A total of 21 metaplastic breast carcinomas (MCs) with chondroid differentiation were evaluated to better establish the clinicopathological features of this variant. The tumors exhibited mainly invasive carcinoma admixed with areas of cartilaginous matrix production. An associated ductal intraepithelial neoplasia component grade 2 or 3 was observed in 43% of cases. Immunohistochemical analysis revealed a triple negative (ER−, PR−, and Her2/neu−) immunoprofile and no expression of the androgen receptor. EGFR-positivity was found in 88% of evaluated cases, consistent with the proposed basaloid phenotype for all MC. Compared with previous studies that reviewed MC with osseus and cartilaginous elements, the incidence of axillary lymph node metastasis was significantly higher in our study and 60% of positive nodes exhibited chondroid differentiation. Available follow-up data (n = 10) revealed aggressive behavior of this MC variant with frequent metastasis, including visceral involvement and local chest wall recurrence despite chemotherapy and radiation. Three patients subsequently died of metastatic disease.
Huvos AG, Lucas JC Jr, Foote FW Jr.Metaplastic breast carcinoma. Rare form of mammary cancer. N Y State J Med. 1973;73:1078-1082.
2.
Reis-Filho JS , Milanezi F., Steele D., et al. Metaplastic carcinoma are basal-like tumours. Histopathology. 2006;49: 10-21.
3.
Nielsen TO, Hsu FD, Jensen K., et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004;10: 5367-5374.
4.
Sørlie T., Perou CM, Tibshirani R., et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98:10869-10874.
5.
Sotiriou C., Neo SY, McShane LM, et al. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci U S A. 2003;100:10393-10398.
6.
Banerjee S., Reis-Filho JS, Ashley S., et al. Basal-like breast carcinomas: clinical outcome and response to chemotherapy. J Clin Pathol. 2006;59:729-735.
7.
Al Sayed AD, El Weshi AN, Tulbah AM, et al. Metaplastic carcinoma of the breast clinical presentation, treatment results and prognostic factors. Acta Oncol. 2006;45: 188-195.
8.
Barnes PJ, Boutilier R., Chiasson D., Rayson D.Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression. Breast Cancer Res Treat. 2005;91:173-178.
9.
Beatty JD, Atwwod M., Tickman R., et al. Metaplastic breast cancer: clinical significance. Am J Surg. 2006; 191:657-664.
10.
Bellino R., Arisio R., D’Addato F., et al. Metaplastic breast carcinoma: pathology and clinical outcome . Anticancer Res. 2003;23:669-673.
11.
Chao TC, Wang CS, Chen SC, et al. Metaplastic carcinomas of the breast. J Surg Oncol. 1999;71:220-225.
12.
Gibson GR, Qian D., Ku J., et al. Metaplastic breast cancer: clinical features and outcomes. Am Surg. 2005;71: 725-730.
13.
Luini A., Aguilar M., Gatti G., et al. Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat. 2007;101:349-353.
14.
Tse GM, Tan PH, Putti TC, et al. Metaplastic carcinoma of the breast: a clinicopathological review . J Clin Pathol. 2006;59:1079-1083.
15.
Pezzi CM, Patel-Parekh L., Cole K., et al. Characteristics and treatment of metaplastic breast cancer: analysis of 892 cases from the National Cancer Data Base. Ann Surg Oncol. 2007;14:166-173.
16.
Tavassoli FAMetaplastic carcinoma. In: Tavassoli FA, ed. Pathology of the Breast. 2nd ed. Stamford, CT: Appleton & Lange; 1999.
17.
Ellis IO, Schnitt SJ, Sastre-Garau X., et al. Invasive breast carcinoma. Metaplastic carcinoma. In: Tavassoli FA, Devilee P, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs . 1st ed. Lyon, France: IARC Press ; 2003.
18.
Wargotz ES, Norris HJMetaplastic carcinomas of the breast. I. Matrix-producing carcinoma. Hum Pathol. 1989; 20:628-635.
19.
Chhieng C., Cranor M., Lesser ME, et al. Metaplastic carcinoma of the breast with osteocartilaginous heterologous elements. Am J Surg Pathol. 1998 ;22: 188-194.
20.
Spagnolo DV , Shilkin KBBreast neoplasms containing bone and cartilage in mammary tumors. Virchows Arch A Pathol Anat Histopathol . 1983;400:287-295.
21.
Wolff AC, Hammond EH, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologist guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007;25:118-145.
22.
Tavassoli FAClassification of metaplastic carcinomas of the breast. Pathol Annu. 1992;27(pt 2):89-119.
23.
Turner NC, Reis-Filho JSBasal-like breast cancer and the BRCA1 phenotype. Oncogene . 2006;25:5846-5853.
24.
McCarthy A. , Savage K., Gabriel A., et al. A mouse model of basal-like breast carcinoma with metaplastic elements. J Pathol. 2007;211:389-398.
25.
Oberman HAMetaplastic carcinoma of the breast. A clinicopathologic study of 29 patients . Am J Surg Pathol. 1987;11:918-929.
26.
Shin HJ, Kim HH, Kim SM, et al. Imaging features of metaplastic carcinoma with chondroid differentiation of the breast. AJR Am J Roentgenol. 2007;188:691-696.
27.
Kaufman MW, Marti JR, Gallager HS, et al. Carcinoma of the breast with pseudosarcomatous metaplasia. Cancer. 1984;53:1908-1917.
28.
Leibl S., Moinfar F.Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors? J Clin Pathol. 2005;58:700-704.
29.
Moinfar F., Okcu M., Tsybrovskyy O., et al. Androgen receptors frequently are expressed in breast carcinomas: potential relevance to new therapeutic strategies. Cancer . 2003;98:703-711.
30.
Iqbal S., Lenz HJIntegration of novel agents in the treatment of colorectal cancer. Cancer Chemother Pharmacol. 2004;54(suppl 1):S32-S39.
31.
Saltz LB, Meropol NJ, Loehrer PJ Sr, et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol. 2004;22:1201-1208.
32.
Bossuyt V., Fadare O., Martel M., et al. Remarkably high frequency of EGFR expression in breast carcinomas with squamous differentiation. Int J Surg Pathol. 2005;13:319-327.
33.
Reis-Filho JS, Pinheiro C., Lambros MB, et al. EGFR amplification and lack of activating mutations in metaplastic breast carcinomas. J Pathol. 2006;209:445-453.
34.
Reis-Filho JS, Milanezi F.Carvalho S., et al. Metaplastic breast carcinomas exhibit EGFR, but not HER2, gene amplification and overexpression: immunohistochemical and chromogenic in situ hybridization analysis. Breast Cancer Res. 2005;7:R1028-R1035.
35.
Carter MR, Hornick JL, Lester S., et al. Spindle cell (sarcomatoid) carcinoma of the breast: a clinicopathologic and immunohistochemical analysis of 29 cases. Am J Surg Pathol . 2006;30:300-309.
