Yonsei Med J.  2010 Nov;51(6):864-869. 10.3349/ymj.2010.51.6.864.

Clinicopathologic Features and Outcomes of Metaplastic Breast Carcinoma: Comparison with Invasive Ductal Carcinoma of the Breast

• Park HS
• Park S
• Kim JH
• Lee JH
• Choi SY
• Park BW
• Lee KS

• KMID: 1779632
• DOI: http://doi.org/10.3349/ymj.2010.51.6.864

Abstract

PURPOSE
Metaplastic breast carcinoma (MBC) is rare. Its clinicopathologic features and prognosis are uncertain. The aim of this study was to evaluate the clinicopathologic characteristics and outcomes in comparison with invasive ductal carcinoma (IDC).
MATERIALS AND METHODS
We reviewed the data of 29 patients with MBC and 4,851 patients with IDC, who received surgery at Yonsei University Severance Hospital between 1980 and 2008. Various clinicopathologic features, recurrence free, and overall survival were investigated and compared to each other.
RESULTS
Stage IV cases at diagnosis were more common in MBC (10.3%) than in IDC (0.9%). The incidence rates of triple negative breast cancer (TNBC) were significantly higher in MBC (84.0%) than in IDC (20.1%). Larger tumors (>2 cm) and lower tendency of axillary metastasis were frequently observed in MBC. Only one of 24 preoperative core needle biopsies (CNB) correctly diagnosed MBC. There was no significant difference in survival between the two groups.
CONCLUSION
MBC was characterized by a higher incidence of TNBC, larger tumor size, and lower tendency of axillary metastasis, and was difficult to diagnose with CNB. Although the incidence of stage IV disease at diagnosis was higher in MBC, the survival rates of stage I-III were comparable to those of IDC.

Keyword

Breast neoplasms; metaplasia; survival; triple negative breast cancer

MeSH Terms

Adult
Aged
Breast Neoplasms/*diagnosis/*physiopathology
Carcinoma/*diagnosis/*physiopathology
Carcinoma, Ductal, Breast/*diagnosis/*physiopathology
Female
Humans
Incidence
Medical Oncology/methods
Middle Aged
Neoplasm Invasiveness
Neoplasm Metastasis
Recurrence
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Recurrence-free and overall survival according to histologic type of breast cancer in Stage I-III. MBC, metaplastic breast carcinoma; IDC, invasive ductal carcinoma.

Reference

1. Oberman HA. Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients. Am J Surg Pathol. 1987. 11:918–929.

2. Wargotz ES, Deos PH, Norris HJ. Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol. 1989. 20:732–740.

3. Wargotz ES, Norris HJ. Metaplastic carcinomas of the breast. III. Carcinosarcoma. Cancer. 1989. 64:1490–1499.

4. Wargotz ES, Norris HJ. Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma. Hum Pathol. 1989. 20:628–635.

5. Wargotz ES, Norris HJ. Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. Hum Pathol. 1990. 21:1142–1150.

6. Wargotz ES, Norris HJ. Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin. Cancer. 1990. 65:272–276.

7. Beatty JD, Atwood M, Tickman R, Reiner M. Metaplastic breast cancer: clinical significance. Am J Surg. 2006. 191:657–664.

8. Chao TC, Wang CS, Chen SC, Chen MF. Metaplastic carcinomas of the breast. J Surg Oncol. 1999. 71:220–225.

9. Gutman H, Pollock RE, Janjan NA, Johnston DA. Biologic distinctions and therapeutic implications of sarcomatoid metaplasia of epithelial carcinoma of the breast. J Am Coll Surg. 1995. 180:193–199.

10. Bellino R, Arisio R, D'Addato F, Attini R, Durando A, Danese S, et al. Metaplastic breast carcinoma: pathology and clinical outcome. Anticancer Res. 2003. 23:669–673.

11. Khan HN, Wyld L, Dunne B, Lee AH, Pinder SE, Evans AJ, et al. Spindle cell carcinoma of the breast: a case series of a rare histological subtype. Eur J Surg Oncol. 2003. 29:600–603.

12. Reis-Filho JS, Milanezi F, Steele D, Savage K, Simpson PT, Nesland JM, et al. Metaplastic breast carcinomas are basal-like tumours. Histopathology. 2006. 49:10–21.

13. Rakha EA, Ellis IO. Triple-negative/basal-like breast cancer: review. Pathology. 2009. 41:40–47.

14. Korsching E, Jeffrey SS, Meinerz W, Decker T, Boecker W, Buerger H. Basal carcinoma of the breast revisited: an old entity with new interpretations. J Clin Pathol. 2008. 61:553–560.

