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Presented by Pedram Argani, M.D. and prepared by Mark Samols, M.D., Ph.D.
Case 2: This is a 58 year old female with a breast mass.
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Question 1 of 1
1. Question
Week 514: Case 2
This is a 58 year old female with a breast mass.images/samols/0604122a.jpg
images/samols/0604122b.jpg
images/samols/0604122c.jpg
images/samols/0604122d.jpgCorrect
Answer: Metaplastic carcinoma
Histology: This is a very bland spindle cell proliferation which features dense collagen deposition, including abundant keloidal collagen. However, the hypocellular collagen merges sharply with more cellular storiform spindle cell areas. The sharp transition between hypocellular collagen and cellular fibroblastic-like cells is striking. This morphology in the breast strongly suggests the possibility of a metaplastic (spindle cell) carcinoma, low grade. The diagnosis is confirmed by the demonstration of immunoreactivity for high molecular weight cytokeratin (34BE12) and p63.
Discussion: None of the other entities in the differential diagnosis would demonstrate immunoreactivity for cytokeratin or p63. Fibromatosis has a more fascicular growth pattern and is more uniformly cellular.
Incorrect
Answer: Metaplastic carcinoma
Histology: This is a very bland spindle cell proliferation which features dense collagen deposition, including abundant keloidal collagen. However, the hypocellular collagen merges sharply with more cellular storiform spindle cell areas. The sharp transition between hypocellular collagen and cellular fibroblastic-like cells is striking. This morphology in the breast strongly suggests the possibility of a metaplastic (spindle cell) carcinoma, low grade. The diagnosis is confirmed by the demonstration of immunoreactivity for high molecular weight cytokeratin (34BE12) and p63.
Discussion: None of the other entities in the differential diagnosis would demonstrate immunoreactivity for cytokeratin or p63. Fibromatosis has a more fascicular growth pattern and is more uniformly cellular.
