Abstract
Metaplastic sarcomatoid carcinoma (MSC) of the breast is usually triple receptor (ER, PR, and HER2) negative and is not currently recognized as being more aggressive than other triple receptor-negative breast cancers. We reviewed archival tissue sections from surgical resection specimens of 47 patients with MSC of the breast and evaluated the association between various clinicopathologic features and patient survival. We also evaluated the clinical outcome of MSC patients compared to a control group of patients with triple receptor-negative invasive breast carcinoma matched for patient age, clinical stage, tumor grade, treatment with chemotherapy, and treatment with radiation therapy. Factors independently associated with decreased disease-free survival among patients with stage I–III MSC of the breast were patient age > 50 years (P = 0.029) and the presence of nodal macrometastases (P = 0.003). In early-stage (stage I–II) MSC, decreased disease-free survival was observed for patients with a sarcomatoid component comprising ≥95% of the tumor (P = 0.032), but tumor size was the only independent adverse prognostic factor in early-stage patients (P = 0.043). Compared to a control group of triple receptor-negative patients, patients with stage I–III MSC had decreased disease-free survival (two-sided log rank, P = 0.018). Five-year disease-free survival was 44 ± 8% versus 74 ± 7% for patients with MSC versus triple receptor-negative breast cancer, respectively. We conclude that MSC of the breast appears more aggressive than other triple receptor-negative breast cancers.
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References
Wargotz ES, Norris HJ (1989) Metaplastic carcinomas of the breast. III. Carcinosarcoma. Cancer 64:1490–1499
Gutmann JL (2005) Biologic perspectives to support clinical choices in root canal treatment. Aust Endod J 31:9–13
Wargotz ES, Deos PH, Norris HJ (1989) Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol 20:732–740
Wargotz ES, Norris HJ (1989) Metaplastic carcinomas of the breast. I. Matrix-producing carcinoma. Hum Pathol 20:628–635
Wargotz ES, Norris HJ (1990) Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. Hum Pathol 21:1142–1150
Wargotz ES, Norris HJ (1990) Metaplastic carcinomas of the breast. IV. Squamous cell carcinoma of ductal origin. Cancer 65:272–276
Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, Erban JK, Farrar WB, Goldstein LJ, Gradishar WJ, Hayes DF, Hudis CA, Jahanzeb M, Kiel K, Ljung BM, Marcom PK, Mayer IA, McCormick B, Nabell LM, Pierce LJ, Reed EC, Smith ML, Somlo G, Theriault RL, Topham NS, Ward JH, Winer EP, Wolff AC (2009) Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw 7:122–192
Downs-Kelly E, Nayeemuddin KM, Albarracin C, Wu Y, Hunt KK, Gilcrease MZ (2009) Matrix-producing carcinoma of the breast: an aggressive subtype of metaplastic carcinoma. Am J Surg Pathol 33:534–541
Davis WG, Hennessy B, Babiera G, Hunt K, Valero V, Buchholz TA, Sneige N, Gilcrease MZ (2005) Metaplastic sarcomatoid carcinoma of the breast with absent or minimal overt invasive carcinomatous component: a misnomer. Am J Surg Pathol 29:1456–1463
Carter MR, Hornick JL, Lester S, Fletcher CD (2006) Spindle cell (sarcomatoid) carcinoma of the breast: a clinicopathologic and immunohistochemical analysis of 29 cases. Am J Surg Pathol 30:300–309
Kaufman MW, Marti JR, Gallager HS, Hoehn JL (1984) Carcinoma of the breast with pseudosarcomatous metaplasia. Cancer 53:1908–1917
