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Presented by Pedram Argani, M.D. and prepared by Matthew Olson, M.D.
Case 2: This is a 93 year old female with a breast mass that showed nuclear labeling for B-catenin on core biopsy.
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Question 1 of 1
1. Question
Week 480: Case 2
This is a 93 year old female with a breast mass that showed nuclear labeling for B-catenin on core biopsy.images/1Alex/05022011_2_1.jpg
images/1Alex/05022011_2_2.jpg
images/1Alex/05022011_2_3.jpgCorrect
Answer: Metaplastic carcinoma
Histology: This lesion has a predominant myofibroblastic phenotype, in that the spindled lesional cells are separated by thick bands of keloid-like collagen. Focally within the lesion, there are ducts lined by epithelial cells with moderate atypia. In other areas, the spindle cells are more cellular, and demonstrate moderate nuclei atypia. The neoplasm is diffusely immunoreactive for cytokeratins and p63, supporting the diagnosis of metaplastic carcinoma. Metaplastic carcinomas of the breast may demonstrate nuclear b-catenin labeling, creating confusion with fibromatosis. Also of note is that phyllodes tumors of the breast may show nuclear labeling for b-catenin.
Discussion: Fibromatosis would lack the immunoreactivity for cytokeratins and atypia of the current lesion. Phyllodes tumors should have epithelial component, and would not label for cytokeratins. Sarcomas of the breast should generally not label for cytokeratins.
Incorrect
Answer: Metaplastic carcinoma
Histology: This lesion has a predominant myofibroblastic phenotype, in that the spindled lesional cells are separated by thick bands of keloid-like collagen. Focally within the lesion, there are ducts lined by epithelial cells with moderate atypia. In other areas, the spindle cells are more cellular, and demonstrate moderate nuclei atypia. The neoplasm is diffusely immunoreactive for cytokeratins and p63, supporting the diagnosis of metaplastic carcinoma. Metaplastic carcinomas of the breast may demonstrate nuclear b-catenin labeling, creating confusion with fibromatosis. Also of note is that phyllodes tumors of the breast may show nuclear labeling for b-catenin.
Discussion: Fibromatosis would lack the immunoreactivity for cytokeratins and atypia of the current lesion. Phyllodes tumors should have epithelial component, and would not label for cytokeratins. Sarcomas of the breast should generally not label for cytokeratins.
