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Indian Journal of Cancer, Vol. 47, No. 1, January-March, 2010, pp. 88-89 Letter To Editor Metaplastic carcinoma of breast-giant cell rich variant Jadhav DS, Bagate AN, Swami SY, Sonwane BR Department of Pathology, S.R.T.R.Medical College, Ambajogai, Beed, Maharashtra, India Code Number: cn10028 PMID: 20071807 DOI: 10.4103/0019-509X.58876 Sir, The term metaplasia describes the change of one cell type to another. The term Metaplastic carcinoma was first introduced by Huvos et al.[1] Metaplastic carcinoma of the breast is a well-recognized, uncommon entity, constituting less than 1% of malignant breast neoplasms. [2] This entity is often confused with benign and malignant lesions on both clinical and histological grounds and at times may cause diagnostic difficulty. Here we are reporting a case of metaplastic carcinoma of breast-giant cell rich variant, diagnosed in a 45-year-old female, a rare occurrence. A 45-year-old female presented with a lump in her right breast since three months. On local examination, the swelling of size 3 x 4 cm was seen in the lower outer quadrant of the right breast, not fixed to the underlying structures and without peaud'orange of overlying skin. Clinical diagnosis of fibroadenoma/carcinoma of breast was made and the patient was advised to do the biopsy. On gross, a lumpectomy specimen of size 5 x 4 x 4 cm, with a grayish white cut surface, along with necrotic areas was received. Microscopy revealed that the tumor tissue was predominantly composed of mononuclear cells, with round-to-oval nuclei and basophilic cytoplasm. These cells showed mild nuclear atypia and were admixed with numerous giant cells. Focal areas of necrosis and hemorrhage were also seen. The diagnosis was, giant cell tumor of breast arising from soft tissue on H and E (Hematoxiline and Eosin). Immunohistochemistry (IHC) revealed the mononuclear giant cells to be cytokeratin positive and the final diagnosis was given as metaplastic carcinoma of breast-giant cell rich variant. A primary giant cell tumor of soft tissue (GCT-ST) arising in the breast is an exceedingly rare neoplasm, having a low potential for malignancy. Histopathological evaluation revealed a neoplasm composed of mononuclear cells admixed with osteoclast-like giant cells resembling a giant cell tumor of the bone. The immunohistological study showed negativity for a panel of epithelial markers for this neoplasm. [3] Kajo et al. reported two cases of mammary carcinoma with osteoclast-like giant cells. Both cases were invasive ductal carcinomas with osteoclast-like giant cells, which were negative for cytokeratin, EMA (Epithelial Membrane Antigen), and S-100 protein. Furthermore, they insisted not to include these neoplasms among metaplastic breast carcinomas. [4] The disease-specific cumulative five-year survival rate for patients with metaplastic carcinoma with OGC (Osteoclastic Giant Cells) was 68%, but notably different from that of patients with carcinosarcoma (49%). Histological features like admixture of osteoclast-like giant cells in cellular stroma, foci of hemorrhages, and positivity of stromal component for cytokeratin were comparable to other studies. [5] References
Copyright 2010 - Indian Journal of Cancer |
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