• Breast cancer-specific survival
• Hormone receptor status
• Metaplastic breast carcinoma
• Overall survival
• Race disparities
• Survival trends

• Humans
• Female
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Breast Neoplasms/therapy
• SEER Program
• Middle Aged
• Retrospective Studies
• Receptors, Progesterone/metabolism
• Receptors, Estrogen/metabolism
• Aged
• Adult
• Receptor, ErbB-2/metabolism
• Prognosis
• Cohort Studies
• Metaplasia
• Kaplan-Meier Estimate
• United States/epidemiology

• 21S11900400 Shanghai Municipal Science and Technology Project

• Metaplastic breast carcinoma
• anti-angiogenic targeted therapy
• epidermal growth factor receptor
• prognostic factors
• progression-free survival

• breast cancer
• breast imaging
• conventional and advanced imaging
• invasive lobular carcinoma
• special types

• chemotherapy
• metaplastic breast cancer
• metastasis
• overall survival
• systemic treatment

• Diagnosis
• Diagnostic
• Prognosis
• Pronostic
• Rare breast tumours
• Traitement
• Treatment
• Tumeurs rares du sein

• Humans
• Female
• Prognosis
• Carcinoma, Lobular/pathology
• Breast Neoplasms/diagnostic imaging
• Breast Neoplasms/therapy

• Clinical management
• Clinical outcomes
• Epithelial-to-mesenchymal transition
• Immunotherapy
• Metaplastic breast cancer
• Pathology
• Targeted therapy

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.

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.

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.

Given the variety of immunohistochemical types of bilateral breast cancer, achieving effective chemotherapy should be a key research focus.

• Metaplastic breast cancer
• Invasive ductal carcinoma
• Carcinosarcoma
• Chondrosarcoma differentiation
• Bilateral breast cancer
• Case report

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.

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.

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.

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.

• breast cancer
• metaplastic
• radiation
• triple negative

Purpose: Chemotherapy is the clinically recommended treatment for patients with operable metaplastic breast carcinoma (MBC); however, its impact remains controversial. This study investigated the possible role of chemotherapy in the treatment of MBC.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify the operable MBC patients. The competing risk analysis along with the propensity score matching (PSM) method was performed to evaluate the effect of chemotherapy. Moreover, a competing risk nomogram was built to identify prognosis in patients with MBC.

Results: Of the 1137 patients with MBC, 775 received chemotherapy and 362 did not receive chemotherapy. The 5-year cumulative incidence of breast cancer-specific death (BCSD) showed similar outcomes in both the Chemo and No-Chemo groups (21.1 vs. 24.3%, p = 0.57). Chemotherapy showed no apparent association with BCSD (HR, 1.07; 95% CI, 0.72–1.60; p = 0.72), even after subgroup analysis or PSM. Race, tumor size, lymph node status, and radiation were identified as the significant factors for MBC after a penalized variable selection process. In addition, a competing risk nomogram showed relatively good accuracy of prediction with a C-index of 0.766 (95% CI, 0.700–0.824).

Conclusion: Our findings demonstrated that chemotherapy did not improve BCSD for operable MBC patients. Thus, it may indicate the need to reduce exposure to the current chemotherapy strategies for patients with resectable MBC. Additionally, some novel treatment strategies are required urgently to identify and target the potential biomarkers.

• SEER
• chemotherapy
• metaplastic breast carcinoma
• nomogram
• survival analysis

• Basement membrane
• Nidogen 1
• blood biomarker
• breast cancer
• extracellular matrix
• gene expression
• lung metastasis
• mRNA levels.

• biphasic
• carcinosarcoma
• metaplastic
• triple negative

• Breast neoplasms
• magnetic resonance imaging
• mammography
• survival analysis
• triple-negative breast cancer
• ultrasonography

Metaplastic breast cancer is difficult to diagnose, resistant to conventional treatment, and biologically aggressive. A suspicious timeline and discordance between imaging findings and histopathologic tissue diagnosis should trigger additional workup. New, large lesions or rapidly growing lesions with complex echogenicity on ultrasound warrant correlation with image-guided biopsy for a definitive diagnosis. Lesions that appear aggressive on imaging, with negative biopsy findings, may represent false negatives due to sampling bias from intratumoral heterogeneity. In such cases, it may be advisable to obtain an excisional biopsy. These tumors are known to progress even with neoadjuvant chemotherapy. Immunotherapy, however, may be effective even for metastatic disease. A multidisciplinary approach and a high index of suspicion may, therefore, confer survival benefits in circumstances where the imaging phenotype does not fit with the timeline or pathologic diagnosis. This report describes five cases of metaplastic breast cancer diagnosed at our institution to highlight the importance of a timely and accurate diagnosis of this rare but aggressive breast malignancy.

