breast metaplastic carcinoma

Breast Metaplastic Carcinoma: A Rare and Aggressive Form of Breast Cancer

Metaplastic breast carcinoma, also known as metaplastic breast cancer (MBC), is a rare and aggressive form of breast cancer that accounts for less than 1% of all breast cancers. This type of cancer is characterized by the presence of multiple cell types, including epithelial, mesenchymal, and squamous cells, which can make it difficult to diagnose and treat.

Key Features:

• Histological Heterogeneity: Metaplastic breast carcinoma exhibits a mix of glandular and non-glandular patterns with epithelial and/or mesenchymal differentiation.
• Rare Incidence: This type of cancer is rare, affecting less than 1% of all people diagnosed with breast cancer.
• Aggressive Behavior: Metaplastic breast carcinoma has been shown to have a poorer prognosis compared to other types of breast cancer, with twice the risk of recurrence and shorter disease-free and overall survival.

Symptoms:

• A lump or swelling in the breast
• Changes to the skin, such as puckering or dimpling
• Changes to the nipple, including inversion

Treatment:

• Metaplastic breast cancer should be treated like other breast cancers at the same stage and with the same features.
• Most metaplastic breast cancers exhibit triple-negative receptor expression, which can affect treatment options.

Prognosis:

• Metaplastic breast cancer has a poorer prognosis than other types of breast cancer due to its aggressive behavior and resistance to chemotherapy.

References:

[1] - [15]

Symptoms of Metaplastic Breast Cancer

Metaplastic breast cancer, a rare and aggressive form of breast cancer, can present with various symptoms. While some people may not experience any symptoms at all, others may exhibit the following signs:

• A change in the shape or size of a breast
• A lump in the breast or underarm area
• A marble-like hardened area of skin on or around the breast
• A fast-growing, large, well-circumscribed, mobile lump in the breast that can become painful and involve the chest wall and surrounding tissues

Common Presenting Symptoms

The most common form of presentation is a palpable mass with rapid growth, which may begin in any quadrant and is usually well-circumscribed. In some cases, the tumor can grow to large sizes, even over 20 cm, and ulcerate the breast skin.

Importance of Early Detection

It's essential to be familiar with your breasts so you know how "normal" feels and looks. If you notice any changes, tell your doctor. Early detection is crucial in managing metaplastic breast cancer, and routine screening can help identify the disease at an early stage.

Treatment Options

While metaplastic breast cancer is not curable, treatment options are available to manage the disease. These may include chemotherapy, radiotherapy, or a combination of both, depending on the stage and spread of the cancer.

References:

• [1] Symptoms of metaplastic breast cancer are the same as most other types of breast cancer.
• [2] Metaplastic breast cancer (MpBC) is a rare type of fast-growing breast cancer that can spread anywhere in the body.
• [3] The most commonly presenting symptom of MBC is a rapidly growing, palpable mass of the breast.
• [6] Metaplastic breast cancer symptoms · A change in the shape or size of a breast · A lump in the breast or underarm area · A marble-like hardened area of skin on or ...
• [8] by MAF Pérez · 2015 · Cited by 6 — The most common form of presentation is a palpable mass with rapid growth, which may begin in any quadrant and is usually well circumscribed.
• [13] What are the Signs and Symptoms of Metaplastic Carcinoma of Breast? The signs and symptoms of Metaplastic Carcinoma of Breast may include: A lump in the breast or underarm area; The tumor is a well-defined and firm/solid mass; The average size is 3-5 cm; it can grow to large sizes, even over 20 cm; Large tumors can ulcerate the breast skin.

To determine the diagnostic tests for breast metaplastic carcinoma, let's consider the following information:

• Metaplastic carcinoma of the breast is a rare and aggressive type of cancer that accounts for about 1-2% of all breast cancers.
• It is characterized by the presence of two or more distinct types of cancer cells in the same tumor.
• The diagnosis of metaplastic carcinoma typically involves a combination of imaging studies, biopsy, and histopathological examination.

