J Pathol Transl Med.  2017 Jul;51(4):418-421. 10.4132/jptm.2016.10.06.

Metaplastic Carcinoma with Chondroid Differentiation Arising in Microglandular Adenosis

• Kim GE
• Kim NI
• Lee JS
• Park MH

• KMID: 2392583
• DOI: http://doi.org/10.4132/jptm.2016.10.06

Abstract

Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

Keyword

Breast; Metaplastic carcinoma; Fibrocystic breast disease

MeSH Terms

Breast
Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Epithelial Cells
Estrogens
Fibrocystic Breast Disease*
Korea
Receptor, Epidermal Growth Factor
Receptors, Progesterone
S100 Proteins
Estrogens
Receptor, Epidermal Growth Factor
Receptors, Progesterone
S100 Proteins

Figure

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  Fig. 1. Metaplastic carcinoma with mesenchymal differentiation arising in microglandular adenosis (MGA). (A) MGA on the right shows direct transition to invasive carcinoma on the left. (B) Invasive carcinoma primarily composed of cord-like cells scattered in the chondromyxoid matrix with focal chondroid differentiation (inset). (C) Typical glands in MGA are lined by uniform cuboidal cells regularly spaced around a lumen containing a colloid-like secretion. (D) Basement membranes highlighted by the reticulin stain are preserved in the MGA area (inset) but disrupted in the invasive carcinoma area.

• 

  Fig. 2. Immunohistochemical stains. (A) S-100 protein is strongly positive in microglandular adenosis (MGA) and invasive carcinoma. Entrapped normal mammary gland is negative for S-100 protein (arrow). (B) Estrogen receptor (ER) is positive in entrapped normal mammary glands (arrow); however, MGA and invasive carcinoma are negative for ER. (C) No immunoreactivity for p63 is observed in the MGA area or invasive carcinoma area. Normal mammary glands are stained positively in myoepithelial cells (arrow). (D) An increase in p53 labelling index is observed from MGA to invasive carcinoma.

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