology, University Hospital, 30-688 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Agnieszka Rudzinska
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | | | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
- Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Anna Mucha-Malecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Jerzy W. Mitus
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
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15
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Suzuki T, Nakanishi Y, Tanino T, Nishimaki-Watanabe H, Kobayashi H, Ohni S, Tang X, Hakamada K, Masuda S. Immunohistochemical and molecular profiles of heterogeneous components of metaplastic breast cancer: a squamous cell carcinomatous component was distinct from a spindle cell carcinomatous component. Discov Oncol 2024; 15:95. [PMID: 38564036 PMCID: PMC10987432 DOI: 10.1007/s12672-024-00950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Metaplastic breast carcinoma (MBC), a category of breast cancer, includes different histological types, which are occasionally mixed and heterogeneous. Considering the heterogeneity of cancer cells in a tumour mass has become highly significant, not only from a biological aspect but also for clinical management of recurrence. This study aimed to analyse the immunohistochemical and molecular profiles of each MBC component of a tumour mass. Twenty-five MBC tumours were histologically evaluated, and the most frequent MBC component (c) was squamous cell carcinoma (SCC), followed by spindle cell carcinoma (SpCC). A total of 69 components of MBC and non-MBC in formalin-fixed paraffin-embedded sections were examined for 7 markers by immunohistochemistry. SCC(c) were significantly PTEN negative and CK14 positive, and SpCC(c) were significantly E-cadherin negative and vimentin positive. Multivariate analyses revealed that immunohistochemical profiles of normal/intraductal (IC)(c), no special type (NST)(c), and MBC(c) differed; moreover, SCC(c) and SpCC(c) were distinctly grouped. PTEN gene mutation was detected only in SCC(c) (2/7), but not in SpCC(c). Next-generation sequence analyses for 2 cases with tumours containing SCC(c) demonstrated that PTEN gene mutation increased progressively from IC(c) to NST(c) to SCC(c). In conclusion, the immunohistochemical and molecular profiles of the SCC(c) of MBC are distinct from those of the SpCC(c).
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Affiliation(s)
- Takahiro Suzuki
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, Japan
| | - Yoko Nakanishi
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Tomoyuki Tanino
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Haruna Nishimaki-Watanabe
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Hiroko Kobayashi
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Sumie Ohni
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Xiaoyan Tang
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, Japan
| | - Shinobu Masuda
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan.
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16
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Zhang M, Yuan J, Wang M, Zhang M, Chen H. Chemotherapy is of prognostic significance to metaplastic breast cancer. Sci Rep 2024; 14:1210. [PMID: 38216630 PMCID: PMC10786888 DOI: 10.1038/s41598-024-51627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
This study aimed to evaluate the significance of chemotherapy (CT) among metaplastic breast cancer (MpBC), and to compare the survival outcomes between triple negative MpBC (MpBC-TNBC) and triple negative invasive ductal carcinoma (IDC-TNBC). SEER database was indexed to identify female unilateral primary MpBC diagnosed from 2010 to 2017. Patients were classified into neoadjuvant chemotherapy (NAC) with response (NAC-response), NAC-no response, adjuvant chemotherapy, and no CT. Breast cancer-specific survival (BCSS) and overall survival (OS) was estimated using the Kaplan-Meier method and compared by log-rank test. Cox regression was used to evaluate the independent prognostic factors. A 1:4 propensity score matching method was adopted to balance baseline differences. Altogether 1186 MpBC patients were enrolled, among them 181 received NAC, 647 received adjuvant CT and 358 did not receive any CT. Chemotherapy was an independent favorable prognostic factor. NAC-response and adjuvant CT had a significant or an obvious trend of survival improvement compared with NAC-no response or no CT. MpBC-TNBC was an independent unfavorable prognostic factor compared with IDC-TNBC. Among them, there was significant or trend of survival improvement among all TNBCs receiving NAC or adjuvant CT compared with no CT. Chemotherapy was of important significance to MpBC prognosis and should be integrated in comprehensive treatment for MpBC.
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Affiliation(s)
- Meilin Zhang
- Department of breast surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Jingjing Yuan
- Department of breast surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Maoli Wang
- Department of breast surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mingdi Zhang
- Department of breast surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hongliang Chen
- Department of breast surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
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Bagbudar S, Karanlık H, Cabioglu N, Bayram A, Tükenmez M, Aydıner A, Yavuz E, Onder S. Evaluation of immune density, PD-L1, and CXCR4 expressions in metaplastic breast carcinoma to predict potential immunotherapy benefit. Med Oncol 2023; 41:18. [PMID: 38102446 DOI: 10.1007/s12032-023-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023]
Abstract
Metaplastic breast carcinoma (MBC) -rare but fatal subtype of invasive breast carcinomas- provides limited benefit from conventional triple-negative breast carcinoma chemotherapy. We aimed to determine the immune density of this tumor and to evaluate of programmed death-ligand 1 (PD-L1) and chemokine receptor type 4 (CXCR4) expressions to determine whether it would benefit from immunotherapy. Clinicopathological characteristics of 85 patients diagnosed as MBC between 1997 and 2017 were retrospectively assessed. We evaluated the immunohistochemical expression of PD-L1 and CXCR4, and the extent of tumour infiltrating lymphocytes (TILs), with survival data. TILs groups were statistically significantly associated with lymph node status, histological subtype, squamous component, local recurrence and/or systemic metastasis, and disease-related deaths (p < 0.05). PD-L1 positivity in immune cells (ICs) has a statistically significant relationship with the presence of squamous component (p = 0.011) and HER2 positivity (p = 0.031). PD-L1 positivity in tumor cells (TCs) was found to be significantly more frequent in high-TILs density (p = 0.003). PD-L1 combined positive score was significantly associated with the tumors containing high-TILs density (p = 0.012) and squamous component (p = 0.035). Disease-free and disease-specific survival rates were found to be longer for the cases displaying PD-L1 positivity in ICs; and also PD-L1 positivity in ICs was found to be an independent prognostic factor. When the expression of CXCR4 was compared with clinicopathological and survival parameters, no statistically significant association was found (p > 0.05). Based on the results of this retrospective study, PD-L1 and TILs appear to be prognostic. This study provides rationale for further studies to determine whether a subset of patients with metaplastic breast cancer could derive a meaningful benefit from immune-targeting therapies.
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Affiliation(s)
- Sidar Bagbudar
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey.
| | - Hasan Karanlık
- Department of Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysel Bayram
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
| | - Mustafa Tükenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Aydıner
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ekrem Yavuz
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
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Tan Y, Yang B, Chen Y, Yan X. Outcomes of Metaplastic Breast Cancer Versus Triple-Negative Breast Cancer: A Propensity Score Matching Analysis. World J Surg 2023; 47:3192-3202. [PMID: 37709983 DOI: 10.1007/s00268-023-07106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE This study aims to compare the survival outcomes of metaplastic breast cancer (MPBC) with triple-negative breast cancer (TNBC) and identify prognostic factors that influence the survival outcomes of MPBC patients and TNBC patients. METHODS Patients with nonmetastatic MPBC or TNBC were reviewed from our database. Patients' clinicopathologic and molecular features were analyzed with respect to outcomes, including disease-free survival (DFS) and overall survival (OS). Propensity score matching (PSM) with a one-to-three matching between MPBC patients and TNBC patients was performed. RESULTS A total of 857 female patients (76 MPBC patients and 781 TNBC patients) were included in this study. A subgroup of triple-negative MPBC (n = 60) was matched with TNBC (n = 180) cases based on patient characteristics and treatments. Kaplan-Meier analysis indicated that the MPBC group was associated with worse OS and DFS before (P = 0.0046 both) and after (P = 0.011 and P = 0.0046, respectively) PSM. Multivariable analysis revealed that a higher T stage (T > 2) (P = 0.032) and higher lymph node stage (N3 vs. N0-2, P = 0.012) were associated with worse OS after PSM. For DFS, the MPBC group (P = 0.012), higher T stage (T > 2) (P = 0.032), and higher lymph node stage (N3 vs. N0-2, P = 0.045) were associated with worse DFS. Among the 76 MPBC patients, a higher T stage and mesenchymal differentiation were associated with worse OS (pT1/2 vs. pT3/4 and mesenchymal differentiation vs. other subtypes, P = 0.007 and P = 0.011, respectively). CONCLUSIONS Compared with TNBC, MPBC was associated with worse OS and DFS. Mesenchymal differentiation has a worse DFS than other subtypes of MPBC.
