Breast – Malignant, Males, Children - Metaplastic carcinoma, matrix-producing subtype

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Breast-malignant, males, children

Metaplastic carcinoma - Matrix producing subtype

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 27 September 2009

Last major update: September 2009

Definition

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● Invasive breast carcinoma with direct transition of carcinoma to cartilaginous or osseous matrix, without an intervening spindle cell component (Hum Pathol 1989;20:628)

Epidemiology

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● Rare

● 44% are age 50 years or less

Clinical

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● Poorer prognosis than invasive ductal carcinoma (Am J Surg Pathol 2009;33:534), but may have comparable outcomes with aggressive treatment (Am J Surg 2006;191:657)

● A type of basal-like carcinoma

Case reports

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● 42 year old woman #1 (World J Surg Oncol 2008;6:60), #2 (Univ Pittsburgh Case #116)

● 49 year old woman (Archives 2003;127:1385)

Gross description

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● 31% are 2 cm or smaller, 50% are between 2-5 cm, 19% are 5 cm or larger

Gross images

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Metaplastic carcinoma with chondroid differentiation

Cartilaginous tumor with Circumscribed tumor with

arrows at tumor margin bulging mucoid surfaces

Micro description

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● Invasive breast carcinoma with direct transition of carcinoma to cartilaginous or osseous matrix, without an intervening spindle cell component

● Nests, sheets and cords of tumor cells with cellular atypia, plus scattered cancer cells within myxoid or myxohyalinous stroma.

● Almost always chondroid matrix, rarely osseous matrix

● Matrix volume varies from 10% of less (44% of cases) to 40% or higher (28%)

● Usually (94%) high grade matrix tumor cells with peripheral lymphocytic infiltration

● Expansile growth with well circumscribed margins, accompanied by basophilic and myxoid intercellular matrix

● Gradual transition from cellular to acellular areas, with gradual loss of tumor cell adhesion

● Central necrosis (59%), angiolymphatic invasion (25%) and axillary nodal metastases (22%)

Micro images

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Malignant chondrocytes with Various images Central myxoedematous

chondroid matrix area with necrosis

Chondroid matrix and necrosis

Chondroid areas

Junction between poorly differentiated Matrix producing carcinoma (AFIP)

carcinoma and lobulated areas of

chondromyxoid metaplasia (AFIP)

Chondroid appearance of Chondroid metaplasia in anaplastic

matrix metaplasia (AFIP) portion of a carcinoma (AFIP)

Zone of osteoid separates two areas

of poorly differentiated carcinoma (AFIP)

Vimentin+ AE1/AE3+ Various markers Cartilaginous proteins

Cytology description

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● Markedly atypical spindle cells with mitotic figures, also atypical chondrocytes (Diagn Cytopathol 2005;33:205)

● Background is necrotic debris and myxoid substance displaying metachromasia

Cytology images

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Various images

Fig 1: FNA shows metachromatic chondromyxoid extracellular material with chondrocyte-like cells

Fig 2: poorly differentiated tumor with sheets of small undifferentiated cells, mitotic figures and necrosis

Fig 3: chondromyxoid matrix with pleomorphic cells within lacunae

Fig 4: cells in chondromyxoid matrix are S100+

Positive stains

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● Keratin, EMA

● Also EGFR (J Clin Pathol 2005;58:700), myoepithelial differentiation (Am J Clin Pathol 2003;120:161, Ceska Gynekol 2004;69:229)

● Also aggrecan and type II collagen (cartilage-specific matrix molecules, Mod Pathol 2008;21:1282)

Negative stains

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● ER, PR, HER2 (triple negative)

EM images

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Actin filaments and

desmosome-like junctions

Differential diagnosis

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● Central acellular carcinoma - margins are relatively sharp with infiltrative growth accompanied by eosinophilic intercellular matrix; abrupt transition from peripheral cellular to central acellular zones without alteration of tumor cell adhesion (Pathol Int 2009;59:390)

End of Breast – Malignant, Males, Children > Metaplastic carcinoma > Matrix producing subtype

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