Breast malignant, males, children - Metaplastic carcinoma

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Breast malignant, males, children

Carcinoma subtypes

Metaplastic carcinoma - fibromatosis-like variant

Reviewer: Monika Roychowdhury, M.D. (see Reviewerspage)
Revised: 25 September 2012, last major update September 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● Variant of metaplastic carcinoma resembling fibromatosis with propensity for local recurrence
● First described in 1999 (Cancer 1999;85:2170)
● A basal-like tumor with a favorable clinical outcome (Tumori 2009;95:264)

Clinical features
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● Mean age 65 years (range, 40-85 years)
● May recur locally or have distant metastases (Am J Surg Pathol 2001;25:1009), usually no nodal metastases

Case reports
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● 59 year old woman (Arch Pathol Lab Med 2006;130:e81)
● 74 year old woman (Acta Cytol 2010;54:712)
● 77 year old woman (World J Surg Oncol 2007;5:24)

Gross description
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● Mean 3 cm (1-7 cm), well-defined borders

Micro description
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● Fibromatosis-like or myofibroblastic-like growth pattern of bland spindle cells in prominent collagenous stroma, infiltrative borders, usually inflammatory infiltrate
● < 5% of tumor is composed of carcinoma or epithelial elements
● Low mitotic activity (Cesk Patol 2002;38:164)

Micro images
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Various images

Fig 1: rare nests of bland epithelial cells with focal squamous metaplasia (inset); fig 2: rare mitotic figures; fig 3: keratin+ and smooth muscle actin+ spindle cells; fig 4: p63+ spindle cells

Positive stains
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● Cytokeratin for epithelial elements (high molecular weight subtypes)
● p63
● Smooth muscle actin (usually only in keratin negative cells)

Negative stains
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● Estrogen receptor (ER), progesterone receptor (PR), HER2

Electron microscopy images
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Single cell with peripheral villous processes in collagenous stroma
Inset shows tumor cell cluster with microvilli and cell junctions (arrow)

Differential diagnosis
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Benign or malignant spindle cell lesions (keratin negative) including:
● Fibrosarcoma
● Melanoma
● Myoepithelial carcinoma
● Myofibroblastoma
● Nodular fasciitis
● Primary mammary fibromatosis
● Pseudoangiomatous stromal hyperplasia
● Solitary fibrous tumor

Additional references
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● Breast Cancer Res Treat 2008;109:199

End of Breast malignant, males, children > Carcinoma subtypes > Metaplastic carcinoma - fibromatosis-like variant

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