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Affiliation(s)
- YuPing Tan
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine University, Chengdu, People's Republic of China
| | - Biao Yang
- Department of Gastroenterology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - YuHong Chen
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Yan
- Cancer Center, Breast Disease Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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19
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McMurtry V, Cleary AS, Ruano AL, Lomo L, Gulbahce HE. Metaplastic Breast Carcinoma: Clinicopathologic Features and Recurrence Score Results From a Population-based Database. Am J Clin Oncol 2023; 46:559-566. [PMID: 37705411 DOI: 10.1097/coc.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Metaplastic breast carcinoma (MBC) is a rare, aggressive form of cancer comprising epithelial and mesenchymal elements. The purpose of this study was to use population-based data to review the clinicopathologic, molecular features, and outcomes of MBC. METHODS Surveillance, Epidemiology, and End Results Program (SEER) data were used to identify MBC and invasive ductal carcinoma (IDC), no special type (NOS) between 2004 and 2015. Results from Oncotype DX's 21-gene assay linked to SEER registries were included for hormone receptor (HR)-positive tumors. χ 2 analysis was performed to determine the differences between MBC and IDC. Kaplan-Meier curves and multivariate Cox proportional hazards models were used for breast cancer specific death (BCSD). RESULTS Compared with IDC, NOS (n=509,864), MBC (n=3876) were more likely to present at an older age, be black, have negative lymph nodes, be >2 cm, grade 3, and triple negative (TN). All subtypes [HR-positive/human epidermal growth receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and TN] had higher BCSD than IDC, NOS. 22.3% of MBC cases were HR-positive. HR-positive MBCs tested for a recurrence score (RS) 65% were high-risk compared with 16.8% of IDC, NOS. Within the MBC cohort, no significant differences in BCSD were identified with respect to different molecular subtypes. In a fully adjusted model, TN or HER2-positive status did not adversely affect BCSD compared with HR-positive MBC. CONCLUSIONS All molecular subtypes of MBC had a poorer prognosis compared with IDC, NOS. The different molecular subtypes of MBC did not affect the BCSD. HR-positive MBC patients had a significantly higher high-risk RS than IDC, NOS patients.
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Affiliation(s)
- Valarie McMurtry
- Department of Pathology and Laboratory Medicine, Huntsman Cancer Institute University of Utah Health, Salt Lake City, UT
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20
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Noor R, Lajara S, Bhargava R. Large Solitary Lung Metastasis of a Matrix-Producing Metaplastic Breast Carcinoma: A Diagnostic Challenge. Cureus 2023; 15:e50265. [PMID: 38196420 PMCID: PMC10775645 DOI: 10.7759/cureus.50265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Metaplastic breast carcinoma represents a diverse category of invasive breast cancers distinguished by the transformation of neoplastic epithelial cells into squamous cells or cells with mesenchymal appearance. Matrix-producing breast carcinoma is a variant of metaplastic breast carcinoma, an exceedingly uncommon malignancy accounting for less than 1% of all breast tumors. The precise origin of this tumor remains elusive; some molecular research points to a potential derivation from myoepithelial cells, while other studies emphasize the possibility of neoplastic transformation originating from multipotent stem cells. We report a case of recurrent matrix-producing breast carcinoma. The patient presented with a breast mass. The tumor cells displayed a lack of reactivity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2), and exhibited a Ki-67 proliferation index of approximately 40%. Additionally, the tumor cells demonstrated significant reactivity for cytokeratins and S100. The patient underwent surgery, radiation, and chemotherapy and then developed metastasis to the lower lobe of her left lung, seven years after primary diagnosis. Diagnosis of metastasis was confirmed by comparing the metastasis to the primary tumor and staining with a panel of immunohistochemical stains. The patient is currently undergoing chemotherapy and immunotherapy.
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Affiliation(s)
- Rida Noor
- Department of Pathology, Faisalabad Medical University, Faisalabad, PAK
| | - Sigfred Lajara
- Department of Pathology, UPMC (University of Pittsburgh Medical Center) Presbyterian-Shadyside Hospital, Pittsburgh, USA
| | - Rohit Bhargava
- Department of Pathology, UPMC (University of Pittsburgh Medical Center) Magee-Womens Hospital, Pittsburgh, USA
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21
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Thomas A, Douglas E, Reis-Filho JS, Gurcan MN, Wen HY. Metaplastic Breast Cancer: Current Understanding and Future Directions. Clin Breast Cancer 2023; 23:775-783. [PMID: 37179225 PMCID: PMC10584986 DOI: 10.1016/j.clbc.2023.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/16/2023] [Indexed: 05/15/2023]
Abstract
Metaplastic breast cancers (MBC) encompass a group of highly heterogeneous tumors which share the ability to differentiate into squamous, mesenchymal or neuroectodermal components. While often termed rare breast tumors, given the relatively high prevalence of breast cancer, they are seen with some frequency. Depending upon the definition applied, MBC represents 0.2% to 1% of breast cancers diagnosed in the United States. Less is known about the epidemiology of MBC globally, though a growing number of reports are providing information on this. These tumors are often more advanced at presentation relative to breast cancer broadly. While more indolent subtypes exist, the majority of MBC subtypes are associated with inferior survival. MBC is most commonly of triple-negative phenotype. In less common hormone receptor positive MBCs, hormone receptor status appears not to be prognostic. In contrast, relatively rare HER2-positive MBCs are associated with superior outcomes. Multiple potentially targetable molecular features are overrepresented in MBC including DNA repair deficiency signatures and PIK3/AKT/mTOR and WNT pathways alterations. Data on the prevalence of targets for novel antibody-drug conjugates is also emerging. While chemotherapy appears to be less active in MBC than in other breast cancer subtypes, efficacy is seen in some MBCs. Disease-specific trials, as well as reports of exceptional responses, may provide clues for novel approaches to this often hard-to-treat breast cancer. Strategies which harness newer research tools, such as large data and artificial intelligence hold the promise of overcoming historic barriers to the study of uncommon tumors and could markedly advance disease-specific understanding in MBC.
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Affiliation(s)
- Alexandra Thomas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Emily Douglas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jorge S Reis-Filho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Metin N Gurcan
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Hannah Y Wen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Abstract
Breast carcinomas classified based on traditional morphologic assessment provide useful prognostic information. Although morphology is still the gold standard of classification, recent advances in molecular technologies have enabled the classification of these tumors into four distinct subtypes based on its intrinsic molecular profile that provide both predictive and prognostic information. This article describes the association between the different molecular subtypes with the histologic subtypes of breast cancer and illustrates how these subtypes may affect the appearance of tumors on imaging studies.
