Metaplastic Carcinoma of the Breast: A Clinical Study of 7 Cases from Balochistan

Abdul Hameed Baloch, Shakeela Daud, Jameela Shuja, Adeel Ahmad, Fateh Ali, Mohammad Akram, Dost Mohammad Baloch, Abdul Majeed Cheema, Mohammad Iqbal, Jamil Ahmad

Bolan Medical College/Hospital (BMC) Quetta.
CENAR, Quetta, Pakistan.
Center for Advanced Molecular Biology (CAMB), Lahore, Pakistan.
Department of Biotechnology and Informatics, BUITEMS, Quetta, Pakistan.
Institute of Biochemistry and Biotechnology (IBBt), UVAS, Lahore, Pakistan.
Institute of Molecular Biology and Biotechnology, The University of Lahore, Pakistan.
Lasbela University of Agriculture, Water and Marine Sciences, Balochistan.

DOI: 10.4236/abcr.2014.33016                

Abstract

Metaplastic carcinomas of the breast are rare heterogenous neoplasms characterized by adenocarcinoma with dominant areas of spindle cells, squamous and/or other mesenchymal differentiation, that comprise of <5% of all invasive breast cancers. Our objective in this study was to review the pathological features and clinical outcomes for metaplastic carcinoma of breast in breast cancer patients registered in CENAR (Center for Nuclear Medicines and Radiotherapy), Balochistan. Present study was performed on 7 patients affected with metaplastic carcinoma of breast, who were registered patients in CENAR. Informed consent was taken from the patients and BMI was calculated by measuring the height and weight of the patients. Available clinical history obtained by retrieving the patients file and a copy of biopsy report was also obtained from the file. Metaplastic carcinoma of breast was 4.11% of all 170 breast cancer cases registered in CENAR from 2010-2012. Mean age was 40 years ranging from 25 - 50 years. Four subtypes of metaplastic carcinoma of breast were reported in this study; DCIS component was present in one case and mean tumor size was 6.12 cm ranging from 3.5 - 10 cm. Metaplastic carcinomas of breast are rare heterogenous neoplasm with different characteristics, demographics and tumor biology and accounts for almost >5% of all breast cancer cases.

