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Presented by Jonathan Epstein, M.D. and prepared by Angelique W. Levi, M.D.
Case 3: 47 year old female with a breast mass
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1. Question
Week 9: Case 3
47 year old female with a breast mass
Correct
Answer: Metaplastic carcinoma
Histology: The lesion has a biphasic component. In areas the lesion resembles a classic infiltrating poorly differentiated duct carcinoma with nests and cords of malignant appearing epithelial cells. Elsewhere, the lesion has a distinct chondroid appearance. The chondroid areas merge imperceptibly with the epithelial areas. The cells within the chondroid appearance have similar malignant features to that of the surrounding infiltrating carcinoma. The presence of both a malignant cartilagenous and epithelial component is diagnostic of metaplastic carcinoma. Metaplastic carcinoma is a general term for breast carcinomas in which there is an additional component other than epithelial and glandular. In this case, with both epithelial and malignant spindle cell features this lesion would be regarded as a sarcomatoid carcinoma. Some individuals make the distinction between sarcomatoid carcinoma where the epithelial and spindle cell carcinoma merges with each other in contrast to “carcinosarcoma” where the two components are distinct. However, there is overlap between the two both histologically and immunohistochemically, and prognostically there is no difference. Consequently, we regard both sarcomatoid carcinoma (carcinoma with spindle cell differentiation) and carcinosarcoma as the same entity.
Discussion: The presence of an epithelial component typical of infiltrating duct carcinoma rules out a pure chondrosarcoma. Malignant phyllodes tumor has a malignant mesenchymal component yet the epithelium appears benign. In carcinoma with chondroid metaplasia, the cartilage would have a totally benign appearance and would not merge in with the carcinoma.
Incorrect
Answer: Metaplastic carcinoma
Histology: The lesion has a biphasic component. In areas the lesion resembles a classic infiltrating poorly differentiated duct carcinoma with nests and cords of malignant appearing epithelial cells. Elsewhere, the lesion has a distinct chondroid appearance. The chondroid areas merge imperceptibly with the epithelial areas. The cells within the chondroid appearance have similar malignant features to that of the surrounding infiltrating carcinoma. The presence of both a malignant cartilagenous and epithelial component is diagnostic of metaplastic carcinoma. Metaplastic carcinoma is a general term for breast carcinomas in which there is an additional component other than epithelial and glandular. In this case, with both epithelial and malignant spindle cell features this lesion would be regarded as a sarcomatoid carcinoma. Some individuals make the distinction between sarcomatoid carcinoma where the epithelial and spindle cell carcinoma merges with each other in contrast to “carcinosarcoma” where the two components are distinct. However, there is overlap between the two both histologically and immunohistochemically, and prognostically there is no difference. Consequently, we regard both sarcomatoid carcinoma (carcinoma with spindle cell differentiation) and carcinosarcoma as the same entity.
Discussion: The presence of an epithelial component typical of infiltrating duct carcinoma rules out a pure chondrosarcoma. Malignant phyllodes tumor has a malignant mesenchymal component yet the epithelium appears benign. In carcinoma with chondroid metaplasia, the cartilage would have a totally benign appearance and would not merge in with the carcinoma.
