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Fibromatosis-like carcinoma-an unusual phenotype of a metaplastic breast tumor associated with a micropapilloma.

Rekhi B, Shet TM, Badwe RA, Chinoy RF - World J Surg Oncol (2007)

Bottom Line: A diagnosis of a low-grade fibromatosis-like carcinoma breast associated with a micropapilloma was formed.The importance of making this diagnosis to facilitate an intra operative surgical planning is marred by diagnostic difficulties.In such cases, IHC is imperative in forming an objective diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India. rekhi.bharat@gmail.com

ABSTRACT

Background: Fibromatosis-like metaplastic carcinoma is a newly described metaplastic breast tumor, literature on which is still evolving.

Case presentation: A 77-year-old lady presented with a 2 x 2 cm mass with irregular margins in the upper and outer quadrant of left breast. Fine needle aspiration cytology (FNAC) from the lump was inconclusive. A lumpectomy was performed and sent for frozen section, which revealed presence of spindle cells showing mild atypia in a sclerotic stroma. The tumor cells revealed prominent infiltration into the adjacent fat. A differential diagnosis of a low-grade sarcoma vs. a metaplastic carcinoma, favoring the former, was offered. Final histology sections revealed an infiltrating tumor with predominant spindle cells in a collagenous background, simulating a fibromatosis. Adjacent to the tumor were foci of benign ductal hyperplasia and a micropapilloma. Immunohistochemistry (IHC) showed diffuse co-expression of epithelial markers i.e. cytokeratins (CK, HMWCK, CK7) and EMA along with a mesenchymal marker i.e. vimentin in the tumor cells. Myoepithelial markers (SMA and p63) showed focal positivity. A diagnosis of a low-grade fibromatosis-like carcinoma breast associated with a micropapilloma was formed.

Conclusion: Fibromatosis-like carcinoma is a rare form of a metaplastic breast tumor. This diagnosis requires an index of suspicion while dealing with spindle cell breast tumors. The importance of making this diagnosis to facilitate an intra operative surgical planning is marred by diagnostic difficulties. In such cases, IHC is imperative in forming an objective diagnosis.

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A). Tumor cells exhibiting strong cytokeratin (CK) expression (DAB × 200). Inset showing an occasional clusterof CK positive 'epithelial-like' cells. (DAB × 400). B). Tumor cellsadjacent to the micropapilloma showing positive CK7 expression. Arrow showing a cluster of cells (DAB × 100). C). Strongdiffuse expression for HMWCK. D). Positive vimentin expression. (DAB × 400). E). Focal expression for smooth muscle actin (SMA). A vessel identified in the proximity of tumor cells (DAB × 400). F). Positiveintranuclear p63 expression. (DAB × 400). G). Focal Ki-67 expression(arrows). (DAB × 400).. H). Negative expression for CD34 in the tumorcells. (DAB × 200).I. Negative CerbB-2/HER 2/neu expression. (DAB × 200).
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Figure 3: A). Tumor cells exhibiting strong cytokeratin (CK) expression (DAB × 200). Inset showing an occasional clusterof CK positive 'epithelial-like' cells. (DAB × 400). B). Tumor cellsadjacent to the micropapilloma showing positive CK7 expression. Arrow showing a cluster of cells (DAB × 100). C). Strongdiffuse expression for HMWCK. D). Positive vimentin expression. (DAB × 400). E). Focal expression for smooth muscle actin (SMA). A vessel identified in the proximity of tumor cells (DAB × 400). F). Positiveintranuclear p63 expression. (DAB × 400). G). Focal Ki-67 expression(arrows). (DAB × 400).. H). Negative expression for CD34 in the tumorcells. (DAB × 200).I. Negative CerbB-2/HER 2/neu expression. (DAB × 200).

Mentions: Histological sections revealed a spindle cell tumor showing an infiltrative growth pattern with prominent areas of sclerosis reminiscent of keloid formation. The cells were mainly arranged in fascicles and displayed tapering nuclei with mild anisonucleosis. Mitoses were inconspicuous. Occasionally, the cells were plump with epithelioid shapes and revealed mild atypia with an occasional small cluster formation. Interspersed were foci of benign ductal hyperplasia and papillary hyperplasia, including a micropapilloma along with focal aggregates of chronic inflammatory cells. The micropapilloma did not show any significant atypia. (Figure 2A, 2B, 2C, 2D). No discrete squamous differentiation was identified. No focus of Ductal-carcinoma-in-situ (DCIS) was seen in any of the sections. The two closest differential diagnoses considered were fibromatosis and a "fibromatosis like" metaplastic carcinoma. A wide panel of IHC antibody markers was performed (Table 1). The tumor cells were simultaneously diffusely positive for epithelial markers i.e. the various cytokeratins CK, CK7, High molecular weight (HMWCK) and epithelial membrane antigen (EMA), along with a mesenchymal marker i.e. vimentin. (Figure 3A, 3B, 3C and 3D). All the cytokeratins were positive in the interspersed benign ducts that acted as internal controls. The tumor cells were negative for Gross cystic disease fluid protein (GCDFP), estrogen (ER) and progesterone receptor (PR). The myoepithelial markers i.e. smooth muscle actin (SMA) and p63 showed focal, positive expression. (Figure 3E, 3F). S100 and Desmin were negative. Ki-67 (proliferation marker) showed focal positivity in less than 5% tumor cells (Figure 3G). The tumor cells were negative for CD34 and CerbB-2/HER-2/neu. (Figure 3H, 3I). A diagnosis of a low-grade "fibromatosis-like" metaplastic carcinoma, associated with a micropapilloma, was finally made. All the cut margins were free of tumor.


