ABSTRACT
Objective To analyze the clinicopathological features,immunohistochemistry and differential diagnosis of metaplastic breast carcinoma.Methods A total of 32 cases of patients with metaplastic breast cancer in our hospital from March 2013 to March 2016 was randomly selected.The specimens were fixed with 4％ neutral formaldehyde solution,then dehydrated,embedded,sliced,stained with HE,and immunohistochemically stained with immunohistochemical staining machine,and then the results of macroscopic examination,microscopic examination and immunohistochemical examination were analyzed.Results Metaplastic breast cancer was lack of clear boundaries,and had no envelope.The tumor diameter was 1-5 cm,and its average was(3.1 ±1.2) cm.Section was tough and solid.Some had nodular shape,and their color was gray.Some had cysts appearance in the section.Among the 32 patients,20 patients underwent sentinel lymph node biopsy without cancer metastasis,and 12 patients underwent axillary lymph node dissection,including 8 cases with axillary lymph node metastasis;32 patients were presented as estrogen receptor (ER) (-),progesterone receptor(PR) (-),epidermal growth factor receptor-2 (HER-2) (-),broad spectrum CK (+),28 patients presented as epidermal growth factor receptor(EGFR)(+),20 patients presented as CK5/6 (+),and 8 patients presented as p53 (+),myoepithelial carcinoma p63 (+),respectively accounting for 100.0％,87.5 ％,62.5 ％ and 25.0％ in their total number.A total of 32 cases of patients with metaplastic breast carcinoma was divided into two types according to the metaplasia:pure epithelial type,including 4 cases of squamous cell carcinoma,2 cases of glandular squamous cell carcinoma and 13 cases of adenocarcinoma differentiated by spindle cell;epithelial/mesenchymal metaplastic carcinoma,its heterologous elements including 3 cases of sarcomatoid components,3 cases of rhabdomyosarcoma-like ingredients and 7 cases of ossification of cartilage and natural ingredients.Conclusion Metaplastic breast cancer,ER(-),PR(-),and HER-2 (-) should be identified with primary breast sarcoma,malignant follicular tumor,sarcomatosis and desmoplastic breast cancer.
ABSTRACT
De todas las neoplasias malignas de mama los carcinomas ductales son los más frecuentes. Menos del 5% son denaturaleza metaplásica y 0,04%-0,1% presentan diferenciación de células escamosas, subtipo que se considera más agresivo. Debido a los pocos casos en la literatura,no hay consenso sobre su diagnósticoy tratamiento. Presentamos tres casos con ese diagnóstico vistos entre 2014 y 2015 en nuestra institución y que corresponden a mujeres de 57, 49 y 65 años sin factores de riesgo y que presentaron cuadros clínicos similares consistentes con aparición de masa de crecimiento rápido. Dos de las pacientes se habían diagnosticado previamente con carcinoma ductal infiltrante de tipo no especial en biopsias por tru-cut con diagnóstico definitivo en la mastectomía radical que reportó en todos los casos carcinoma metaplásico escamoso confirmado por inmunohistoquímica.
Ductal carcinomas are the most common of all breast malignancies, less than 5% are of metaplastic nature, and 0.04% to 0.1% have squamous cell differentiation. These special subtypes are considered more aggressive. Due to the few cases in the literature, there is no consensus about its diagnosis and treatment. Three cases are presented with this diagnosis, seen in our institution between 2014 and 2015. They were women of 57, 49, and 65 years old with no risk factors, and who presented with similar clinical features, consisting of the appearance of a rapid growing mass. Two of the patients had been previously diagnosed with infiltrating ductal carcinoma of no special type by core needle biopsy, with a definitive diagnosis in radical mastectomy, which reported squamous metaplastic carcinoma confirmed by immunohistochemistry.