Two case of breast cancer with cartilaginous and osseous metaplasia

Abstract

Invasive breast cancer (IBC) with cartilaginous or osseous metaplasia is rare. Here we report two cases of this unusual variation. Case 1: The patient was a 33-year-old woman with a right breast tumor, 2.2 cm in size. Mammograms (MMG) presented no specific findings, but ultrasound (US) showed a cystic-like lesion. Excisional biopsy confirmed IBC with cartilaginous and osseous metaplasia. Biopsy was followed with a modified radical mastectomy. One lymph node was positive, and both estrogen receptor (ER) and progesterone receptor (PgR) were negative. Case 2: The patient was a 43-year-old woman with a left breast tumor, 4.2 cm in size. MMGs presented no findings but US showed an irregular shaped, low-echoic area, suggesting malignancy. Core needle biopsy confirmed IBC with cartilaginous metaplasia. A total adenectomy and lymph node dissection with breast reconstruction using a lattisimus dorsi muscle flap were performed. Two of 18 lymph nodes were positive for metastasis and both ER and PgR were negative. IBC with cartilaginous or osseus metaplasia seem to be divided into two types pathologically, with or without intervening spindle cells, which is related to the prognosis. Matrix producing carcinoma (MPC) has no intervening spindle cells and a better prognosis than other types, however, MPC has been reported to have the same prognosis as ordinary breast cancer after for adjusting its stage. Our two cases were MPC's and no recurrence has been detected 5 and 3 years from the initial therapy, respectively.

Metastatic seeding of colon adenocarcinoma manifesting as synchronous breast and chest wall localization: Report of a case

“…Cartilaginous and/or bone metaplasia have been reported in the rare "matrix-producing" carcinoma, which shows negative immunostaining for ERs, PRs, and HER-2 and positive immunostaining for CK5 expression, and is included within the basal-like phenotype. [6][7][8] Although CK7 expression is present in most breast carcinomas, it is noteworthy that it was reported in one case of "matrix-producing" carcinoma 25 and in some metaplastic spindle cell carcinomas. 26 On the contrary, no primary breast carcinomas have been reported to be positive for CK20 immunostaining.…”

“…5 Expression of CK5 has been reported in basal-like breast carcinomas, which are negative for ER, PR, and HER-2 expression and enclose an even rarer histotype, known as a "matrix-producing" carcinoma, showing cartilaginous and/or bone metaplasia. [6][7][8] We report a case of breast metastatic seeding of colon cancer cells, developing into bone metaplasia, in a woman who had undergone resection of lung metastasis from colon adenocarcinoma 6 years earlier. The surgical indications for pulmonary metastasis resection were the resectability of the lung lesion, and the absence of any sign of local recurrence of the primary lesion or of extrapulmonary lesions.…”

Carcinosarcoma of the breast with massive osseous malignant component: a basal-like entity with myoepithelial differentiation

“…Although the most commonly encountered heterologous elements in mammary gland are bone and cartilage, invasive breast cancer with cartilaginous or osseous metaplasia is rare, with a reported frequency of 0.003-0.12% (2,3). Osseous metaplasia may have either a benign pattern or a malignant one.…”

“…Cartilaginous and/or osseous metaplasias are exceptionally rare, occurring in 0.003-0.12% of cases (2,3). Osseous differentiation can have either benign or malignant features.…”

Breast cancer with cartilaginous and/or osseous metaplasia

“…There are no specific findings on radiographic examinations; therefore, it is difficult to diagnose metaplastic breast carcinoma, although the malignant lesion has been diagnosed [6,7]. There have been only four cases of metaplastic breast carcinoma diagnosed (Table 1), and most cases were diagnosed by histopathological examination postoperatively [7][8][9]. According to previous reports, preoperative diagnoses of this disease were scirrhous carcinoma, spindle-cell carcinoma or adenocarcinoma, but for the most part, this disease was only diagnosed as malignant.…”