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Year : 2014  |  Volume : 57  |  Issue : 1  |  Page : 146-147
Metaplastic breast carcinoma with extensive chondrosarcomatous differentiation

1 Department of Pathology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
2 Department of Surgery, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India

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Date of Web Publication17-Apr-2014

How to cite this article:
Venkatachala S, Jayaraman A, Chaitra V, Rjeshkumar S. Metaplastic breast carcinoma with extensive chondrosarcomatous differentiation. Indian J Pathol Microbiol 2014;57:146-7

How to cite this URL:
Venkatachala S, Jayaraman A, Chaitra V, Rjeshkumar S. Metaplastic breast carcinoma with extensive chondrosarcomatous differentiation. Indian J Pathol Microbiol [serial online] 2014 [cited 2021 Sep 22];57:146-7. Available from: https://www.ijpmonline.org/text.asp?2014/57/1/146/130930

We report a case of a 51-year-old female patient who presented with left breast lump since 3 months. There was no history of nipple discharge or pain. On examination, a hard lump measuring 3 cm × 3 cm was seen in the upper inner quadrant of the left breast. There were no palpable axillary lymph nodes. An ultrasound and mammogram revealed rounded nodular swellings with a rounded margin. Trucut biopsy done elsewhere was reported as invasive duct carcinoma. Left modified radical mastectomy was done.

The specimen measured 19 cm × 16 cm × 5.5 cm. The cut surface showed a circumscribed grey white mass with translucent areas and irregular margins measuring 5 cm × 4 cm × 3.5 cm [Figure 1]a. On histological examination, the neoplasm was composed of Invasive duct carcinoma, no specific type (NST) merging intimately with large areas of heterologous mesenchymal component in the form of chondrosarcoma [Figure 1]b and c]. Atypical binucleate, multinucleate cells with surrounding lacunae were seen embedded in the chondroid matrix [Figure 1]d. The tumor sections were subjected to a panel of immunohistochemical markers including S100, CK7, EMA, ER, PR, HER-2/neu. Invasive duct carcinoma component was positive for CK7, EMA, vimentin, S100, HER-2/neu and negative for ER, PR [Figure 2]a-d; whereas the malignant chondroid element was only positive for S100, vimentin and negative for CK7 and EMA [Figure 2]a-c]. The 25 axillary lymph nodes were free of tumor. With these morphological and immunohistochemical features, the diagnosis of metaplastic carcinoma (carcinosarcoma - infiltrating duct carcinoma grade 2 and chondrosarcoma) was favored.
Figure 1: (a) Mass with translucent areas, (b and c) invasive ductal carcinoma (red arrow) with malignant cartilage (yellow arrow) H and E, 100, (d) malignant cartilage H and E, 400

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Figure 2: (a) S100+, (b) vimentin + carcinoma and mesenchymal components (100), (c) epithelial membrane antigen + 100, (d) HER-2/ neu+ carcinoma cells 400

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   Discussion Top

Tumors exhibiting both carcinomatous and sarcomatous features are uncommon and occur in various anatomical sites. In the breast the tumor is often referred to as metaplastic carcinoma accounting for 0.3% of all invasive cancers [1] . These neoplasms are characterised by an intimate admixture of adenocarcinoma with dominant areas of spindle cell, squamous and/or mesenchymal differentiation. [2] Mesenchymal component in the form of chondrosarcoma is even more rare (0.17% of metaplastic carcinoma) [3] . We report a case of this extremely rare entity-metaplastic carcinoma with chondrosarcomatous differentiation.

The metaplastic carcinomas of the breast have been broadly classified as purely epithelial and mixed epithelial - mesenchymal [1] The purely epithelial group includes squamous cell carcinomas, adenocarcinoma with spindle cell differentiation and adenosquamous carcinoma. The second broad category metaplastic carcinoma also called as matrix producing carcinoma show an infiltrating carcinoma mixed with heterologous mesenchymal elements ranging from benign chondroid/osseous matrix to frank sarcoma (chondrosarcoma, osteosarcoma, rhabdomyosarcoma, fibrosarcoma) [1] . The designation of carcinosarcoma is used when the mesenchymal component is malignant. The popular theory explaining the histiogenesis of metaplastic components is through transformation of myoepithelial cells or a multipotent duct progenitor cell after p53 mutation [4] .