Keywords

Breast Cancer, Metaplastic Carcinoma of Breast, CENAR, Balochistan, BMI, MBC

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Brenner, R.J., Turner, R.R., Schiller, V., Arndt, R.D. and Giuliano, A. (1998) Metaplastic Carcinoma of the Breast: Report of Three Cases. Cancer, 82, 1082-1087. http://dx.doi.org/10.1002/(SICI)1097-0142(19980315)82:6<1082::AID-CNCR11>3.0.CO;2-2
[2]	Rauf, F., Kiyani, N. and Bhurgri, Y. (2006) Metaplastic Carcinoma of Breast, an Intriguing Rarity. Asian Pacific Journal of Cancer Prevention, 7, 667-71.
[3]	Pitts, W.C., Rajos, V.A., Gaffey, M.J., Rouse, R.V., Esteban, J., Frierson, H.F., Kempson, R.L. and Weiss, L.M. (1991) Carcinomas with Metaplasia and Sarcomas of the Breast. American Journal of Clinical Pathology, 95, 623-632
[4]	Tavassoli, F.A. (1992) Classification of Metaplstic Carcinomas of the Breast. Annual Review of Pathology, 27, 89-119.
[5]	Rosen, P.P. (1997) Rosen’s Breast Pathology. Lippencott-Raven Philadelphia, 375-395.
[6]	Elston, C.W. and Ellis, I.O. Vol. 13. The Breast In: Systemic Pathology. 3rd Edition, Churchill Livingstone, Edinburugh, 1998, 323-328.
[7]	Wargotz, E.S. and Norris, H.J. (1990) Metaplastic Carcinomas of the Breast: IV. Squamous Cell Carcinoma of Ductal Origin. Cancer, 65, 272-276. http://dx.doi.org/10.1002/1097-0142(19900115)65:2<272::AID-CNCR2820650215>3.0.CO;2-6
[8]	Oberman, H.A. (1987) Metaplastic Carcinoma of the Breast. The American Journal of Surgical Pathology, 11, 918-929. http://dx.doi.org/10.1097/00000478-198712000-00002
[9]	Feder, J.M., de Paredes, E.S., Hogge, J.P. and Wilken, J.J. (1999) Unusual Breast Lesions: Radiologic-Pathologic Correlation. Radio Graphics, 19, S11-S26. http://dx.doi.org/10.1148/radiographics.19.suppl_1.g99oc07s11
[10]	Luini, A., Aguilar, M., Gatti, G., Fasani, R., Brito, J.A., Maisonneuve, P., Vento, A.R. and Viale, G. (2007) 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 Research and Treatment, 101, 349-353. http://dx.doi.org/10.1007/s10549-006-9301-1
[11]	Wargotz, E.S. and Norris, H.J. (1989) Metaplastic Carcinomas of the Breast: I. Matrix-Producing Carcinoma. Human Pathology, 20, 628-635. http://dx.doi.org/10.1016/0046-8177(89)90149-4
[12]	Wargotz, E.S. Deos, P.H. and Norris, H.J. (1989) Metaplastic Carcinomas of the Breast: II. Spindle Cell Carcinoma. Human Pathology, 20, 732-740. http://dx.doi.org/10.1016/0046-8177(89)90065-8
[13]	Gutman, H., Pollock, R.E., Janjan, N.A. and Johnson, D.A. (1995) Biological Distributions and Therapeutic Implications of Sarcomatoid Metaplasia of Epithelial Carcinoma of the Breast. Journal of the American College of Surgeons, 180, 193-199.
[14]	Al Sayed, A.D. El Weshi, A.N., Tulbah, A.M., Rahal, M.M. and Ezzat, A.A. (2006) Metaplastic Carcinoma of the Breast Clinical Presentation, Treatment Results and Prognostic Factors. Acta Oncologica, 45, 188-195. http://dx.doi.org/10.1080/02841860500513235
[15]	Tse, G.M., Tan, P.H., Putti, T.C., Lui, P.C.W., Chaiwun, B. and Law, B.K.B. (2006) Metaplastic Carcinoma of the Breast: A Clinicopathological Review. Journal of Clinical Pathology, 59, 1079-1083. http://dx.doi.org/10.1136/jcp.2005.030536
[16]	Weigelt, B., Kreike, B. and Reis-Filho, J.A. (2009) Metaplastic Breast Carcinomas Are Basal-Like Breast Cancers: A Genomic Profiling Analysis. Breast Cancer Research and Treatment, 117, 273-280. http://dx.doi.org/10.1007/s10549-008-0197-9
[17]	Rayson, D., Adjei, A.A., Suman, V.J., Wold, L.E. and Ingle, J.N. (1999) Metaplastic Breast Cancer: Prognosis and Response to Systemic Therapy. Annals of Oncology, 10, 413-419. http://dx.doi.org/10.1023/A:1008329910362
