Sarcomatoid (metaplastic) spindle cell carcinoma arising in a phylloid tumor with massive squamous metaplasia – a case report and review of the literature
Authors:
Z. Kinkor 1; E. Sticová 2; J. Šach 2; J. Rychtera 3; A. Skálová 1
Authors place of work:
Bioptická laboratoř, s. r. o. a Šiklův ústav patologie, LF UK, Plzeň
1; Ústav patologie, FN a 3. LF UK, Královské Vinohrady, Praha
2; RTG-U, s. r. o., Jičín
3
Published in the journal:
Čes.-slov. Patol., 48, 2012, No. 3, p. 156-160
Category:
Original Articles
Summary
A 76-years-old woman underwent a partial mastectomy and a low-grade malignant homologous phyllodes tumor measuring 45 mm in maximum diameter was diagnosed. Beyond its typical dual composition the tumor displayed extensive intraductal squamous metaplasia. Approximately in one third of the lesion the original mesenchymal component cytologically and structurally changed which ultimately led to seeming stromal overgrowth. The loose storiform background contained isolated larger atypical elements with ample eosinophilic cytoplasm and obvious mitotic activity. This final fibromatosis-like arrangement was completed either by multiple dispersed abrupt squamous morules or just by pearl-like abortive form of squamous differentiation. Conventional in situ or invasive ductal carcinoma was not present. A combined expression of both low and high molecular weight cytoketatins, S100 protein, p63, CD10 and GFAP confirmed the incomplete basal/myoepithelial phenotype and ultimately led to the diagnosis of a spindle cell metaplastic carcinoma arising in a phyllodes tumor - a neoplasm unpublished so far. A review of the literature concerning epithelial malignancies originating from a milieu of phyllodes tumor guides discussion/speculation over the possible histopathogenesis of this vanishingly rare lesion.
Keywords:
breast – phylloid tumor – phyllodes tumor – spindle cell sarcomatoid/metaplastic carcinoma – squamous metaplasia
Zdroje
1. Carter BA, Page DL. Phyllodes tumor of the breast: local recurrence versus metastatic capacity Hum Pathol 2004; 35(9): 1051–1052.
2. Rosen PP. Fibroepithelial neoplasms. In: Rosen PP, Hoda SA. Breast pathology. Diagnosis by needle core biopsy (2nd edn). Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 69–84.
3. Tavassoli FA. Tumours of the breast. Fibroepithelial tumours. In: Tavassoli FA, Devilee P. WHO classification of tumours. Pathology and genetics of tumours of the breast and female genital organs. IARC Press: Lyon; 2003: 99–103.
4. Abdul Aziz M, Sullivan F, Kerin MJ, Callagy G. Malignant phyllodes tumour with liposarcomatous differentiation, invasive tubular carcinoma, and ductal and lobular carcinoma in situ: case report and review of the literature. Patholog Res Int 2010; 2010: 501274.
5. De Rosa G, Ferrara G, Goglia P, Ghicas C, Zeppa P. In situ and microinvasive carcinoma with squamoid differentiation arising in a phyllodes tumor: report of a case. Tumori 1989; 75(5): 514–517.
6. Deodhar KK, Baraniya JB, Naresh KN, Shinde SR, Chinoy RF. Cancerization of phyllodes tumour. Histopathology 1997; 30(1): 98–99.
7. Gilks B, Tavassoli FA. Coexistence of intracytoplasmic lumens and membrane-bound vesicles in an invasive carcinoma arising in cystosarcoma phyllodes. Ultrastruct Pathol 1988; 12(6): 631–642.
8. Hunger E, Türk R, Wurster K. Malignant cystosarcoma phylloides and squamous cell carcinoma of the breast. A rare tumor combination. Geburtshilfe Frauenheilkd 1984; 44(10): 640–642.
9. Christensen L, Nielsen M, Madsen PM. Cystosarcoma phyllodes. A review of 19 cases with emphasis on the occurrence of associated breast carcinoma. Acta Pathol Microbiol Immunol Scand A 1986; 94(1): 35–41.
10. Ishida T, Izuo M, Kawai T. Breast carcinoma arising in cystosarcom phyllodes: report of a case with a review of the literature. Jpn J Clin Oncol 1984; 14(1): 99–106.
