Low-Grade (Fibromatosis-Like) Spindle Cell Carcinoma of the Breast

Abstract

Spindle cell carcinoma of the breast, a variant of metaplastic carcinoma, includes a wide spectrum of lesions with histomorphologic and nuclear features ranging from overtly malignant to mildly atypical. Spindle cell carcinomas with mildly atypical features may resemble fasciitis, fibromatosis, or myofibroblastic tumors and therefore are often misinterpreted as such. A recent study has suggested that spindle cell carcinomas with a dominant fibromatosis-like phenotype, unlike spindle cell carcinomas in general, have no propensity for distant metastasis and should be termed "tumors" rather than "carcinomas." To investigate the question of fibromatosis-like spindle cell breast carcinoma (FLSpCCs) metastatic potential, we studied cases of FLSpCC seen at the University of Texas M.D. Anderson Cancer Center between 1987 and 2000. Clinical, pathologic, and immunophenotypic features were reviewed, with emphasis on biologic behavior and predictors of clinical outcome. Our series included 24 women who ranged in age from 55 to 85 years (mean 66 years). Tumor size ranged from 1.0 to 5 cm (mean 2.8 cm). Most tumors were grossly well defined but had microscopic infiltrative borders. Tumors showed a dominant fibromatosis-like or myofibroblastic-like growth pattern with prominent collagenization. Inflammatory infiltrate was noted in the majority of tumors. Cytokeratin-positive cells were seen in all cases and usually appeared as cords or sheets of polygonal cells; isolated cytokeratin-positive cells were rare. In most tumors immunoreactivity for smooth muscle actin (SMA) was confined to the cytokeratin-negative cells. In five cases intense co-expression of cytokeratin and SMA was noted. None of the tumors showed immunoreactivity for smooth muscle heavy chain myosin, estrogen receptors, progesterone receptors, or HER-2/neu. Ki-67 expression was noted in fewer than 5% of tumor cells. Treatment consisted of local excision (seven cases) or modified radical mastectomy (13 cases). Treatment was unknown in four cases. In patients who underwent axillary nodal dissection, no lymph node metastases were found. Two of the six patients who underwent local excision developed local recurrence. Two patients who underwent modified radical mastectomy developed lung metastases within 2 years after the initial diagnosis. The metastatic tumors were histologically similar to the primary tumors. Our findings indicate that FLSpCCs have the potential for local recurrence and distant metastasis and should be treated accordingly. Because FLSpCCs may be underdiagnosed as benign, the use of immunohistochemical studies, especially for cytokeratins and SMA, is essential in the evaluation of any spindle cell proliferations of the breast.

Current Progress in the Treatment of Metaplastic Breast Carcinoma

“…Moreover, the overall survival (OS) or disease-free survival (DFS) was also similar (Dave et al, 2006;Pezzi et al, 2007;Tseng and Martinez, 2011). Likewise, when known prognostic factors (eg, histological subtype and tumor grade) were controlled, MBC patients treated with MRM or lumpectomy had similar OS or DFS (Sneige et al, 2001;Tseng and Martinez, 2011;Nonnis et al, 2012). It appears that the prognosis is not affected by the type of surgical treatment.…”

“…An adequate margin (≥ 3 cm) was important to reduce local relapse and distant metastasis when performing local excision or quadrantectomy (Pezzi et al, 2007;Tseng and Martinea, 2011;Nonnis et al, 2012). Sneige et al proposed a lumpectomy with wide margins or even a simple mastectomy relative to the tumor size (Sneige et al, 2001). Some cases with local recurrences had been successfully salvaged by surgery +/-radiotherapy and had a median survival of 47 months (Gutman et al, 1995;Rayson et al, 1999;Al sayed et al, 2006).…”

“…Axillary lymph node involvement was consistently absent in spindle cell carcinoma (SCC) patients who underwent ALND, and no axillary node invasion was documented in patients with local recurrence (Bauer et al, 1984;Oberman, 1987;Sneige et al, 2001), which suggests that ALND is not necessary in patients with SCC. Similarly, carcinosarcoma with malignant mesenchymal component had not clinical or pathological ALN involvement.…”

Spindle Cell Carcinoma of the Breast: MR Findings Correlated with Histopathology

“…1 On gross examination, the tumors areˆrm to hard, well circumscribed or ill-deˆned, and have one or more cysts. 2 Although comparable prognosis of spindle cell carcinoma of the breast and common breast carcinoma has been reported, 3,4 spindle cell carcinoma is a highly aggressive neoplasm with a high rate of extranodular metastasis and lower overall survival rate for metaplastic carcinoma. [5][6][7] Therefore, careful deˆnition of other variants of metaplastic carcinoma is necessary.…”

A rare variant of squamous cell carcinoma of the tongue; spindle cell carcinoma Dilde nadir görülen biryassı hücreli karsinom varyantı: iğsi hücreli karsinom

“…However, it was rarely reported in breast, skin, lung and endometrium in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). A possible relationship was reported between the SCC and radiotherapy owing to most cases encountered in the patients who had had radiotherapy (1).…”