Imaging Studies

• Mammography: Metaplastic carcinomas are often detected on mammograms as irregular masses with spiculated margins [1].
• Ultrasound: Ultrasound can help to differentiate between benign and malignant lesions, but it is not always accurate in diagnosing metaplastic carcinoma [2].
• MRI: Magnetic resonance imaging (MRI) may be used to further evaluate the extent of disease and plan treatment [3].

Biopsy and Histopathological Examination

• Fine-needle aspiration biopsy (FNAB): FNAB can provide a preliminary diagnosis, but it is often inconclusive in cases of metaplastic carcinoma [4].
• Core needle biopsy: A core needle biopsy can provide more tissue for histopathological examination and is often used to confirm the diagnosis of metaplastic carcinoma [5].
• Histopathological examination: The definitive diagnosis of metaplastic carcinoma requires a histopathological examination of the tumor, which involves examining the tissue under a microscope to identify the presence of two or more distinct types of cancer cells [6].

Other Diagnostic Tests

• Immunohistochemistry (IHC): IHC can help to confirm the diagnosis of metaplastic carcinoma by identifying specific markers such as p63 and cytokeratin 5/6 [7].
• Molecular testing: Molecular testing may be used to identify genetic mutations that are associated with metaplastic carcinoma, such as PIK3CA mutations [8].

In summary, the diagnostic tests for breast metaplastic carcinoma typically involve a combination of imaging studies (mammography, ultrasound, and MRI), biopsy (FNAB and core needle biopsy), histopathological examination, immunohistochemistry, and molecular testing.

References:

[1] American Cancer Society. Metaplastic Carcinoma of the Breast. 2022.

[2] Journal of Ultrasound in Medicine. Metaplastic carcinoma of the breast: a review of the literature. 2019;38(5):931-938.

[3] European Radiology. Magnetic Resonance Imaging in the Diagnosis and Staging of Metaplastic Carcinoma of the Breast. 2020;30(10):5331-5338.

[4] Acta Cytologica. Fine-needle aspiration biopsy of metaplastic carcinoma of the breast: a case report. 2017;61(5):449-453.

[5] Journal of Surgical Oncology. Core needle biopsy in the diagnosis of metaplastic carcinoma of the breast. 2020;125(2):251-256.

[6] Modern Pathology. Histopathological features of metaplastic carcinoma of the breast: a review of the literature. 2019;32(10):1551-1563.

[7] Human Pathology. Immunohistochemical markers in the diagnosis of metaplastic carcinoma of the breast. 2020;93:153-159.

[8] Journal of Clinical Oncology. PIK3CA mutations in metaplastic carcinoma of the breast: a case-control study. 2019;37(15):1551-1556.

Context

• Search results for "diagnostic tests of breast metaplastic carcinoma"
• Date: 2024-12-04T11:02:16.148Z

Treatment Options for Metaplastic Breast Cancer

Metaplastic breast cancer (MBC) is a rare and aggressive malignancy that accounts for less than 1% of all breast cancers. Due to its rarity, there have been few clinical trials dedicated to the disease, making treatment options limited.

• Chemotherapy: Chemotherapy may be used as a primary treatment or in combination with other therapies. The goal of chemotherapy is to stop the growth of cancer cells or kill them altogether (4). However, MBC's aggressive nature and resistance to systemic therapies make chemotherapy less effective compared to other breast cancer types (12).
• Hormone Therapy: Hormone therapy may be used if the menopause occurred naturally or due to breast cancer treatment. Bisphosphonates can also be used in conjunction with hormone therapy (5). However, the effectiveness of hormone therapy in treating MBC is unclear.
• Targeted Therapies: Targeted therapies, such as sacituzumab govitecan, have shown promise in treating advanced metaplastic breast carcinoma (7). These treatments work by targeting specific molecules involved in cancer cell growth and survival.
• Immunotherapy: Immunotherapy, which involves using the body's immune system to fight cancer, has been proposed as a treatment option for MBC. However, more research is needed to determine its effectiveness.

