Journal of Pathology and Translational Medicine

Case Study

Metaplastic Carcinoma with Chondroid Differentiation Arising in Microglandular Adenosis: Ga-Eon Kim, Nah Ihm Kim, Ji Shin Lee, Min Ho Park; J Pathol Transl Med. 2017;51(4):418-421. Published online April 4, 2017; DOI: https://doi.org/10.4132/jptm.2016.10.06

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Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

Citations

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Metaplastic Matrix-Producing Carcinoma and Apocrine Lobular Carcinoma In Situ Associated with Microglandular Adenosis: A Unique Case Report
Nektarios Koufopoulos, Dionysios Dimas, Foteini Antoniadou, Kyparissia Sitara, Dimitrios Balalis, Ioannis Boutas, Alina Roxana Gouloumis, Adamantia Kontogeorgi, Lubna Khaldi
Diagnostics.2022; 12(6): 1458. CrossRef
Salivary gland-type mammary carcinoma arising in microglandular adenosis: A case report and clinicopathological review of the literature
Victoria Rico, Yukiko Shibahara, Marjorie Monteiro, Elzbieta Slodkowska, Samantha Tam, Pearl Zaki, Carlo De Angelis, Edward Chow, Katarzyna Joanna Jerzak
Cancer Treatment and Research Communications.2020; 24: 100178. CrossRef
Microglandular adenosis is an advanced precursor breast lesion with evidence of molecular progression to matrix-producing metaplastic carcinoma
Christopher J. Schwartz, Igor Dolgalev, Esther Yoon, Iman Osman, Adriana Heguy, Eleazar C. Vega-Saenz de Miera, Diana Nimeh, George Jour, Farbod Darvishian
Human Pathology.2019; 85: 65. CrossRef

Original Articles

Comparative Study of Metaplastic Breast Carcinoma and Triple-Negative Breast Carcinoma Using Histologic and Immunohistochemical Analyses.: Ji Yeon Kim, Taeeun Kim, Eun Yoon Cho; Korean J Pathol. 2010;44(6):605-612.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.605

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Abstract PDF

BACKGROUND
Metaplastic carcinoma of the breast is a rare subtype of breast cancer, which is characterized by estrogen receptor/progesterone receptor and HER2 negativity.
METHODS
Tissue specimens from 60 metaplastic breast cancer and 60 triple-negative breast cancer patients diagnosed at a single institution between 1995 and 2009 were analyzed. Immunohistochemistry for caveolin-1 (CAV-1), vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), c-kit, p53, Ki-67, breast cancer type 1 susceptibility protein (BRCA1), cytokeratin (CK)14, and CK17 were performed on both retained tissue sets.
RESULTS
Of the 60 metaplastic carcinomas, 15 tumors (25%) exhibited spindle cell component, 27 (45%) exhibited chondroid differentiation, and 18 (30%) exhibited squamous areas. Compared to triple-negative carcinomas, metaplastic carcinomas significantly more frequently expressed CK14 (p < 0.0001), CK17 (p = 0.002), EGFR (p < 0.0001), CAV-1 (p < 0.0001), and VEGF (p = 0.029). However, expressions of BRCA1, p53, c-kit, and Ki-67 were not significantly different between both groups.
CONCLUSIONS
The expression profile of metaplastic carcinoma of the breast is more homogeneous than that of other triple-negative tumors and frequently over-expresses basal markers, CAV-1, and VEGF. A typical "basal-like" phenotype and frequent expressions of CAV-1 and VEGF may justify specific therapeutic approaches.

Citations

Citations to this article as recorded by

Metaplastic Carcinoma of the Breast with Squamous Differentiation: A Case Report from the University Teaching Hospital of Kigali (CHUK), Rwanda
Delphine Uwamariya, Carine Nyampinga, Anne Yvette Nsenguwera, Belson Rugwizangoga, Piero Tosi
Case Reports in Pathology.2020; 2020: 1. CrossRef

Pathologic Analysis of Gallbladder Cancer by the Stage and Intestinal Metaplasia with the Diagnostic Significance of CEA and p53.: Hee Jin Chang, Jung Il Suh; Korean J Pathol. 1997;31(7):599-607.

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Abstract PDF: Twenty cases of gallbladder cancers were examined using 5 mm stepwise tissue sections. We analyzed the clinicopathologic findings of the early (stage 1, II) and advanced carcinoma (stage III, IV, V) and those of carcinoma with or without metaplasia in the tumor. We also performed CEA and p53 immunohistochemical staining and compared their findings with those of normal mucosa and preneoplastic lesions. The results were as follow: 1) All of the early carcinomas (n=5) were incidentally diagnosed after the resection for the gallstone. They were compared to advanced carcinoma (n=15) in the absence of the lymphatic or angioinvasion, recurrence, metastasis and death. 2) Metaplastic and non-metaplastic carcinoma did not reveal any difference of the clinicopathologic findings except age distribution. 3) CEA and p53 were positive in preneoplastic and malignant lesions. The extent of staining was related to the degree of the atypia. From the above results, an early detection of gallbladder cancer is very important for the prognosis of the patients. Since preoperative diagnosis is difficult, thorough pathologic examination of routinely resected gallbladder is necessary for the early diagnosis. CEA and p53 immunohistochemical staining may be helpful in the differential diagnosis of non-neoplastic and neoplastic lesion of the gallbladder.

Case Reports

Pseudosarcomatous Metaplastic Carcinoma of the Breast with Extensive Cystic Change: A case report.: Ji Shin Lee, Jong Jae Jung, Dong Sug Kim; Korean J Pathol. 2000;34(4):314-317.

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Abstract PDF: Metaplastic carcinomas (carcinomas with metaplasia) of the breast are difficult to accurately diagnose and classify because of their rarity and varied histologic patterns. Cystic change can be encountered in mammary carcinoma, especially in carcinoma with squamous metaplasia, but are rare in pseudosarcomatous metaplastic carcinoma. We recently experienced a case of pseduosarcomatous metaplastic carcinoma in a 69-year-old female who had an extensive cystic change in radiologic and histopathologic findings. The precise cell type that gives rise to metaplastic carcinomas remains uncertain. Immunohistochemical findings raised the possibility of the myoepithelial nature of the tumor.

Fine Needle Aspiration Cytologic Findings of Metaplastic Carcinoma of the Breast: A Case Report.: Soo Kee Min, Hee Jeung Cha, Joon Mee Kim, Young Chae Chu; Korean J Cytopathol. 1996;7(2):202-206.

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Abstract PDF: Metaplastic carcinoma of the breast is a morphologically heterogenous group of neoplasms characterized by ductal adenocarcinoma with extensive squamous differentiation, a spindle-cell pattern of growth, and/or heterologous mesenchymal elements. We experienced a case of metaplastic carcinoma diagnosed by fine needle aspiration(FNA) and confirmed by radical mastectomy in a 46 year-old woman. The FNA cytologic findings included atypical squamous cells with kertinization lying singly and in clusters in a necrotic background. In addition, scattered spindle cells with pleomorphic large nuclei and prominent nucleoli were present in a hemorrhagic and necrotic background. The histopathologic findings showed moderately differentiated squamous cell carcinoma and highly pleomorphic sarcoma with chondroid component. The immunohistochemical stain revealed focal positive reaction for cytokeratin as well as diffuse reactivity for vimentin in the sarcomatous area.

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