• breast mri
• immunotherapy
• intratumoral heterogeneity
• metaplastic breast cancer
• p63
• radiomics
• sampling bias
• spindle cell metaplastic breast cancer

• metaplastic breast carcinoma
• survival
• immunohistochemistry

• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor/analysis
• Breast Neoplasms/chemistry
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Breast Neoplasms/therapy
• Carcinoma/chemistry
• Carcinoma/mortality
• Carcinoma/secondary
• Carcinoma/therapy
• Female
• Humans
• Lymphatic Metastasis
• Metaplasia
• Middle Aged
• Neoplasm Staging
• Receptor, ErbB-2/analysis
• Receptors, Estrogen/analysis
• Receptors, Progesterone/analysis
• Treatment Outcome
• Tumor Burden
• Turkey

• Breast
• Dermatofibrosarcoma protuberans
• Imatinib
• Metaplastic breast carcinoma
• Neoadjuvant

• RNA sequencing
• breast cancer
• canine mammary adenoma
• canine mammary carcinoma
• comparative oncology
• laser-capture microdissection
• tumor microenvironment
• tumor stroma

• metaplastic breast carcinoma
• systematic review
• targeted therapies
• treatment

Breast carcinosarcoma is an extremely rare, clinically aggressive tumor, and no standard treatment has been established. We report about a 34-year-old woman presenting with a 2.5-cm-sized carcinosarcoma in her right breast. She presented to our hospital for examination of this mass. Ultrasonography showed a hypoechoic mass with partially irregular margins. Fine-needle aspiration cytology indicated malignancy. No enlarged lymph nodes or distant metastases were detected. We diagnosed right breast cancer and performed partial mastectomy, sentinel lymph node biopsy, and latissimus dorsi muscle flap transfer. Histological findings revealed that the tumor consisted of a mixture of an epithelial component and a mesenchymal component. The final diagnosis was carcinosarcoma. After undergoing adjuvant chemotherapy and radiotherapy, the patient has had no recurrence, and her cosmesis is maintained. Clinical data of carcinosarcoma are insufficient. Breast conservation and reconstruction for carcinosarcoma may be suitable as local treatments; however, the most appropriate treatment method has not been established.

• Carcinosarcoma
• breast-conserving surgery
• reconstruction

Metaplastic breast cancer (MBC) is a rare type of breast cancer, characterized histologically by the presence of two or more malignant cell types (epithelial and mesenchymal). This retrospective study aimed to review the imaging and histological features of MBC, with a review of the literature.

Nineteen patients with MBC (age range, 28–75 years; mean, 55 years) underwent review of their clinical records, histopathology, immunohistochemistry, and imaging findings, which included mammography, sonography, and magnetic resonance imaging (MRI) with T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and diffusion restriction determined by the apparent diffusion coefficient (ADC) and a time-intensity curve (TIC) for signal intensity.

The mammographic features of MBC were oval shaped (54.5%), with indistinct margin (45.5%), and high tumor density (72.7%), and on sonography, they were oval shaped (57.1%), with hypo-echogenic areas (85.8%). On MRI, MBC showed moderate hyper-intensity with a high signal intensity in the center of the tumor on T2WI (100%), an indistinct margin (75.0%), and rim enhancement (58.3%). Using a TIC, the early phase showed rapid enhancement, and the delay phase showed a signal plateau (91.7%). DWI showed diffusion restriction in all cases determined by the ADC. Immunohistochemistry showed negative expression of estrogen receptor (ER) (91.0%), progesterone receptor (PR) (81%), and HER2 (erbB-2) (80.0%).

Imaging features of MBC on mammography and ultrasound were benign. The use of T2WI MRI showed characteristic features of signal intensity using TIC curve and ADC analysis, which may support biopsy and histological analysis for definitive diagnosis.

• Estrogen receptor
• Metaplastic breast carcinoma
• Progesterone receptor
• Triple-negative breast cancer

• breast
• carcinoma
• carcinosarcoma
• differentiation
• mesenchymal
• metaplastic

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Breast Neoplasms/diagnosis
• Breast Neoplasms/drug therapy
• Breast Neoplasms/pathology
• Breast Neoplasms/surgery
• Carcinoma, Ductal, Breast/diagnosis
• Carcinoma, Ductal, Breast/drug therapy
• Carcinoma, Ductal, Breast/pathology
• Carcinoma, Ductal, Breast/surgery
• Chemotherapy, Adjuvant
• Diagnosis, Differential
• Disease-Free Survival
• Female
• Humans
• Mastectomy
• Metaplasia/pathology
• Middle Aged
• Mixed Tumor, Malignant/diagnosis
• Mixed Tumor, Malignant/drug therapy
• Mixed Tumor, Malignant/pathology
• Mixed Tumor, Malignant/surgery
• Neoplasm Staging
• Receptor, ErbB-2/metabolism

• Breast
• cancer
• lymph
• metaplastic
• node
• sentinel

To review the imaging findings of a series of cases of metaplastic carcinoma of the breast, a rare and aggressive form of breast cancer with variable imaging features.