[18]	Bae, S.Y., Lee, S.K., Koo, M.Y., Hur, S.M., Choi, M.Y., Cho, D.H. Kim, S., Choe, J.H., Lee, J.E., Kim, J.H., Kim, J.S., Nam, S.J. and Yang, J.H. (2011) The Prognoses of Metaplastic Breast Cancer Patients Compared to Those of Triple-Negative Breast Cancer Patients. Breast Cancer Research and Treatment, 126, 471-478. http://dx.doi.org/10.1007/s10549-011-1359-8
[19]	Jung, S.Y., Kim, H.Y., Nam, B.H., Min, S.Y., Lee, S.J., Park, C., et al. (2000) Worse Prognosis of Metaplastic Breast Cancer Patients than Other Patients with Triple-Negative Breast Cancer. Breast Cancer Research and Treatment, 120, 627-637. http://dx.doi.org/10.1007/s10549-010-0780-8
[20]	Okada, N., Hasebe, T., Iwasaki, M., Tamura, N., Akashi-Tanaka, S., Hojo, T., et al. (2010) Metaplastic Carcinoma of the Breast. Human Pathology, 41, 960-970. http://dx.doi.org/10.1016/j.humpath.2009.11.013
[21]	Kaufman, M.W., Marti, J.R., Gallager, H.S. and Hoehn, J.L. (1984) Carcinoma of the Breast with Pseudosarcomatous Metaplasia. Cancer, 53, 1908-1917. http://dx.doi.org/10.1002/1097-0142(19840501)53:9<1908::AID-CNCR2820530917>3.0.CO;2-F
[22]	Chao, T.C., Wang, C.S., Chen, S.C. and Chen, M.F. (1999) Metaplastic Carcinomas of the Breast. Journal of Surgical Oncology, 71, 220-225. http://dx.doi.org/10.1002/(SICI)1096-9098(199908)71:4<220::AID-JSO3>3.0.CO;2-L
[23]	Carter, C.L., Allen, C. and Henson, D.E. (1969) Relation of Tumor Size, Lymph Node Status and Survival in 24,740 Breast Cancer Cases. Cancer, 63, 181-187. http://dx.doi.org/10.1002/1097-0142(19890101)63:1<181::AID-CNCR2820630129>3.0.CO;2-H
[24]	Smith, D.M., Rongaus, V.A., Wehmann, T.W., Agarwal, P.J. and Classen, G.J. (1996) Metaplastic Breast Carcinoma. Journal of the American Osteopathic Association, 96, 419-421.
[25]	Johnson, T.L. and Kini, S.R. (1996) Metaplastic Breast Carcinoma: A Cytohistologic and Clinical Study of 10 Cases. Diagnostic Cytopathology, 14, 226-232. http://dx.doi.org/10.1002/(SICI)1097-0339(199604)14:3<226::AID-DC6>3.0.CO;2-F
[26]	Arce-Grijalva, V., Vela-Chávez, T., Pérez-Sánchez, V.M. and Ruvalcaba-Limón, E. (2007) Metaplastic Carcinoma of the Breast: A Clinical and Pathological Study of 40 Cases. BMC Cancer, 7, A6. http://dx.doi.org/10.1186/1471-2407-7-S1-A6
[27]	Beatty, J.D., Atwood, M., Tickman, R. and Reiner, M. (2006) Metaplastic Breast Carcinoma-Clinical Significance. The American Journal of Surgery, 191, 657-664. http://dx.doi.org/10.1016/j.amjsurg.2006.01.038
[28]	Wargotz, E.S. and Norris, H.J. (1989) Metaplastic Carcinomas of the Breast. Cancer, 64, 1490-1499. http://dx.doi.org/10.1002/1097-0142(19891001)64:7<1490::AID-CNCR2820640722>3.0.CO;2-L
[29]	Wargotz, E.S. and Norris, H.J. (1990) Metaplastic Carcinomas of the Breast: V. Metaplastic Carcinoma with Osteoclastic Giant Cells. Human Pathology, 21, 1142-1150. http://dx.doi.org/10.1016/0046-8177(90)90151-T
[30]	Gunhan-Bilgen, I., Memis, A., üstün, E.E., Zekioglu, O. and Ozdemir, N. (2002) Metaplastic Carcinoma of the Breast: Clinical, Mammographic and Sonographic Findings with Histopathologic Correlation. American Journal of Roentgenology, 178, 1421-1425. http://dx.doi.org/10.2214/ajr.178.6.1781421
[31]	Kurain, K.M. and Al-Nafussi, A. (2002) Sarcomatoid/Metaplastic Carcinoma of the Breast: A Clinicopathological Study of 12 Cases. Histopathology, 40, 58-64. http://dx.doi.org/10.1046/j.1365-2559.2002.01319.x
[32]	Park, J.M, Han, B.K., Moon, W.K., Choe, Y.H., Ahn, S.H. and Gong, G. (2000) Metaplastic Carcinoma of the Breast: Mammographic and Sonographic Findings. Journal of Clinical Ultrasound, 28, 179-186. http://dx.doi.org/10.1002/(SICI)1097-0096(200005)28:4<179::AID-JCU5>3.0.CO;2-Y
[33]	Denley, H., Pinder, S.E., Tan, P.H., Sim, C.S., Brown, R., Barker, T., Gearty, J., Elston, C.W. and Ellis, I.O. (2000) Metaplastic Carcinoma Arising within Complex Sclerosing Lesions: A Report of Five Cases. Histopathology, 36, 203-209. http://dx.doi.org/10.1046/j.1365-2559.2000.00849.x