Carcinosarcoma of the breast: A case of breast conservation surgery and breast reconstruction

Abstract

Breast carcinosarcoma is an extremely rare, clinically aggressive tumor, and no standard treatment has been established. We report about a 34-year-old woman presenting with a 2.5-cm-sized carcinosarcoma in her right breast. She presented to our hospital for examination of this mass. Ultrasonography showed a hypoechoic mass with partially irregular margins. Fine-needle aspiration cytology indicated malignancy. No enlarged lymph nodes or distant metastases were detected. We diagnosed right breast cancer and performed partial mastectomy, sentinel lymph node biopsy, and latissimus dorsi muscle flap transfer. Histological findings revealed that the tumor consisted of a mixture of an epithelial component and a mesenchymal component. The final diagnosis was carcinosarcoma. After undergoing adjuvant chemotherapy and radiotherapy, the patient has had no recurrence, and her cosmesis is maintained. Clinical data of carcinosarcoma are insufficient. Breast conservation and reconstruction for carcinosarcoma may be suitable as local treatments; however, the most appropriate treatment method has not been established.

Presentation and Treatment of Aggressive, Triple-Negative Carcinosarcoma of the Breast

“…22 According to WHO guidelines, MpBCs are classified as spindle cell, squamous cell, matrix-producing, carcinosarcoma, or osteoblastic, 27 although they can be further described according to unique histotype. 9,19,20,22 A biphasic MpBC, carcinosarcoma contains both epithelial and sarcomatous components, 19 indicated by co-expression of epithelial indicators like AE-1/3, and mesenchymal indicators like vimentin and SMA. 22 Differential histological diagnoses of MpBC include myoepithelial carcinoma, myofibroblastic tumors, malignant phyllodes tumors, pleomorphic adenoma, and adenomyoepithelioma.…”

“…10 The patient's tumor presented treatment challenges. Typical of other breast carcinosarcomas, 9,12 it was a triple-negative malignancy at risk of visceral metastasis earlier rather than later in the course of disease. Because such tumors accompany poorer prognoses than receptor-positive tumors, 6 the patient began an aggressive course of adjuvant chemotherapy, as well as a course of radiation at the lumpectomy site.…”

“…A rare and aggressive tumor, carcinosarcoma is a mixed, dedifferentiated carcinoma consisting of an epithelial, carcinomatous component and a non-epithelial, mesenchymal component. 1 Distinct from other metaplastic carcinomas, carcinosarcoma is crucially biphasic 5,12,17 lacking a clearly identifiable transition zone 9 and historically has been known by several names, including biphasic metaplastic carcinoma, sarcomatoid carcinoma, and metaplastic sarcomatoid carcinoma. 16 Various organs have been known to be affected by this malignancy, including the skin, breast, bladder, ovaries, lung, 1 larynx, 2 and the uterus, 3 where uterine carcinosarcomas are known as malignant mixed Müllerian tumors.…”

“…14 In the breast, carcinosarcoma accounts for less than 0.2-1% of new cases. 4,9,18,19 One oft-cited study of this malignancy demonstrated a cumulative 5-year survival rate of 49%, with a precipitous decrease in survival odds at later stages of the disease. Lacking a treatment standard, 9 options for remedying breast carcinosarcoma include surgical resection, chemotherapy, and radiation, 1, 7 although recurrence of disease has been known to occur in these approaches toward treatment.…”

Sarcomatoid Transformation in Carcinomas: Is Precision Medicine the Answer?

“…Sarcomatoid transformation in breast cancer is a rare occurrence. The carcinosarcomas of the breast present as well circumscribed, hypoechoic mass 23 . These tumors are usually Her-2/neu negative and behave similar to triple negative adenocarcinomas with early metastases and overall poor survival 24 .…”