Retrospective review of multimodality imaging features of eleven cases of metaplastic carcinoma of the breast retrieved from a single hospital institution database. Clinical and pathologic data were also documented.

The median age of presentation was 65 years. Four cases had axillary lymphadenopathies, and two had distant metastases. An oval mass was the most common sonographic finding (7/11; 64%). Lesions displayed circumscribed/partially circumscribed margins (6/11; 55%) or non-circumscribed margins (5/11; 45%). Most lesions had a heterogeneous echo structure (9/11; 82%) and posterior acoustic enhancement (6/11; 55%). In nine patients, mammographies were available. An oval dense mass was the most common mammographic finding (5/9; 56%). The majority of cases had non-circumscribed margins (6/9; 67%), and nearly half displayed calcifications (4/9; 44%).

Mammographic findings were not different from the usual features of more prevalent types of breast cancer, though the majority of metaplastic carcinoma of the breast showed possible distinctive sonographic features, such as circumscribed margins or complex echogenicity, reflecting the histologic background.

• breast neoplasms
• breast ultrasonography
• magnetic resonance imaging
• mammography
• metaplastic carcinoma of the breast

• Iran
• acute myeloid leukemia
• adenosquamous carcinoma
• breast cancer
• metaplastic carcinoma

• breast neoplasm
• color doppler flow imaging
• mammography
• metaplastic breast carcinoma
• pathology

• Chemotherapy
• Genetics
• MBC
• Review
• Targeted therapies

• Breast Neoplasms/genetics
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Breast Neoplasms/therapy
• Carcinoma, Ductal, Breast/mortality
• Carcinoma, Ductal, Breast/pathology
• Carcinoma, Ductal, Breast/therapy
• Carcinoma, Lobular/mortality
• Carcinoma, Lobular/pathology
• Carcinoma, Lobular/therapy
• Clinical Trials as Topic
• Combined Modality Therapy/methods
• Disease-Free Survival
• Drug Resistance, Neoplasm
• Female
• Humans
• Immunohistochemistry
• Molecular Targeted Therapy/methods
• Precision Medicine/methods
• Prognosis
• Treatment Outcome

• Metaplastic carcinoma
• breast
• incidence
• prognosis
• treatment

• Adult
• Antineoplastic Agents/therapeutic use
• Bridged-Ring Compounds/therapeutic use
• Carcinoma, Ductal, Breast/epidemiology
• Carcinoma, Ductal, Breast/pathology
• Carcinoma, Ductal, Breast/therapy
• Disease-Free Survival
• Female
• Humans
• Incidence
• Mastectomy/adverse effects
• Mastectomy/methods
• Mastectomy/statistics & numerical data
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Taxoids/therapeutic use
• Triple Negative Breast Neoplasms/epidemiology
• Triple Negative Breast Neoplasms/pathology
• Triple Negative Breast Neoplasms/therapy
• Turkey/epidemiology

• Invasive breast cancer
• Sarcomatous

• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms/mortality
• Breast Neoplasms/pathology
• Breast Neoplasms/therapy
• Carcinoma, Ductal, Breast/mortality
• Carcinoma, Ductal, Breast/pathology
• Carcinoma, Ductal, Breast/therapy
• China/epidemiology
• Female
• Humans
• Lymphatic Metastasis
• Middle Aged
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/pathology
• Prognosis
• Retrospective Studies

• Antineoplastic Agents/therapeutic use
• Breast Neoplasms/drug therapy
• Breast Neoplasms/genetics
• Breast Neoplasms/pathology
• Breast Neoplasms/secondary
• Carcinoma/drug therapy
• Carcinoma/genetics
• Carcinoma/pathology
• Carcinoma/secondary
• Diagnosis, Differential
• Female
• Humans
• Molecular Targeted Therapy/methods
• Prognosis
• Rare Diseases/drug therapy
• Rare Diseases/genetics
• Rare Diseases/pathology

Metaplastic breast carcinomas (MBCs) are rare malignancies usually with poor prognosis. We report a case of an 18-year-old African female patient who presented with a 34-cm tumor on the right breast. Biopsy showed an extensively necrotic MBC negative for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (triple negative). A modified right radical mastectomy was performed, followed by adjuvant chemotherapy. Histology confirmed a widely necrotic undifferentiated malignant tumor, with strong and diffuse expression of vimentin and B-cell lymphoma 2, focal high-molecular-weight keratins and focal CD34 expression; Ki67 was >90%. There was no skin, deep margin or lymph node involvement. Six months after surgery, the patient showed a 9 × 7 cm nodule adjacent to the suture and adherent to the anterior chest wall. The tumor was considered unresectable and the patient evolved with rapid systemic deterioration. The patient had a progression-free survival of 6 months and overall survival of 9 months.

• Breast cancer
• carcinosarcoma
• metaplastic cancer

• VEGF
• VEGFR-2
• cancer
• canine
• carcinosarcomas
• mammary

• Breast cancer
• Rare breast tumors
• Review