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Breast-malignant, males, children
Metaplastic carcinoma - fibromatosis-like variant
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 28 September 2009
Last major update: September 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Variant of metaplastic carcinoma resembling fibromatosis with propensity for local recurrence
● First described in 1999 (Cancer 1999;85:2170)
Clinical
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● Mean age 65 years (range, 40-85 years)
● May recur locally or have distant metastases (AJSP 2001;25:1009), usually no nodal metastases
Case reports
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● 59 year old woman (Archives 2006;130:e81)
● 77 year old woman (World J Surg Oncol 2007 Feb 27;5:24)
Gross description
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● Mean 3 cm (1-7 cm), well defined borders
Micro description
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● Fibromatosis-like or myofibroblastic-like growth pattern of bland spindle cells in prominent collagenous stroma, infiltrative borders, usually inflammatory infiltrate
● <5% of tumor is composed of carcinoma or epithelial elements
● Low mitotic activity (Cesk Patol 2002;38:164)
Micro description
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Various images
Low grade features Bland spindle cells Plump fusiform and polygonal cells
but Infiltrative growth resembling fibromatosis merge with spindle cell component
Island of squamous
cells
Fig 1: rare nests of bland epithelial cells with focal squamous metaplasia (inset)
Fig 2: rare mitotic figures
Fig 3: keratin+ and smooth muscle actin+ spindle cells
Fig 4: p63+ spindle cells
AE1/AE3 stains plump HMW Keratin stains plump epithelioid
epithelioid cells and cells and some spindle cells
some spindle cells
Positive stains
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● Cytokeratin for epithelial elements (high molecular weight subtypes), p63
● Smooth muscle actin (usually only in keratin negative cells)
Negative stains
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● ER, PR, HER2
Electron microscopy images
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Single cell with peripheral villous processes in collagenous stroma
inset shows tumor cell cluster with microvilli and cell junctions (arrow)
Differential diagnosis
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Benign or malignant spindle cell lesions (keratin negative) including:
● Fibrosarcoma
● Melanoma
● Myoepithelial carcinoma
● Myofibroblastoma
● Nodular fasciitis
● Primary mammary fibromatosis
● Pseudoangiomatous stromal hyperplasia
● Solitary fibrous tumor
End of Breast – Malignant, Males, Children > Metaplastic carcinoma > Fibromatosis-like variant
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