15. Irvin WJ Jr, Carey LA. What is triple-negative breast cancer. Eur J Cancer. 2008. 44:2799–2805.

16. Barnes PJ, Boutilier R, Chiasson D, Rayson D. Metaplastic breast carcinoma: clinical-pathologic characteristics and HER2/neu expression. Breast Cancer Res Treat. 2005. 91:173–178.

17. Tavassoli FA. Classification of metaplastic carcinomas of the breast. Pathol Annu. 1992. 27(Pt 2):89–119.

18. Park JH, Han W, Kim SW, Lee JE, Shin HJ, Kim SW, et al. The clinicopathologic characteristics of 38 metaplastic carcinomas of the breast. J Breast Cancer. 2005. 8:59–63.

19. Pezzi CM, Patel-Parekh L, Cole K, Franko J, Klimberg VS, Bland K. Characteristics and treatment of metaplastic breast cancer: analysis of 892 cases from the National Cancer Data Base. Ann Surg Oncol. 2007. 14:166–173.

20. Son BH, Ahn SH. Survival Analysis of Korean Breast Cancer Patients Diagnosed between 1993 and 2002 in Korea - A Nationwide Study of the Cancer Registry. J Breast Cancer. 2006. 9:214–229.

21. Kim EY, Lee S, Bae TS, Kim SW, Kwon Y, Kim EA, et al. The clinical characteristics and predictive factors of stage IV breast cancer at the initial presentation: a review of a single institute's data. J Breast Cancer. 2007. 10:101–106.

22. Gilbert JA, Goetz MP, Reynolds CA, Ingle JN, Giordano KF, Suman VJ, et al. Molecular analysis of metaplastic breast carcinoma: high EGFR copy number via aneusomy. Mol Cancer Ther. 2008. 7:944–951.

23. Rayson D, Adjei AA, Suman VJ, Wold LE, Ingle JN. Metaplastic breast cancer: prognosis and response to systemic therapy. Ann Oncol. 1999. 10:413–419.

24. Geyer FC, Weigelt B, Natrajan R, Lambros MB, de Biase D, Vatcheva R, et al. Molecular analysis reveals a genetic basis for the phenotypic diversity of metaplastic breast carcinomas. J Pathol. 2010. 220:562–573.

25. Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors? J Clin Pathol. 2005. 58:700–704.

26. Kim MJ, Ro JY, Ahn SH, Kim HH, Kim SB, Gong G. Clinicopathologic significance of the basal-like subtype of breast cancer: a comparison with hormone receptor and Her2/neuoverexpressing phenotypes. Hum Pathol. 2006. 37:1217–1226.

27. Chhieng C, Cranor M, Lesser ME, Rosen PP. Metaplastic carcinoma of the breast with osteocartilaginous heterologous elements. Am J Surg Pathol. 1998. 22:188–194.

28. Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000. 406:747–752.

29. Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001. 98:10869–10874.

30. Luini A, Aguilar M, Gatti G, Fasani R, Botteri E, Brito JA, et al. Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat. 2007. 101:349–353.

31. Kuroda N, Fujishima N, Inoue K, Ohara M, Hirouchi T, Mizuno K, et al. Basal-like carcinoma of the breast: further evidence of the possibility that most metaplastic carcinomas may be actually basal-like carcinomas. Med Mol Morphol. 2008. 41:117–120.

32. Garcia S, Dalès JP, Charafe-Jauffret E, Carpentier-Meunier S, Andrac-Meyer L, Jacquemier J, et al. Poor prognosis in breast carcinomas correlates with increased expression of targetable CD146 and c-Met and with proteomic basal-like phenotype. Hum Pathol. 2007. 38:830–841.

33. Weigelt B, Kreike B, Reis-Filho JS. Metaplastic breast carcinomas are basal-like breast cancers: a genomic profiling analysis. Breast Cancer Res Treat. 2009. 117:273–280.

34. Park JM, Han BK, Moon WK, Choe YH, Ahn SH, Gong G. Metaplastic carcinoma of the breast: mammographic and sonographic findings. J Clin Ultrasound. 2000. 28:179–186.

35. Lien HC, Hsiao YH, Lin YS, Yao YT, Juan HF, Kuo WH, et al. Molecular signatures of metaplastic carcinoma of the breast by large-scale transcriptional profiling: identification of genes potentially related to epithelial-mesenchymal transition. Oncogene. 2007. 26:7859–7871.