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Affiliation(s)
- Madhuchhanda Roy
- Department of Pathology and Laboratory Medicine, University of Wisconsin - Madison, B1761 WIMR, 1111 Highland Avenue, Madison, WI 53705, USA.
| | - Amy M Fowler
- Department of Radiology, Section of Breast Imaging and Intervention, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Medical Physics, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Gary A Ulaner
- Hoag Family Cancer Institute, 16105 Sand Canyon Avenue, Ste 215, Irvine, CA 92618, USA; Department of Radiology, Department of Translational Genomics, University of Southern California, Los Angeles, CA 90007, USA
| | - Aparna Mahajan
- Department of Pathology and Laboratory Medicine, University of Wisconsin - Madison, B1781 WIMR, 1111 Highland Avenue, Madison, WI 53705, USA
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23
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Wang S, Lou J, Zou Q, Jiang Y, Wang S, Shi H. Metaplastic Carcinoma of the Breast: MRI Features with Clinical and Histopathologic Correlation. Acad Radiol 2023; 30:1786-1793. [PMID: 36137916 DOI: 10.1016/j.acra.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Metaplastic carcinoma of the breast (MCB) is a rare type of breast carcinoma, and there are only limited data about the MRI findings of MCB. This article aimed to review the MRI features of MCB and correlate the MRI findings with clinical and histopathologic characteristics. MATERIALS AND METHODS A total of 23 patients were enrolled from a signal institution. The clinical data, histological diagnosis and MRI findings were retrospectively reviewed. RESULTS The average age of the 23 patients was 51.6 years. Twenty-one (91.3%) patients presented with a palpable mass. Squamous cell carcinoma was the most common subtype (10/23, 43.5%). Axillary lymph node metastasis was detected in 4 (17.4%) patients. The immunohistochemical profile showed the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor-2 (Her-2) expression were negative in 87.0%, 95.7%, and 91.3% of the patients respectively. On MRI, most cases exhibited an irregular mass (18/23, 78.3%) with high signal intensity on T2-weighted images (22/23,95.7%), non-circumscribed margin (19/23, 82.6%), heterogeneous enhancement (13/23, 56.5%), Type III (12/23, 52.2%) time intensity curve, and diffusion restriction (20/23, 87.0%) on diffusion weighted images (DWI). CONCLUSION MCB most commonly demonstrated definitely malignant MRI features, which may reflect the histopathologic characteristic of this rare and aggressive breast carcinoma.
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Affiliation(s)
- Siqi Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jianjuan Lou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qigui Zou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanni Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shouju Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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24
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Ismail Y, Kamal A, Allam R, Zakaria AS. The conundrum of metaplastic breast cancer: a single Egyptian institution retrospective 10-year experience (2011-2020). J Egypt Natl Canc Inst 2023; 35:16. [PMID: 37271778 DOI: 10.1186/s43046-023-00178-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/14/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Metaplastic breast cancer (MetBC) still represents a conundrum owing to its peculiar histogenesis and molecular drivers that render it extremely resistant to standard chemotherapy with ultimate dismal survival. AIM Describe the Egyptian National Cancer Institute's (NCI-E) experience with MetBC regarding its clinicopathologic features, treatment, and survival outcomes. PATIENTS AND METHODS Between 2011 and 2020, all MetBC patients presented to NCI-E were retrospectively evaluated. Original clinicopathologic data, therapeutic modalities, pathologic response to neoadjuvant chemotherapy (NACT), recurrence, and date of last follow-up/death were obtained from archived charts. RESULTS A cohort of 135 females, the median age was 52 years, and median follow-up period was 40 months (range: 2.6-130.8). Two-thirds were triple negative (TN). Squamous carcinoma was prevalent in 74.8% followed by carcinoma with osseous/chondroid differentiation, spindle cell, and low-grade adenosquamous carcinoma encountered in 13.3, 7.4, and 4.5%, respectively. Modified radical mastectomy was done in 59.3%, and positive nodes (pN+) were depicted in 37.7%. Median Ki-67 was 45% (range: 10-88); grade III and lymphovascular invasion (LVI) were observed in 83.7 and 43.7%, respectively. Stage II was the most common (49%), whereas initial stage IV was encountered in 8.1%. Anthracyclines/taxane combinations were rampant in adjuvant/neoadjuvant settings. The latter was employed in 41 patients, with only 3 cases (7.3%) achieving pathologic complete response (pCR), while moderate/significant residual tumor burden was found in 83%. The 5-year DFS and OS were 56.4 and 57.6%, respectively. Spindle cell carcinoma showed the worst survival parameters in univariate analysis. On the multivariate level, higher tumor stage (pT3 & 4), Ki-67 ≥ 45%, and TN subtype were independent variables for worse DFS and OS; age ≥ 52 years and the presence of LVI were independent features for worse DFS, whereas pN+ was an independent parameter for worse OS. CONCLUSIONS This study further solidifies the dreadful response of MetBC to conventional chemotherapy regimens employed in common non-metaplastic pathologies. A radical shift in treatment standards tailored to combat the molecular landscape of this distinctive tumor is urgently needed. Immunotherapy and molecularly targeted agents demonstrated promising results in phase I and II trials with hopeful sooner implementation in phase III studies.
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Affiliation(s)
- Yahia Ismail
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt.
| | - Amr Kamal
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Rasha Allam
- Cancer Epidemiology & Biostatistics Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
| | - Al-Shimaa Zakaria
- Pathology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt
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25
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Khoury T. Metaplastic Breast Carcinoma Revisited; Subtypes Determine Outcomes: Comprehensive Pathologic, Clinical, and Molecular Review. Clin Lab Med 2023; 43:221-243. [PMID: 37169444 DOI: 10.1016/j.cll.2023.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.
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Affiliation(s)
- Thaer Khoury
- Pathology Department, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA.
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26
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Hu J, Lang R, Zhao W, Jia Y, Tong Z, Shi Y. The mixed subtype has a worse prognosis than other histological subtypes: a retrospective analysis of 217 patients with metaplastic breast cancer. Breast Cancer Res Treat 2023; 200:23-36. [PMID: 37160814 DOI: 10.1007/s10549-023-06945-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Metaplastic breast cancer (MpBC) is an aggressive subtype of all breast cancer. We aimed to investigate the clinicopathological features, treatments and prognoses of MpBC patients. METHODS We collected the data from MpBC patients diagnosed at Tianjin Medical University Cancer Hospital from 2010 to 2017. Kaplan Meier curves and Cox regression model were used to evaluating clinical outcomes and prognostic factors. After removing baseline differences by propensity score matching (PSM), we analyzed the prognosis between MpBC patients and invasive ductal carcinomas of no special type (IDC-NST) patients. RESULTS A total of 217 MpBC patients were subsumed. Of all histological subtypes, 45.1% were mixed subtypes, followed by with mesenchymal differentiation (27.2%), pure squamous (15.2%) and pure spindle (12.4%) subtypes. 69.6% of MpBC were triple-negative, 25.3% and 6.5% were HR-positive and HER2-positive. MpBC patients had worse survival compared to IDC-NST patients, with 5-year RFS of 73.8 and 83.6% (HR = 1.177 95%CI (1.171-2.676) P = 0.0068), and 5-year BCSS of 79.0% and 89.7% (HR = 2.187 95%CI (1.357-3.523) P = 0.0013). In the multivariate COX model, AJCC stage, mixed subtype and chemotherapy were independent prognostic factors. Mixed MpBC is more aggressive than pure and with heterologous mesenchymal differentiation subtypes. And whether squamous or spindle MpBC, mixed forms have shorter outcomes than pure forms. CONCLUSIONS MpBCs are associated with poorer prognoses than IDC-NSTs. They are heterogeneous with different clinicopathological features and clinical outcomes between histological subtypes. Pure and with heterologous mesenchymal differentiation subtypes have more survival benefits than the mixed subtype.