Very few case reports of metaplastic carcinoma with chondrosarcomatous component have been described in the literature. The commonest epithelial element is poorly differentiated duct carcinoma, NST as in the present case. Metaplasia has also been reported in association with lobular, tubular, medullary and mucinous breast carcinoma [4] . Among the spectrum of heterologous mesenchymal components seen in metaplastic carcinoma, the incidence of osteo/chondrosarcoma is very rare (0.17%) [3] . This rare chondrosarcomatous component was seen in our case.

The definitive areas of carcinoma may at times be minimal (often referred to as monophasic sarcomatoid carcinoma) requiring immunohistochemical analysis of these neoplasms [5] . The most useful panel of markers comprise of S100, CK and EMA, vimentin. The tumor cells in chondrosarcomatous areas are diffusely reactive for S100, vimentin, focally positive for CK but negative for EMA; whereas in carcinomatous areas the tumor cells are diffusely positive for CK and S100 with focal positivity for EMA. Our panel was comprised of all the four markers with similar staining pattern.

Metaplastic carcinoma rarely exhibits estrogen and progesterone receptors. The frequency of HER-2/neu overexpression ranges from negative to 33%. The neoplastic cells in the current case also expressed only HER-2/neu [4] .

The mean age of presentation is 61 years (46yrs-82yrs) [3] . Our patient was a 51-year -old female with similar findings. Metastasis to axillary lymph nodes is relatively uncommon as in our case. Compared with patients with infiltrating duct carcinoma, the overall 3 year survival rate of 53-60% in this group of matrix producing metaplastic carcinoma appears to be more favorable after adjustment for nodal metastases and their sizes. A modified radical mastectomy with adjuvant chemotherapy is being followed. The role of chemotherapy has not been established [4]

The differential diagnoses of chondrosarcomatous lesions of the breast include a pure chondrosarcoma and malignant phyllodes tumor with heterologous component [5] . Extensive meticulous tumor sampling to rule out carcinoma component breast in the former and the presence of benign ductal elements would exclude the possibility of the latter differential diagnosis.

   References Top

1.Ellis IO, Pinder SE, Lee AHS. Tumors of the breast. In: Fletcher CD, editor. Diagnostic Histopathology of Tumors. 3 rd ed., Vol. 1. China: Elsevier Press; 2007. p. 938.  Back to cited text no. 1
2.Ellis IO, Schmitt SJ, Sastre-Garau X, Bussalati G, Tavassoli FA, Eusebiv A, et al. Invasive breast carcinoma. In: Tavassoli FA, Devilee P, editors. WHO Classification of Tumors. Pathology and Genetics. Tumors of the Breast and Female Genital Tract. 5 th ed. Lyon: IARC Press; 2003. p.37-41.  Back to cited text no. 2
3.Kurian KM, Al-Nafussi A. Sarcomatoid/metaplastic carcinoma of the breast: A clinicopathological study of 12 cases. Histopathology 2002;40:58-64.  Back to cited text no. 3
4.Fenyvesi A. A case of carcinoma of the breast with metaplasia to chondrosarcoma: light microscopic and immunohistochemical features. Arch of Oncol 2003;11:273-6.  Back to cited text no. 4
5.Yamaguchi R, Horii R, Maeda I, Suga S, Makita M, Iwase T, et al. Clinicopathologic study of 53 metaplastic breast carcinomas: Their elements and prognostic implications. Hum Pathol 2010;41:679-85.  Back to cited text no. 5

Correspondence Address:
Sandhya Venkatachala
Department of Pathology, PSG Institute of Medical Sciences and Reseach, Peelamedu, Coimbatore - 641 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.130930

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