11. Klausner JM, Lelcuk S, Ilia B, et al. Breast carcinoma originating in cystosarcoma phyllodes. Clin Oncol 1983; 9(1): 71–74.
12. Kodama T, Kameyama K, Mukai M, Sugiura H, Ikeda T, Okada Y. Invasive lobular carcinoma arising in phyllodes tumor of the breast. Virchows Arch 2003; 442(6): 614–616.
13. Korula A, Varghese J, Thomas M, Vyas F, Korula A. Malignant phyllodes tumour with intraductal and invasive carcinoma and lymph node metastasis. Singapore Med J 2008; 49(11): e318–321.
14. Kuo YJ, Ho DM, Tsai YF, Hsu CY. Invasive ductal carcinoma arising in phyllodes tumor with isolated tumor cells in sentinel lymph node. J Chin Med Assoc 2010; 73(11): 602–604.
15. Leong AS, Meredith DJ. Tubular carcinoma developing within a recurring cystosarcoma phyllodes of the breast. Cancer 1980; 46(8): 1863–1867.
16. Macher-Goeppinger S, Marme F, Goeppert B, et al. Invasive ductal breast cancer within a malignant phyllodes tumor: case report and assessment of clonality. Hum Pathol 2010; 41(2): 293–296.
17. Parfitt JR, Armstrong C, O’malley F, Ross J, Tuck AB. In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases. World J Surg Oncol 2004; 2: 46.
18. Ramdass MJ, Dindyal S. Phyllodes breast tumour showing invasive squamous-cell carcinoma with invasive ductal, clear-cell, secretory, and squamous components. Lancet Oncol 2006; 7(10): 880
19. Sharma R, Usmani S, Siegel R. Primary squamous cell carcinoma of breast in background of phyllodes tumor - a case report. Conn Med 2009; 73(6): 341–343.
20. Shirah GR, Lau SK, Jayaram L, Bouton ME, Patel PN, Komenaka IK. Invasive lobular carcinoma and lobular carcinoma in situ in a phyllodes tumor. Breast J 2011; 17(3): 307–309.
21. Sugie T, Takeuchi E, Kunishima F, Yotsumoto F, Kono Y. A case of ductal carcinoma with squamous differentiation in malignant phyllodes tumor. Breast Cancer 2007; 14(3): 327–332.
22. Yasumura T, Matsui S, Hamajima T, et al. Infiltrating ductal carcinoma developing within cystosarcoma phyllodes - a case report. Jpn J Surg 1988; 18(3): 326–329.
23. Alė PL, Andreano T, Monaco S, Sebastiani V, Eleuteri Serpieri D. Malignant phyllodes tumor of the breast with features of intraductal carcinoma. Pathologica 2001; 93(2): 124–127.
24. Brochard-Le-Douarin LA, Laboisse C, Potet F, SenŹze J. Phyllodes tumor associated with in-situ lobular carcinoma. Rev Fr Gynecol Obstet 1989; 84(1): 41–43.
25. Grove A, Deibjerg Kristensen L. Intraductal carcinoma within a phyllodes tumor of the breast: a case report. Tumori 1986; 72(2): 187–190.
26. Knudsen PJ, Ostergaard J. Cystosarcoma phylloides with lobular and ductal carcinoma in situ. Arch Pathol Lab Med 1987; 111(9): 873–875.
27. Lim SM, Tan PH. Ductal carcinoma in situ within phyllodes tumour: a rare occurrence. Pathology 2005; 37(5): 393–396.
28. Nishimura R, Hasebe T, Imoto S, Mukai K. Malignant phyllodes tumour with a noninvasive ductal carcinoma component. Virchows Arch 1998; 432(1): 89–93.
29. Nomura M, Inoue Y, Fujita S, et al. A case of noninvasive ductal carcinoma arising in malignant phyllodes tumor. Breast Cancer 2006; 13(1): 89–94.
30. Yamaguchi R, Tanaka M, Kishimoto Y, Ohkuma K, Ishida M, Kojiro M. Ductal carcinoma in situ arising in a benign phyllodes tumor: report of a case. Surg Today 2008; 38(1): 42–45.
Štítky
Anatomical pathology Forensic medical examiner ToxicologyČlánok vyšiel v časopise
Czecho-Slovak Pathology
2012 Číslo 3
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