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Affiliation(s)
- Jiayue Hu
- Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Ronggang Lang
- Department of Breast Pathology and Lab, Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Weipeng Zhao
- Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yongsheng Jia
- Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Zhongsheng Tong
- Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yehui Shi
- Department of Breast Oncology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
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27
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Çelik H, Başara Akın I, Durak MG, Balcı P. Multimodality imaging and histopathology of metaplastic breast cancer. Diagn Interv Radiol 2023; 29:59-67. [PMID: 36959869 PMCID: PMC10679585 DOI: 10.4274/dir.2022.221363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/08/2022] [Indexed: 03/25/2023]
Abstract
Metaplastic breast cancer (MBC) is a rare subtype of invasive breast cancer characterized by mixed epithelial and mesenchymal differentiation. Commonly seen subtypes include squamous cell carcinoma, spindle cell carcinoma, and metaplastic carcinoma with heterologous mesenchymal differentiation. MBC tends to have a more aggressive clinical presentation, higher metastatic potential, higher rates of local recurrence, and a worse prognosis compared with invasive breast carcinoma of no special type. Most MBCs are triple-negative breast cancers, which explains their resistance to most systemic therapies. Therefore, accurately diagnosing MBC early is crucial for deciding the treatment strategy and predicting the prognosis. In this pictorial essay, the imaging findings of MBC in different modalities and the histopathologic features of its subtypes are reviewed.
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Affiliation(s)
- Hakkı Çelik
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Merih Güray Durak
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Pınar Balcı
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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28
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Rakha EA, Tse GM, Quinn CM. An update on the pathological classification of breast cancer. Histopathology 2023; 82:5-16. [PMID: 36482272 PMCID: PMC10108289 DOI: 10.1111/his.14786] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022]
Abstract
Breast cancer (BC) is a heterogeneous disease, encompassing a diverse spectrum of tumours with varying morphological, biological, and clinical phenotypes. Although tumours may show phenotypic overlap, they often display different biological behaviour and response to therapy. Advances in high-throughput molecular techniques and bioinformatics have contributed to improved understanding of BC biology and refinement of molecular taxonomy with the identification of specific molecular subclasses. Although the traditional pathological morphological classification of BC is of paramount importance and provides diagnostic and prognostic information, current interest focusses on the use of a single gene and multigene assays to stratify BC into distinct groups to guide decisions on systemic therapy. This review considers approaches to the classification of BC, including their limitations, and with particular emphasis on the fundamental role of morphology in establishing an accurate diagnosis of primary invasive carcinoma of breast origin. This forms the basis for further morphological characterization and for all other approaches to BC classification that are used to provide prognostic and therapeutic predictive information.
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Affiliation(s)
- Emad A Rakha
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Nottingham, Nottingham, UK
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong SAR
| | - Cecily M Quinn
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
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29
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Transcriptomic alterations underlying metaplasia into specific metaplastic components in metaplastic breast carcinoma. Breast Cancer Res 2023; 25:11. [PMID: 36707876 PMCID: PMC9883935 DOI: 10.1186/s13058-023-01608-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Metaplastic breast carcinoma (MpBC) typically consists of carcinoma of no special type (NST) with various metaplastic components. Although previous transcriptomic and proteomic studies have reported subtype-related heterogeneity, the intracase transcriptomic alterations between metaplastic components and paired NST components, which are critical for understanding the pathogenesis underlying the metaplastic processes, remain unclear. METHODS Fifty-nine NST components and paired metaplastic components (spindle carcinomatous [SPS], matrix-producing, rhabdoid [RHA], and squamous carcinomatous [SQC] components) were microdissected from specimens obtained from 27 patients with MpBC for gene expression profiling using the NanoString Breast Cancer 360 Panel on a NanoString nCounter FLEX platform. BC360-defined signatures were scored using nSolver software. RESULTS Hierarchical clustering and principal component analysis revealed a heterogeneous gene expression profile (GEP) corresponding to the NST components, but the GEP of metaplastic components exhibited subtype dependence. Compared with the paired NST components, the SPS components demonstrated the upregulation of genes related to stem cells and epithelial-mesenchymal transition and displayed enrichment in claudin-low and macrophage signatures. Despite certain overlaps in the enriched functions and signatures between the RHA and SPS components, the specific differentially expressed genes differed. We observed the RHA-specific upregulation of genes associated with vascular endothelial growth factor signaling. The chondroid matrix-producing components demonstrated the upregulation of hypoxia-related genes and the downregulation of the immune-related MHC2 signature and the TIGIT gene. In the SQC components, TGF-β and genes associated with cell adhesion were upregulated. The differentially expressed genes among metaplastic components in the 22 MpBC cases with one or predominantly one metaplastic component clustered paired NST samples into clusters with correlation with their associated metaplastic types. These genes could be used to separate the 31 metaplastic components according to respective metaplastic types with an accuracy of 74.2%, suggesting that intrinsic signatures of NST may determine paired metaplastic type. Finally, the EMT activity and stem cell traits in the NST components were correlated with specimens displaying lymph node metastasis. CONCLUSIONS We presented the distinct transcriptomic alterations underlying metaplasia into specific metaplastic components in MpBCs, which contributes to the understanding of the pathogenesis underlying morphologically distinct metaplasia in MpBCs.
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30
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Niver HE, Foxhall E, Lahiry A. KEYNOTE-522 and male spindle cell carcinoma of the breast: A case report. Rare Tumors 2023; 15:20363613231163730. [PMID: 36937820 PMCID: PMC10021088 DOI: 10.1177/20363613231163730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Metaplastic Breast Cancer (MBC) is a rare group of tumors often presenting as triple-negative. MBC accounts for less than 1% of all breast cancers with the spindle cell variant comprising less than 0.5%. While rare, spindle cell carcinoma is the commonest subtype in the western world. It has a more aggressive biological behavior with increased risk of recurrence and death due to disease compared to triple negative breast cancers. There is no treatment guideline for management of MBC due to the rarity of the disease. Instead, treatment is theorized based off success with other types of aggressive breast and metaplastic cancers of different tissue. We present the first known case report of male spindle cell carcinoma of the breast treated with KEYNOTE-522 regimen. Therapy included a first phase with pembrolizumab (dose of 200 mg) every 3 weeks plus paclitaxel and carboplatin and second phase, with four cycles of pembrolizumab with doxorubicin-cyclophosphamide.
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Affiliation(s)
- Harper E Niver
- Northeast Georgia Medical Center and Health System, Gainesville, GA, United States
| | - Edward Foxhall
- Northeast Georgia Medical Center and Health System, Gainesville, GA, United States
| | - Anup Lahiry
- Northeast Georgia Medical Center and Health System, Gainesville, GA, United States
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Malignant breast myoepithelioma: A systematic review. J Gynecol Obstet Hum Reprod 2022; 51:102481. [DOI: 10.1016/j.jogoh.2022.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
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Özkurt E, Emiroğlu S, Cabioğlu N, Karanlık H, Önder S, Tükenmez M, İğci A, Özmen V, Müslümanoğlu M. Metaplastic Breast Cancer: Mesenchymal Subtype Has Worse Survival Outcomes. Breast Care (Basel) 2022; 17:554-560. [PMID: 36590148 PMCID: PMC9801396 DOI: 10.1159/000525324] [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: 04/14/2022] [Accepted: 05/31/2022] [Indexed: 01/04/2023] Open
Abstract
Background Metaplastic breast carcinoma (MBC) is a rare type of breast cancer that accounts for 0.2-1% of all breast cancers. To date, there are only few institutional studies comparing survival rates between different subtypes. In this retrospective cohort study, we aim to evaluate factors effecting survival rates of different subtypes of MBC. Methods This retrospective cohort study observed 118 nonmetastatic MBC patient records extracted from 15,244 breast cancer cases between December 2000 and December 2020. In order to analyze factors effecting survival rates of mesenchymal subtype of MBC, all cases are classified as mesenchymal (n = 45) and other (n = 48). Twenty-five cases could not be sub-classified due to the missing data. Univariate and multivariate logistic regression analyses were performed to define factors associated with survival rates. Results Of the 15,244 cases, 118 (0.8%) were nonmetastatic MBC. 105 were triple negative and 12 were nonluminal HER2. There was no significant difference between mesenchymal and other subgroups for age, median tumor size, AJCC staging, and type of surgery. Of the five local recurrences with known subgroup, four of them had mesenchymal subtype. It is demonstrated that mesenchymal subtype was significantly associated with worse 5-year disease-free survival and disease-specific survival (HR: 2.35 [1.01-5.48], p = 0.049, and HR: 3.16 [1.06-9.47], p = 0.040 with 95% CI, respectively). Conclusion This study is one of the few studies presenting the survival outcomes of subtypes of MBCs. Nonetheless, it is the only study demonstrating that mesenchymal subtype had worse survival outcomes. Further studies are needed to determine the outcome of different subtypes of MBCs.
