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Breast malignant, males, children

Carcinoma subtypes

Metaplastic carcinoma - matrix producing subtype


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 25 September 2012, last major update September 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

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 features
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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 (World J Surg Oncol 2008;6:60), #2 (Univ Pittsburgh Case #116)
● 49 year old woman (Arch Pathol Lab Med 2003;127:1385)

Gross description
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● 31% are 2 cm or smaller, 50% are between 2-5 cm and 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

           
Left to right: vimentin+; AE1/AE3+; various markers; cartilaginous markers

AFIP images:
                                          
Junction between poorly differentiated      Matrix producing carcinoma
carcinoma and lobulated areas of
chondromyxoid metaplasia

                                          
Chondroid appearance of                             Chondroid metaplasia in anaplastic
matrix metaplasia                                          portion of a carcinoma


Zone of osteoid separates two areas of poorly differentiated carcinoma

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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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+


Various images

Positive stains
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● Keratin, EMA and S-100
● 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 and HER2 (triple negative, Pathol Int 2011;61:415)

Electron microscopy 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 > Carcinoma subtypes > Metaplastic carcinoma - matrix producing subtype


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