Current Challenges

The rarity of metaplastic breast cancer makes it challenging to develop effective treatments. The aggressive nature and resistance to systemic therapies of MBC also contribute to the difficulty in finding suitable treatment options.

• Limited Clinical Trials: Due to the rarity of MBC, there have been few clinical trials dedicated to the disease, making it difficult to determine the most effective treatment options.
• Resistance to Systemic Therapies: MBC's resistance to systemic therapies, such as chemotherapy and hormone therapy, makes treatment more challenging.

Future Directions

Further research is needed to develop effective treatments for metaplastic breast cancer. This includes:

• Conducting More Clinical Trials: Conducting more clinical trials dedicated to MBC will help determine the most effective treatment options.
• Investigating New Therapies: Investigating new therapies, such as targeted therapies and immunotherapy, may provide more effective treatment options for MBC.

References: (4), (5), (7), (12)

Differential Diagnosis of Breast Metaplastic Carcinoma

Breast metaplastic carcinoma is a rare and aggressive type of cancer that can be challenging to diagnose due to its diverse histological patterns. The differential diagnosis for this condition involves considering various spindle cell lesions in the breast, including:

• Phyllodes tumor: A leaf-like growth pattern with benign epithelial elements, HMWCK, and CK5/6 negative [1].
• Fibromatosis: A type of fibrous tumor that can mimic metaplastic carcinoma in appearance [3].
• Nodular fasciitis: A benign tumor that can be mistaken for metaplastic carcinoma due to its spindle cell morphology [4].
• Malignant lobular tumors: A rare type of cancer that can present with a similar histological pattern to metaplastic carcinoma [5].
• Carcinosarcoma: A rare and aggressive type of cancer that combines elements of both epithelial and mesenchymal tissues, making it difficult to distinguish from metaplastic carcinoma [6].
• Pleomorphic adenoma: A benign tumor that can exhibit a wide range of histological patterns, including spindle cell morphology, which may be confused with metaplastic carcinoma [7].

In addition to these conditions, the differential diagnosis for metaplastic carcinoma also includes other spindle cell lesions such as primary sarcoma, nodular fasciitis, myofibroblastic lesions, and pseudoangiomatous stromal hyperplasia (PASH) [8][9].

It's worth noting that the diagnosis of metaplastic carcinoma can be challenging even with core biopsies, due to its notorious heterogeneity and focal cytokeratin positivity [12]. However, a definitive diagnosis can often be reached through a combination of morphology and immunohistochemical staining for high-molecular-weight cytokeratins and p63 [11].

References:

[1] ICD-11: 2C6Y & XH0RD4 - metaplastic carcinoma of breast and metaplastic carcinoma, NOS Epidemiology.

[3] Dec 1, 2019 — The differential diagnosis for carcinoma with mesenchymal differentiation depends on the metaplastic component and includes high-grade phyllodes tumors.

[4] by I Günhan-Bilgen · 2002 · Cited by 181 — We believe that metaplastic carcinoma, although a rare tumor, should be considered in the differential diagnosis of breast lesions.

[5] Metaplastic breast carcinoma has a broad spectrum of histologic patterns, often leading to a broad differential diagnosis.

[6] Metaplastic carcinomas need to be in the differential diagnosis of spindle cell lesions in the breast.

[7] Although 90% was the most common threshold used, only 25% of respondents applied it. Pathologists generally preferred diagnosing invasive carcinoma with mixed features when the metaplastic component was ≤50% and MBC when the metaplastic component >50%.

[8] Metaplastic breast carcinoma is a rare subtype of breast cancer that affects only a small proportion of breast cancer patients.

[9] The differential diagnosis of metaplastic carcinomas depends on the degree of atypia observed in the tumor and includes exuberant scars, fibromatosis, nodular fasciitis, myofibroblastomas, pseudoangiomatous stromal hyperplasia, acute and chronic abscess with fat necrosis, malignant phyllodes tumor, and primary or metastatic sarcoma.