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Affiliation(s)
- Enver Özkurt
- Department of General Surgery, Başarı Hospital, Istanbul, Turkey
| | - Selman Emiroğlu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Neslihan Cabioğlu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Karanlık
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semen Önder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Tükenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Abdullah İğci
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mahmut Müslümanoğlu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul, Turkey
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Damera VV, Chowdhury Z, Tripathi M, Singh R, Verma RK, Jain M. Clinicopathologic Features of Metaplastic Breast Carcinoma: Experience From a Tertiary Cancer Center of North India. Cureus 2022; 14:e28978. [PMID: 36237767 PMCID: PMC9548328 DOI: 10.7759/cureus.28978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Metaplastic breast cancer (MBC) is a rare malignancy that accounts for < 1% of all breast cancers. The aim of this study is to evaluate the clinicopathologic characteristics of MBC patients treated at a tertiary cancer center. Materials and methods In this study, the authors retrospectively analyzed the prospectively maintained data of MBC patients treated at a tertiary cancer care center in North India between January 2019 and July 2022. Results A total of 28 MBCs were identified. The median age of presentation was 47 years (range 27-81 years). Seventeen patients (60.7%) presented with clinical T3/T4 disease, and axillary nodal involvement was detected in 11 patients (39.3%) at presentation. Two patients had metastatic disease at presentation. A preoperative diagnosis of MBC on core biopsy was attained in five patients (17.9%), and the most common histologic subtype was sarcomatoid carcinoma. Triple-negative receptor status was observed in 15 patients (53.6%). Six patients (21.4%) underwent upfront breast conservation surgery and another six (21.4%) upfront mastectomy. Thirteen patients (46.4%) underwent mastectomy following neoadjuvant therapy. Definitive axillary nodal metastasis was found in eight patients (32%). Following neoadjuvant chemotherapy, five patients (35.7%) had stable disease, disease progression was evident in five patients (35.7%), partial response in four patients (28.6%), and no patient evinced complete response. Adjuvant postoperative radiation therapy was administered in 16 patients (57.1%). At a median follow-up of 13.2 months (range 4-26 months), 16 patients (57.1%) were alive with no evidence of disease, one patient (3.6%) was alive with disease, nine patients (32.1%) died of disease, and two patients (7.2%) died of other causes. One patient suffered from locoregional recurrence and nine patients developed distant metastasis. Conclusion MBC is an infrequent entity among breast carcinomas in India, which is similar to the reports of MBC worldwide. The diagnosis of MBC is difficult and requires the use of immunohistochemistry. Most of the cases in our study presented with a larger tumor size; however, they displayed a relatively lower incidence of nodal involvement as well as hormone receptor negativity. Being a rare and heterogeneous disease, large-scale studies are essential for better understanding and management of these tumors.
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Thapa B, Arobelidze S, Clark BA, Xuefei J, Daw H, Cheng YC, Patel M, Spiro TPP, Haddad A. Metaplastic Breast Cancer: Characteristics and Survival Outcomes. Cureus 2022; 14:e28551. [PMID: 36185859 PMCID: PMC9517584 DOI: 10.7759/cureus.28551] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Metaplastic breast cancer (MBC) is a rare neoplasm accounting for <1% of all breast cancer. We evaluated the clinical characteristics and survival outcomes of MBC. Methods Patients diagnosed with pathologically proven MBC were reviewed from the institutional breast cancer database from 2000 to 2017. Results A total of 136 patients diagnosed with MBC were included in the study. The median age of the diagnosis was 60 years, and 60% of patients were stage II at diagnosis, and 22% were stage III. About two-thirds of the patients were triple-negative; 93% had nuclear grade III, and 25% had a lymphovascular invasion. Squamous differentiation (29%) was the most common histologic subtype, followed by the spindle subtype (21%). The most common distant metastases were lung (22%), followed by bone (13%). Moreover, 60% had a mastectomy, 19% had endocrine therapy, 58% had radiation, 51% received anthracycline-based chemotherapy, 26% had non-anthracycline chemotherapy, and 22% received no chemotherapy. In the entire cohort, the two-year overall survival (OS) and five-year OS were 79% and 69%, respectively, and the two-year progression-free survival (PFS) and five-year PFS were 72% and 61%, respectively. On multivariable analysis, the stage of MBC (stage III: hazard ratio (HR), 5.065 (95% confidence interval (CI), 1.02-25.27) (p=0.048)), poor functional status (Eastern Cooperative Oncology Group (ECOG) score, 2; HR, 24.736 (95% CI, 1.92-318.73) (p=0.014)), and distant metastasis to the brain (HR, 8.453 (95% CI, 1.88-38.04) (p=0.005)) and lung (HR, 42.102 (95% CI, 7.20-246.36) (p<0.001)) were significant predictors of decreased OS. Conclusions MBC demonstrated early disease progression and poor overall survival. The stage of MBC, decreased performance status, and metastasis to the lung and brain were independent poor prognostic factors.
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Differences of Clinicopathological Features between Metaplastic Breast Carcinoma and Nonspecific Invasive Breast Carcinoma and Prognostic Profile of Metaplastic Breast Carcinoma. Breast J 2022; 2022:2500594. [PMID: 36051469 PMCID: PMC9424033 DOI: 10.1155/2022/2500594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Introduction Metaplastic breast carcinoma is a rare special type of breast cancer, which has distinguished clinical characteristics. We aimed to evaluate the clinicopathological features of metaplastic breast carcinoma compared with nonspecific invasive breast carcinoma and study the prognosis of metaplastic breast carcinoma. Methods We reviewed metaplastic breast carcinoma cases (n = 37) from January 2000 to December 2021 and nonspecific invasive breast carcinoma cases (n = 433) from January 2019 to December 2020 extracted from our institution retrospectively. The following variables were recorded, including the patients' general information, complications, T stage, expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, molecular subtyping, lymph node status, skin or chest wall involvement, vessel carcinoma embolus, therapy modality (surgical treatments, chemotherapy, and radiotherapy), and survival. Results Patients with metaplastic breast carcinoma had more advanced disease than patients with nonspecific invasive breast carcinoma (T stage: P=0.0011). A greater proportion of metaplastic breast carcinoma presented with triple-negative breast cancer than nonspecific invasive breast carcinoma (79.41% vs. 12.47%, P ≤ 0.001). Our study showed that the skin or chest wall invasion was more frequent in metaplastic breast carcinoma patients (11.76% vs. 1.62%, P=0.005). The 5-year survival rate for metaplastic breast carcinoma patients was 57.66% (95% CI: 0.3195∼0.7667). No local recurrence was observed while distant metastasis occurred in 33.33% of patients with metaplastic breast carcinoma. Death due to disease occurred in 24.24% of patients with metaplastic breast carcinoma. Conclusion The majority of metaplastic breast carcinoma patients had more advanced disease and triple-negative disease than nonspecific invasive breast carcinoma patients. Also, metaplastic breast carcinoma patients had frequent skin or chest wall invasion and a high rate of distant metastasis and mortality.
