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Presented by Pedram Argani, M.D. and prepared by Justin Poling, M.D.
Case 1: This is a 61 year old female with a breast mass.
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1. Question
Week 516: Case 1
This is a 61 year old female with a breast mass.images/jsp6182012/6182012case14x.jpg
images/jsp6182012/6182012case120x.jpg
images/jsp6182012/6182012case140x.jpgCorrect
Answer: Metaplasia carcinoma
Histology: This is a deceptive spindle cell lesion in the breast. Some of the areas are hypocellular, bland and myxoid, suggesting fasciitis. However, other areas demonstrate marked nuclei atypia, hypercellularity, and atypical mitotic figures. The neoplastic cells label for cytokeratin and for p63, supporting diagnosis of metaplastic carcinoma.
Discussion: The neoplasm grows between existing ducts, which raises the possibility malignant phyllodes tumor; however, the ducts do not demonstrate the intracanalicular pattern of a phyllodes tumor, and diffuse cytokeratin labeling essentially excludes the diagnosis of phyllodes tumor. Fasciitis can be excluded by the extensive atypia and atypical mitotic figures in much of the lesion. Fibromatosis would feature well defined fascicles without cytologic atypia as seen in the current case.
Incorrect
Answer: Metaplasia carcinoma
Histology: This is a deceptive spindle cell lesion in the breast. Some of the areas are hypocellular, bland and myxoid, suggesting fasciitis. However, other areas demonstrate marked nuclei atypia, hypercellularity, and atypical mitotic figures. The neoplastic cells label for cytokeratin and for p63, supporting diagnosis of metaplastic carcinoma.
Discussion: The neoplasm grows between existing ducts, which raises the possibility malignant phyllodes tumor; however, the ducts do not demonstrate the intracanalicular pattern of a phyllodes tumor, and diffuse cytokeratin labeling essentially excludes the diagnosis of phyllodes tumor. Fasciitis can be excluded by the extensive atypia and atypical mitotic figures in much of the lesion. Fibromatosis would feature well defined fascicles without cytologic atypia as seen in the current case.
