Carcinosarcoma of the Breast: Case Report

Abstract

Carcinosarcoma of the breast represents less than 1% of primary breast mailgnancies. Both malign epithelial and malign mesenchymal elements exist together in the breast. A 59 year old postmenopausal women presents with a bloody nipple discharge and mass in breast. In left breast 2x1 cm mss detected and excisied. At pathological examination breast carcinosarcoma was detec-ted. Then modified radical mastectomy was performed. Tumor measured 4x4x3.5 cm. Tumor cells were negative for estrogen, progesteron. C-erb-B2 was negative. There was no metastasis in axillary lymph node metastasis. Carcinosarcoma of breast is rare tumor. It mass be consider in diagnosis of patients with large breast mass.Key words: Breast cancer, carcinosarcoma, metaplastic cancer IntroductionCarcinosarcoma of the breast is an aggressive tumor constituting less than 1% of all breast cancers (1). It contains a combination of malignant epithelial and malignant mesenchymal cells (2). In this case report, findings of a patient who had been operated with a diagnosis of breast carcinosarcoma and the relevant literature data are presented. Case PresentationA 59-year-old female patient presented with bloody nipple discharge and a lump in her left breast for the last 2 months. On physical examination, a 4x4 cm mass was observed at the 1-2 o'clock position in the left breast. The ultrasonographic examination showed a regular bordered, hypoechoic solid lesion that contains calcifications, and in 40 mm diameter at the 12 o'clock position in the left breast. Distortion was observed in the breast parenchyma surrounding the lesion. Mammographic examination revealed a nodular opacity of 3.5 cm in size in the outer quadrant of the left breast that contains microcalcifications and distortion of the surrounding tissues.An excisional biopsy was performed in another center and the histopathological examination was compatible with carcinosarcoma, thus the patient was referred to our clinic. An informed consent was obtained and surgery was recommended. The patient underwent modified radical mastectomy.The histopathological examination of the mastectomy specimen identified the tumor size as 4x4x3,5 cm. The tumor contained 5-10% of ductal carcinoma in situ foci, with areas of microcalcifications, tumor necrosis was observed in 50% -60 of the tumor, there was no lymphovascular invasion, but perineural invasion was frequently seen. Immunohistochemical examination showed the tumor as epithelial membrane antigen (+), Vimentin (+), high molecular weight cytokeratin (-), CK 7 and smooth muscle actin (+), and non-specific staining with S 100 (Figure 1, 2). The estrogen receptor (ER) and progesterone receptor (PR) were negative. C-erbB 2 was negative. Metastasis was not observed in any of the 20 removed axillary lymph nodes. Discussion and ConclusionsCarcinosarcoma of the breast is a malignant sarcomatoid metaplasia of epithelial carcinoma. It is included in the group of metaplastic breast tumors. Malignant epithelial and malignant mesenchymal cells are found together. ...

Extrem seltene Differenzialdiagnose eines Mammakarzinoms: aggressiver Subtyp des metaplastischen Karzinoms – Karzinosarkom

“…In den meisten Fällen zeigt sich keine Expression von Östrogen-und Progesteronrezeptoren und/oder HER2neu mit einem sogenannten "Triple-Negativ"-Muster [4]. Der typische klinische Befund ist ein schnell wachsender, tastbarer Tumor [5]. Die 5-Jahres-Überlebensrate für das Karzinosarkom wird in der Literatur mit unter 50 % angegeben und ist damit geringer als bei anderen Subtypen des metaplastischen Karzinoms [6].…”

Breast Carcinosarcoma: The Report of a Unique Case Including Fibrosarcoma and Metaplasia of Squamous Carcinoma with Adenocarcinoma; a Case Report and the Literature Review

“…The clinical symptoms of breast carcinosarcoma are similar to invasive ductal carcinoma, and include the presence of a large painful mass, nipple discharge, nipple depression, and skin ulceration (7,8,12,14). One study reported a case of carcinosarcoma presenting as a breast abscess (15).…”

“…Chemotherapy may include CMF (cyclophosphamide, methotrexate, and 5 fluorouracil)-based TA (anthracyclines/taxane) regimes, but side effects are undesirable (16). Radiation therapy is recommended for patients with ≥ 4 axillary lymph node metastases, with a tumor size of ≥ 5 cm and in the presence of chest wall invasion, which may prevent local recurrence (8,12,14,16). Gefitinib and cetuximab, as therapeutic agents targeting EGFR/HER-1, are potent as novel treatment regimens (1,3,9,13,14).…”