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Zhu K, Chen Y, Guo R, Dai L, Wang J, Tang Y, Zhou S, Chen D, Huang S. Prognostic Factor Analysis and Model Construction of Triple-Negative Metaplastic Breast Carcinoma After Surgery. Front Oncol 2022; 12:924342. [PMID: 35814407 PMCID: PMC9261478 DOI: 10.3389/fonc.2022.924342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The study aimed to analyze the prognostic factors of patients with triple-negative (TN) metaplastic breast carcinoma (MpBC) after surgery and to construct a nomogram for forecasting the 3-, 5-, and 8-year overall survival (OS). Methods A total of 998 patients extracted from the Surveillance, Epidemiology, and End Results (SEER) database were assigned to either the training or validation group at random in a ratio of 7:3. The clinical characteristics of patients in the training and validation sets were compared, and multivariate Cox regression analysis was used to identify the independent risk variables for the OS of patients with TN MpBC after surgery. These selected parameters were estimated through the Kaplan–Meier (KM) curves using the log-rank test. The nomogram for predicting the OS was constructed and validated by performing the concordance index (C-index), receiver operating characteristics (ROC) curves with area under the receiver operating characteristic curves (AUC), calibration curves, and decision curve analyses (DCAs). Patients were then stratified as high-risk and low-risk, and KM curves were performed. Results Multivariate Cox regression analysis indicated that factors including age, marital status, clinical stage at diagnosis, chemotherapy, and regional node status were independent predictors of prognosis in patients with MpBC after surgery. Separate KM curves for the screened variables revealed the same statistical results as with Cox regression analysis. A prediction model was created and virtualized via nomogram based on these findings. For the training and validation cohorts, the C-index of the nomogram was 0.730 and 0.719, respectively. The AUC values of the 3-, 5-, and 8-year OS were 0.758, 0.757, and 0.785 in the training group, and 0.736, 0.735, and 0.736 for 3, 5, and 8 years in the validation group, respectively. The difference in the OS between the real observation and the forecast was quite constant according to the calibration curves. The generated clinical applicability of the nomogram was further demonstrated by the DCA analysis. In all the training and validation sets, the KM curves for the different risk subgroups revealed substantial differences in survival probabilities (P <0.001). Conclusion The study showed a nomogram that was built from a parametric survival model based on the SEER database, which can be used to make an accurate prediction of the prognosis of patients with TN MpBC after surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - Dedian Chen
- *Correspondence: Sheng Huang, ; Dedian Chen,
| | - Sheng Huang
- *Correspondence: Sheng Huang, ; Dedian Chen,
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Yang SY, Li Y, Nie JY, Yang ST, Yang XJ, Wang MH, Zhang J. Metaplastic breast cancer with chondrosarcomatous differentiation combined with concurrent bilateral breast cancer: A case report. World J Clin Cases 2022; 10:5064-5071. [PMID: 35801025 PMCID: PMC9198873 DOI: 10.12998/wjcc.v10.i15.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metaplastic breast carcinoma (MBC) is a rare subtype of invasive breast cancer comprising malignant epithelial and mesenchymal cells. Compared with other invasive breast cancers, MBC is not only histologically distinctly heterogeneous but also has a rapid and aggressive growth pattern, which leads to a significant risk of recurrence and mortality.
CASE SUMMARY In this study, we report the case of a patient with a large left breast mass diagnosed with bilateral invasive ductal carcinoma in both breasts after a preoperative core needle aspiration biopsy of the bilateral breast mass. The patient received neoadjuvant chemotherapy and underwent bilateral breast modified radical mastectomy. Postoperative pathology suggested carcinosarcoma with predominantly chondrosarcoma in the left breast and invasive ductal carcinoma (luminal B) in the right breast. As the patient did not achieve complete pathological remission after six cycles of neoadjuvant chemotherapy, we administered six months of intensive capecitabine treatment. Then the patient was switched to continuous treatment with endocrine therapy using letrozole + goserelin, and the patient is currently in stable condition. However, as MBC of the breast is concurrently diagnosed with chondrosarcoma differentiation, our case is sporadic.
CONCLUSION Given the variety of immunohistochemical types of bilateral breast cancer, achieving effective chemotherapy should be a key research focus.
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Affiliation(s)
- Si-Yuan Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Yang Li
- Department of Digestive Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Jian-Yun Nie
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Shou-Tao Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Xiao-Juan Yang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Mao-Hua Wang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
| | - Ji Zhang
- Department of Breast Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, Yunnan Province, China
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Unique clinicopathological characteristic and survival rate of metaplastic breast cancer;a special subtype of breast cancer a 5 year cohort study in single referral centre in North Borneo. Ann Med Surg (Lond) 2022; 78:103822. [PMID: 35734649 PMCID: PMC9207046 DOI: 10.1016/j.amsu.2022.103822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Metaplastic Breast Cancer (MBC) of the breast is a rare entity of breast cancer, with a very poor prognosis, and whose pathophysiology is still unwell established. Therapeutic management is very heterogeneous due to its incomplete understanding. The aim of this study is to describe the demographic, clinical, and therapeutic characteristics of our MBC patient. Material and methods A cross-sectional study was conducted to evaluate the demographic and clinicopathological features of these patients. Data of patients diagnosed with metaplastic breast cancer were retrieved from our breast cancer database in Queen Elizabeth Hospital II from January 2015 to May 2021. Results 14 patients were diagnosed with metaplastic breast cancer during this period of study. All of them were female, with the average age of 52 years old. The patients were predominantly Bajau and Kadazan Dusun, each comprising of 35%(n = 5). 57% (n = 8) of patients were postmenopausal. 85% (n = 12) of patients were presented with breast lump of an average largest diameter of 69.23 mm. BIRADS staging of the affected breast revealed that most of the patients were BIRADS 5.57% (n = 8) patients underwent mastectomy, 4 went for either breast conserving surgery of the breast. The most common histopathological type is squamous cell carcinoma, which accounts for 42% (n = 6) of the patients. 71% (n = 10) were pathologically triple negative. 7 patients were pathologically node positive. 35% (n = 5) had lung metastasis, and one of the patients had concurrent lung and liver metastasis. Conclusion The prognosis of patients with Metaplastic carcinoma of breast remains poor because most of it detected late and histologically triple negative type. Till date, there is no specific management guideline which warrant a multi institutional studies evaluating role of new therapies such as Anti-PD-1 Therapy in combination with chemotherapy to improve patient outcome.
This article highlight the unique clinicopathological characteristic of special type of breast cancer, metaplastic breast cancer from cross sectional study from 2015 until 2021. It is important to know the characteristic of metaplastic breast cancer in order to predict the respond of the treatment and prognosticate the disease. This article also review current treatment guideline regarding metaplastic breast cancer.
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Khoury T. Metaplastic Breast Carcinoma Revisited; Subtypes Determine Outcomes: Comprehensive Pathologic, Clinical, and Molecular Review. Surg Pathol Clin 2022; 15:159-174. [PMID: 35236632 DOI: 10.1016/j.path.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Metaplastic breast carcinoma (MpBC) is a heterogeneous group of tumors that clinically could be divided into low risk and high risk. It is important to recognize the different types of MpBC, as the high-risk subtypes have worse clinical outcomes than triple-negative breast cancer. It is important for the pathologist to be aware of the MpBC entities and use the proposed algorithms (morphology and immunohistochemistry) to assist in rendering the final diagnosis. Few pitfalls are discussed, including misinterpretation of immunohistochemistry and certain histomorphologies, particularly spindle lesions associated with complex sclerosing lesions.
