Advertisement
Advertisement
Table of Contents
Definition / general | Epidemiology | Clinical features | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Positive stains | Negative stains | Differential diagnosisCite this page: Metaplastic carcinoma - matrix producing subtype. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantmetaplasticmatrix.html. Accessed July 14th, 2017.
Definition / general
- Invasive breast carcinoma with direct transition of carcinoma to cartilaginous or osseous matrix, without an intervening spindle cell component (Hum Pathol 1989;20:628)
Epidemiology
- Rare
- 44% are age 50 years or less
Clinical features
- Poorer prognosis than invasive ductal carcinoma (Am J Surg Pathol 2009;33:534), but may have comparable outcomes with aggressive treatment (Am J Surg 2006;191:657)
- A type of basal-like carcinoma
Case reports
- 42 year old woman with 2 cm tumor in the right breast (World J Surg Oncol 2008;6:60), #2 (Univ Pittsburgh Case #116)
- 49 year old woman with lower outer quadrant left breast mass (Arch Pathol Lab Med 2003;127:1385)
Gross description
- 31% are 2 cm or smaller, 50% are between 2 - 5 cm and 19% are 5 cm or larger
Gross images
Images hosted on PathOut server:
Cartilaginous tumor with arrows at tumor margin
Circumscribed tumor with bulging mucoid surfaces
Microscopic (histologic) description
- Invasive breast carcinoma with direct transition of carcinoma to cartilaginous or osseous matrix, without an intervening spindle cell component
- Nests, sheets and cords of tumor cells with cellular atypia, plus scattered cancer cells within myxoid or myxohyalinous stroma
- Almost always chondroid matrix, rarely osseous matrix
- Matrix volume varies from 10% of less (44% of cases) to 40% or higher (28%)
- Usually (94%) high grade matrix tumor cells with peripheral lymphocytic infiltration
- Expansile growth with well-circumscribed margins, accompanied by basophilic and myxoid intercellular matrix
- Gradual transition from cellular to acellular areas, with gradual loss of tumor cell adhesion
- Central necrosis (59%), angiolymphatic invasion (25%) and axillary nodal metastases (22%)
Microscopic (histologic) images
Images hosted on PathOut server:
AFIP images
Matrix producing
carcinoma
Chondroid
appearance of
matrix metaplasia
Chondroid
metaplasia in
anaplastic portion
of a carcinoma
Zone of osteoid
separates two
areas of poorly
differentiated
carcinoma
Junction between
poorly differentiated
carcinoma and
lobulated areas of
chondromyxoid
metaplasia
Images hosted on other servers:
Various images
Central myxoedematous area with necrosis
Vimentin+
AE1 / AE3+
Cytology description
- Markedly atypical spindle cells with mitotic figures, also atypical chondrocytes (Diagn Cytopathol 2005;33:205)
- Background is necrotic debris and myxoid substance displaying metachromasia
Cytology images
Images hosted on other servers:
Fig 1: FNA shows metachromatic chondromyxoid extracellular material with chondrocyte-like cells
Fig 2: poorly differentiated tumor with sheets of small undifferentiated cells, mitotic figures and necrosis
Fig 3: chondromyxoid matrix with pleomorphic cells within lacunae
Fig 4: cells in chondromyxoid matrix are S100+
Positive stains
- Keratin, EMA and S100
- Also EGFR (J Clin Pathol 2005;58:700), myoepithelial differentiation (Am J Clin Pathol 2003;120:161, Ceska Gynekol 2004;69:229)
- Also aggrecan and type II collagen (cartilage-specific matrix molecules, Mod Pathol 2008;21:1282)
Negative stains
- ER, PR and HER2 (triple negative, Pathol Int 2011;61:415)
Differential diagnosis
- Central acellular carcinoma: margins are relatively sharp with infiltrative growth accompanied by eosinophilic intercellular matrix; abrupt transition from peripheral cellular to central acellular zones without alteration of tumor cell adhesion (Pathol Int 2009;59:390)
Advertisement