Fibromatosis-like carcinoma-an unusual phenotype of a metaplastic breast tumor associated with a micropapilloma.

Rekhi B, Shet TM, Badwe RA, Chinoy RF - World J Surg Oncol (2007)

A). Tumor cells exhibiting strong cytokeratin (CK) expression (DAB × 200). Inset showing an occasional clusterof CK positive 'epithelial-like' cells. (DAB × 400). B). Tumor cellsadjacent to the micropapilloma showing positive CK7 expression. Arrow showing a cluster of cells (DAB × 100). C). Strongdiffuse expression for HMWCK. D). Positive vimentin expression. (DAB × 400). E). Focal expression for smooth muscle actin (SMA). A vessel identified in the proximity of tumor cells (DAB × 400). F). Positiveintranuclear p63 expression. (DAB × 400). G). Focal Ki-67 expression(arrows). (DAB × 400).. H). Negative expression for CD34 in the tumorcells. (DAB × 200).I. Negative CerbB-2/HER 2/neu expression. (DAB × 200).
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Figure 3: A). Tumor cells exhibiting strong cytokeratin (CK) expression (DAB × 200). Inset showing an occasional clusterof CK positive 'epithelial-like' cells. (DAB × 400). B). Tumor cellsadjacent to the micropapilloma showing positive CK7 expression. Arrow showing a cluster of cells (DAB × 100). C). Strongdiffuse expression for HMWCK. D). Positive vimentin expression. (DAB × 400). E). Focal expression for smooth muscle actin (SMA). A vessel identified in the proximity of tumor cells (DAB × 400). F). Positiveintranuclear p63 expression. (DAB × 400). G). Focal Ki-67 expression(arrows). (DAB × 400).. H). Negative expression for CD34 in the tumorcells. (DAB × 200).I. Negative CerbB-2/HER 2/neu expression. (DAB × 200).
Mentions: Histological sections revealed a spindle cell tumor showing an infiltrative growth pattern with prominent areas of sclerosis reminiscent of keloid formation. The cells were mainly arranged in fascicles and displayed tapering nuclei with mild anisonucleosis. Mitoses were inconspicuous. Occasionally, the cells were plump with epithelioid shapes and revealed mild atypia with an occasional small cluster formation. Interspersed were foci of benign ductal hyperplasia and papillary hyperplasia, including a micropapilloma along with focal aggregates of chronic inflammatory cells. The micropapilloma did not show any significant atypia. (Figure 2A, 2B, 2C, 2D). No discrete squamous differentiation was identified. No focus of Ductal-carcinoma-in-situ (DCIS) was seen in any of the sections. The two closest differential diagnoses considered were fibromatosis and a "fibromatosis like" metaplastic carcinoma. A wide panel of IHC antibody markers was performed (Table 1). The tumor cells were simultaneously diffusely positive for epithelial markers i.e. the various cytokeratins CK, CK7, High molecular weight (HMWCK) and epithelial membrane antigen (EMA), along with a mesenchymal marker i.e. vimentin. (Figure 3A, 3B, 3C and 3D). All the cytokeratins were positive in the interspersed benign ducts that acted as internal controls. The tumor cells were negative for Gross cystic disease fluid protein (GCDFP), estrogen (ER) and progesterone receptor (PR). The myoepithelial markers i.e. smooth muscle actin (SMA) and p63 showed focal, positive expression. (Figure 3E, 3F). S100 and Desmin were negative. Ki-67 (proliferation marker) showed focal positivity in less than 5% tumor cells (Figure 3G). The tumor cells were negative for CD34 and CerbB-2/HER-2/neu. (Figure 3H, 3I). A diagnosis of a low-grade "fibromatosis-like" metaplastic carcinoma, associated with a micropapilloma, was finally made. All the cut margins were free of tumor.

Bottom Line: A diagnosis of a low-grade fibromatosis-like carcinoma breast associated with a micropapilloma was formed.The importance of making this diagnosis to facilitate an intra operative surgical planning is marred by diagnostic difficulties.In such cases, IHC is imperative in forming an objective diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India. rekhi.bharat@gmail.com

ABSTRACT

Background: Fibromatosis-like metaplastic carcinoma is a newly described metaplastic breast tumor, literature on which is still evolving.

Case presentation: A 77-year-old lady presented with a 2 x 2 cm mass with irregular margins in the upper and outer quadrant of left breast. Fine needle aspiration cytology (FNAC) from the lump was inconclusive. A lumpectomy was performed and sent for frozen section, which revealed presence of spindle cells showing mild atypia in a sclerotic stroma. The tumor cells revealed prominent infiltration into the adjacent fat. A differential diagnosis of a low-grade sarcoma vs. a metaplastic carcinoma, favoring the former, was offered. Final histology sections revealed an infiltrating tumor with predominant spindle cells in a collagenous background, simulating a fibromatosis. Adjacent to the tumor were foci of benign ductal hyperplasia and a micropapilloma. Immunohistochemistry (IHC) showed diffuse co-expression of epithelial markers i.e. cytokeratins (CK, HMWCK, CK7) and EMA along with a mesenchymal marker i.e. vimentin in the tumor cells. Myoepithelial markers (SMA and p63) showed focal positivity. A diagnosis of a low-grade fibromatosis-like carcinoma breast associated with a micropapilloma was formed.

Conclusion: Fibromatosis-like carcinoma is a rare form of a metaplastic breast tumor. This diagnosis requires an index of suspicion while dealing with spindle cell breast tumors. The importance of making this diagnosis to facilitate an intra operative surgical planning is marred by diagnostic difficulties. In such cases, IHC is imperative in forming an objective diagnosis.

Show MeSH
Related in: MedlinePlus