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Affiliation(s)
- Thaer Khoury
- Pathology Department, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA.
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Tan BY, Lim EH, Tan PH. Special Histologic Type and Rare Breast Tumors - Diagnostic Review and Clinico-Pathological Implications. Surg Pathol Clin 2022; 15:29-55. [PMID: 35236633 DOI: 10.1016/j.path.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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Yoon E, Ding Q, Hunt K, Sahin A. High-Grade Spindle Cell Lesions of the Breast: Key Pathologic and Clinical Updates. Surg Pathol Clin 2022; 15:77-93. [PMID: 35236635 DOI: 10.1016/j.path.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most of the high-grade spindle cell lesions of the breast are malignant phyllodes tumors (MPTs), spindle cell carcinomas (SpCCs), and matrix-producing metaplastic breast carcinomas (MP-MBCs). MPTs have neoplastic spindle stromal cells and a classic leaf-like architecture with subepithelial stromal condensation. MPTs are often positive for CD34, CD117, and bcl-2 and are associated with MED12, TERT, and RARA mutations. SpCCs and MP-MBCs are high-grade metaplastic carcinomas, whereas neoplastic epithelial cells become spindled or show heterologous mesenchymal differentiation, respectively. The expression of epithelial markers must be evaluated to make a diagnosis. SAS, or rare metastatic spindle cell tumors, are seen in the breast, and clinical history is the best supporting evidence. Surgical resection is the standard of care.
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Affiliation(s)
- Esther Yoon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA.
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 85, Room G1.3565C, Houston, TX 77030-4009, USA
| | - Aysegul Sahin
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
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Chen Q, Zhou Q, He H, He Y, Yuan Y, Zou Q, Yi W. Chemotherapy significantly improves long-term survival of small lesion node negative metaplastic breast carcinoma in T1c population rather than T1a and T1b. Sci Rep 2022; 12:871. [PMID: 35042902 PMCID: PMC8766593 DOI: 10.1038/s41598-022-04946-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 12/24/2021] [Indexed: 12/05/2022] Open
Abstract
Metaplastic breast carcinoma (MpBC) is considered a highly aggressive disease, the outcome of chemotherapy on small lesions (T1abcN0M0) MpBC patients remain unclear. We identified 890 female MpBC patients in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2016. After propensity score matching (PSM), 584 patients were matched. Survival probability was compared among T1a, T1b, and T1c patients and between patients with and without chemotherapy using Kaplan-Meier analysis and Cox proportional hazard analysis. Significance was set at two-sided P < 0.05. We classified 49, 166, and 675 patients as T1a, T1b, and T1c MpBC, respectively. The chemotherapy group included 404 patients (45.4%). Following PSM, survival analysis indicated that the patients who underwent chemotherapy had higher OS (P = 0.0002) and BCSS (P = 0.0276) in the T1c substage, but no significant difference was detected in T1a or T1b patients. In this population-based study, small lesion MpBC showed a favorable prognosis. Chemotherapy improved the prognosis of T1c MpBC patients but not T1a and T1b patients to a beneficial extent. Our findings may offer novel insight into a therapeutic strategy for MpBC.
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Affiliation(s)
- Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Qin Zhou
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Hongye He
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Yeqing He
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China.
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Vohra P, Chen YY, Krings G. Less Common Triple-Negative Breast Cancers. A COMPREHENSIVE GUIDE TO CORE NEEDLE BIOPSIES OF THE BREAST 2022:463-573. [DOI: 10.1007/978-3-031-05532-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Xia LY, Xu WY, Hu QL. The different outcomes between breast-conserving surgery plus radiotherapy and mastectomy in metaplastic breast cancer: A population-based study. PLoS One 2021; 16:e0256893. [PMID: 34473783 PMCID: PMC8412345 DOI: 10.1371/journal.pone.0256893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background Metaplastic breast cancer (MBC) are rare. The survival outcomes of MBC patients after breast conserving surgery plus radiotherapy (BCS+RT) or mastectomy have not been established. The study aimed to compare survival outcomes of MBC patients subjected to BCS+RT or mastectomy therapeutic options. Methods Patients who were subjected to BCS+RT or mastectomy between 2004 and 2014 were enrolled in this study through the Surveillance, Epidemiology and End Results (SEER) database. Breast cancer-specific survival (BCSS) and the overall survival (OS) of the participants were determined. Cox proportional hazard model and the Kaplan Meier method were used to determine the correlation between the two surgical methods and survival outcomes. Results A total of 1197 patients were enrolled in this study. Among them, 439 patients were subjected to BCS+RT, while 758 patients were subjected to mastectomy. After propensity score matching (PSM), the BCS+RT and mastectomy groups consisted of 321 patients, respectively. The univariate and multivariate analysis with a 6-month landmark all indicate that patients receiving BCS+RT has higher OS than patients receiving mastectomy (HR = 0.701,95% CI = 0.496–0.990, P = 0.044; HR = 0.684,95% CI = 0.479–0.977, P = 0.037) while the BCSS was no difference between the two groups (HR = 0.739,95% CI = 0.474–1.153, P = 0.183; HR = 0.741,95% CI = 0.468–1.173, P = 0.200). Conclusion The BCS+RT therapeutic option exhibits a higher OS in MBC patients compared to the mastectomy approach.
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Affiliation(s)
- Lin-Yu Xia
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- * E-mail:
| | - Wei-Yun Xu
- Department of Breast Surgery, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Qing-Lin Hu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Ishizuka Y, Horimoto Y, Yanagisawa N, Arakawa A, Nakai K, Saito M. Clinicopathological Examination of Metaplastic Spindle Cell Carcinoma of the Breast: Case Series. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211039433. [PMID: 34413650 PMCID: PMC8369969 DOI: 10.1177/11782234211039433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Spindle cell carcinoma (SpCC) of the breast is a rare histological type, a subtype of metaplastic carcinoma characterized by atypical spindle cell and epithelial carcinoma. The proportions of the spindle cell and epithelial components vary among tumours. Due to its rarity, biological characteristics of this disease have been poorly studied. Methods: In total, 10 patients with SpCC were surgically treated at our institution from January 2007 to December 2018. We retrospectively investigated these SpCC cases, focusing on the differences between spindle cell and epithelial components. Microsatellite status was also examined. Results: Nine cases were triple-negative breast cancer (TNBC). The rates of high tumour grade were 70% in spindle cell components and 56% in epithelial components (P = .65), while the mean Ki67 labelling index were 63% and 58%, respectively (P = .71). Mean programmed death ligand 1 (PD-L1) expression in these components was 11% and 1%, respectively (P = .20). All 10 tumours were microsatellite stable. Patient outcomes of triple-negative SpCC did not differ from those of propensity-matched patients with conventional TNBC. Conclusions: Spindle cell components showed higher values in factors examined, although there was no statistically significant difference. Our data reveal that these 2 components of SpCC may be of different biological nature.
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Affiliation(s)
- Yumiko Ishizuka
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan.,Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | | | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Katsuya Nakai
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University, School of Medicine, Tokyo, Japan
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Rakha EA, Brogi E, Castellano I, Quinn C. Spindle cell lesions of the breast: a diagnostic approach. Virchows Arch 2021; 480:127-145. [PMID: 34322734 PMCID: PMC8983634 DOI: 10.1007/s00428-021-03162-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/27/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Spindle cell lesions of the breast comprise a heterogeneous group of lesions, ranging from reactive and benign processes to aggressive malignant tumours. Despite their rarity, they attract the attention of breast pathologists due to their overlapping morphological features and diagnostic challenges, particularly on core needle biopsy (CNB) specimens. Pathologists should recognise the wide range of differential diagnoses and be familiar with the diverse morphological appearances of these lesions to make an accurate diagnosis and to suggest proper management of the patients. Clinical history, immunohistochemistry, and molecular assays are helpful in making a correct diagnosis in morphologically challenging cases. In this review, we present our approach for the diagnosis of breast spindle cell lesions, highlighting the main features of each entity and the potential pitfalls, particularly on CNB. Breast spindle cell lesions are generally classified into two main categories: bland-appearing and malignant-appearing lesions. Each category includes a distinct list of differential diagnoses and a panel of immunohistochemical markers. In bland-appearing lesions, it is important to distinguish fibromatosis-like spindle cell metaplastic breast carcinoma from other benign entities and to distinguish fibromatosis from scar tissue. The malignant-appearing category includes spindle cell metaplastic carcinoma, stroma rich malignant phyllodes tumour, other primary and metastatic malignant spindle cell tumours of the breast, including angiosarcoma and melanoma, and benign mimics such as florid granulation tissue and nodular fasciitis.
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Affiliation(s)
- Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | - Edi Brogi
- Department of Pathology At Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Cecily Quinn
- Histopathology, BreastCheck, Irish National Breast Screening Programme and St. Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
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47
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Rakha E, Toss M, Quinn C. Specific cell differentiation in breast cancer: a basis for histological classification. J Clin Pathol 2021; 75:76-84. [PMID: 34321225 DOI: 10.1136/jclinpath-2021-207487] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/03/2022]
Abstract
Breast parenchyma progenitor cells show a high degree of phenotypic plasticity reflected in the wide range of morphology observed in benign and malignant breast tumours. Although there is evidence suggesting that all breast cancer (BC) arises from a common epithelial progenitor or stem cell located at the terminal duct lobular units (TDLUs), BC shows a broad spectrum of morphology with extensive variation in histological type and grade. This is related to the complexity of BC carcinogenesis including initial genetic changes in the cell of origin, subsequent genetic and epigenetic alterations and reprogramming that occur at various stages of BC development and the interplay with the surrounding microenvironment, factors which influence the process of differentiation. Differentiation in BC determines the morphology, which can be measured using histological grade and tumour type. Histological grade, which measures the similarity to the TDLUs, reflects the degree of differentiation whereas tumour type reflects the type of differentiation. Understanding BC phenotypic differentiation facilitates the accurate diagnosis and histological classification of BC with corresponding clinical implications in terms of disease behaviour, prognosis and management plans. In this review, we highlight the potential pathways that BC stem cells follow resulting in the development of different histological types of BC and how knowledge of these pathways impacts our ability to classify BC in diagnostic practice. We also discuss the role of cellular differentiation in producing metaplastic and neuroendocrine carcinomas of the breast and how the latter differ from their counterparts in other organs, with emphasis on clinical relevance.
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Affiliation(s)
- Emad Rakha
- School of Medicine, The University of Nottingham, Nottingham, UK
| | - Michael Toss
- School of Medicine, The University of Nottingham, Nottingham, UK
| | - Cecily Quinn
- Histopathology, St. Vincent's Hospital, Dublin, Ireland.,Belfield, University College Dublin - National University of Ireland, Dublin, Ireland
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48
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Abada E, Daaboul F, Ebare K, Jang H, Fehmi Z, Kim S, Ali-Fehmi R, Bandyopadhyay S. Clinicopathologic Characteristics and Outcome Descriptors of Metaplastic Breast Carcinoma. Arch Pathol Lab Med 2021; 146:341-350. [PMID: 34237136 DOI: 10.5858/arpa.2020-0830-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Metaplastic breast carcinoma is an aggressive form of breast cancer that accounts for 0.5% to 3% of all breast cancers. OBJECTIVE.— To study the clinicopathologic characteristics and outcomes of this rare disease. DESIGN.— Retrospective study of patients with a diagnosis of metaplastic breast carcinoma between 2000 and 2019. Hematoxylin-eosin-stained slides were reviewed and additional clinical data were obtained from electronic medical records. Univariable and multivariable Cox proportional hazard regression analyses were used to determine associations between overall survival and several clinicopathologic variables. RESULTS.— Of the 125 patients with metaplastic breast carcinoma identified, only patients with high-grade disease (N = 115) were included in the data analysis. A total of 38 participants (33%) were white, 66 (57%) were African American, and 11 (10%) belonged to other ethnicities. The median age at diagnosis was 57 years. The median tumor size was 3 cm. Heterologous histology was seen in 30% of cases. Multivariable analyses showed that patients with a larger tumor size had worse overall survival (hazard ratio [HR], 1.25; 95% CI, 1.10-1.44; P < .001). Distant metastatic disease was also associated with worse overall survival on multivariable analysis (HR, 10.27; 95% CI, 2.03-55.54; P = .005). In addition to treatment with either partial or complete mastectomies, 84 patients (73%) received chemotherapy. Multivariable analyses showed that chemotherapy had no effect on overall survival (HR, 0.53; 95% CI, 0.09-6.05; P = .55). CONCLUSIONS.— A larger tumor size and distant metastatic disease are associated with worse overall survival in patients with metaplastic breast carcinoma. Additional studies are needed to further characterize our findings.
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Affiliation(s)
- Evi Abada
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Fayez Daaboul
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Kingsley Ebare
- the Department of Pathology, Baylor College of Medicine, Houston, Texas (Ebare)
| | - Hyejeong Jang
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Ziad Fehmi
- the Department of Biomolecular Science, University of Michigan, Ann Arbor (Fehmi)
| | - Seongho Kim
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Rouba Ali-Fehmi
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Sudeshna Bandyopadhyay
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
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Gortman A, Aherne NJ, Westhuyzen J, Amalaseelan JV, Dwyer PM, Hoffmann M, Last AT, Shakespeare TP. Metaplastic carcinoma of the breast: Clinicopathological features and treatment outcomes with long-term follow up. Mol Clin Oncol 2021; 15:178. [PMID: 34276997 DOI: 10.3892/mco.2021.2340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Metaplastic breast carcinoma is an uncommon subtype of invasive ductal carcinoma with a tendency towards poorer clinical outcomes. Following ethical approval, the current study reviewed the institutional records of ~2,500 women with breast cancer. A total of 14 cases of metaplastic breast cancer were reviewed for management and treatment outcomes. The results demonstrated that patients had median follow up of 30 months, a 5-year disease-free survival of 57.1% and 5-year overall survival of 57.1%. The majority of patients had at least T2 disease and all tumours were high grade. Additionally, most patients were triple negative and nodal metastases were uncommon. Metaplastic breast cancer is an aggressive variant of invasive breast cancer. Most patients can be treated with breast conservation and survival parameters tend to be worse than more common breast cancer subtypes.
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Affiliation(s)
- Aron Gortman
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia.,Rural Clinical School, Faculty of Medicine, University of New South Wales, New South Wales 2450, Australia.,School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales 2450, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia
| | - Julan V Amalaseelan
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - Patrick M Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - Matthew Hoffmann
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales 2444, Australia
| | - Andrew T Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales 2444, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia.,Rural Clinical School, Faculty of Medicine, University of New South Wales, New South Wales 2450, Australia
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50
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Trapani D, Giugliano F, Uliano J, Zia VAA, Marra A, Viale G, Ferraro E, Esposito A, Criscitiello C, D'amico P, Curigliano G. Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review. Breast Cancer Res Treat 2021; 187:323-337. [PMID: 34043122 DOI: 10.1007/s10549-021-06259-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting. METHODS We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818). RESULTS We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min-max: 17-5142); median follow-up: 51 months (range: 21-268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients. CONCLUSIONS There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.
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Affiliation(s)
- D Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Giugliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - J Uliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - V A A Zia
- Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04037-004, Brazil
| | - A Marra
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Viale
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Ferraro
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - A Esposito
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - C Criscitiello
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - P D'amico
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy.
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