Sneige N, Yaziji H, Mandavilli SR, Perez ER, Ordonez NG, Gown AM, Ayala A (2001) Low-grade (fibromatosis-like) spindle cell carcinoma of the breast. Am J Surg Pathol 25:1009–1016
Gobbi H, Simpson JF, Borowsky A, Jensen RA, Page DL (1999) Metaplastic breast tumors with a dominant fibromatosis-like phenotype have a high risk of local recurrence. Cancer 85:2170–2182
Rosen PP, Ernsberger D (1987) Low-grade adenosquamous carcinoma. A variant of metaplastic mammary carcinoma. Am J Surg Pathol 11:351–358
Van Hoeven KH, Drudis T, Cranor ML, Erlandson RA, Rosen PP (1993) Low-grade adenosquamous carcinoma of the breast. A clinicopathologic study of 32 cases with ultrastructural analysis. Am J Surg Pathol 17:248–258
Azzopardi JG (1979) Problems in breast pathology. Saunders, Philadelphia
Pitts WC, Rojas VA, Gaffey MJ, Rouse RV, Esteban J, Frierson HF, Kempson RL, Weiss LM (1991) Carcinomas with metaplasia and sarcomas of the breast. Am J Clin Pathol 95:623–632
Ellis IO, Bell J, Ronan JE, Elston CW, Blamey RW (1988) Immunocytochemical investigation of intermediate filament proteins and epithelial membrane antigen in spindle cell tumours of the breast. J Pathol 154:157–165
Santeusanio G, Pascal RR, Bisceglia M, Costantino AM, Bosman C (1988) Metaplastic breast carcinoma with epithelial phenotype of pseudosarcomatous components. Arch Pathol Lab Med 112:82–85
Koker MM, Kleer CG (2004) p63 expression in breast cancer: a highly sensitive and specific marker of metaplastic carcinoma. Am J Surg Pathol 28:1506–1512
Wada H, Enomoto T, Tsujimoto M, Nomura T, Murata Y, Shroyer KR (1998) Carcinosarcoma of the breast: molecular-biological study for analysis of histogenesis. Hum Pathol 29:1324–1328
Teixeira MR, Qvist H, Bohler PJ, Pandis N, Heim S (1998) Cytogenetic analysis shows that carcinosarcomas of the breast are of monoclonal origin. Genes Chromosomes Cancer 22:145–151
Toikkanen S (1981) Primary squamous cell carcinoma of the breast. Cancer 48:1629–1632
Cardoso F, Leal C, Meira A, Azevedo R, Mauricio MJ, Leal da Silva JM, Lopes C, Pinto Ferreira E (2000) Squamous cell carcinoma of the breast. Breast 9:315–319
Eggers JW, Chesney TM (1984) Squamous cell carcinoma of the breast: a clinicopathologic analysis of eight cases and review of the literature. Hum Pathol 15:526–531
Hennessy BT, Krishnamurthy S, Giordano S, Buchholz TA, Kau SW, Duan Z, Valero V, Hortobagyi GN (2005) Squamous cell carcinoma of the breast. J Clin Oncol 23:7827–7835
Rayson D, Adjei AA, Suman VJ, Wold LE, Ingle JN (1999) Metaplastic breast cancer: prognosis and response to systemic therapy. Ann Oncol 10:413–419
Oberman HA (1987) Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients. Am J Surg Pathol 11:918–929
Hennessy BT, Giordano S, Broglio K, Duan Z, Trent J, Buchholz TA, Babiera G, Hortobagyi GN, Valero V (2006) Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol 17:605–613
Hennessy BT, Gonzalez-Angulo AM, Stemke-Hale K, Gilcrease MZ, Krishnamurthy S, Lee JS, Fridlyand J, Sahin A, Agarwal R, Joy C, Liu W, Stivers D, Baggerly K, Carey M, Lluch A, Monteagudo C, He X, Weigman V, Fan C, Palazzo J, Hortobagyi GN, Nolden LK, Wang NJ, Valero V, Gray JW, Perou CM, Mills GB (2009) Characterization of a naturally occurring breast cancer subset enriched in epithelial-to-mesenchymal transition and stem cell characteristics. Cancer Res 69:4116–4124
Weigelt B, Kreike B, Reis-Filho JS (2009) Metaplastic breast carcinomas are basal-like breast cancers: a genomic profiling analysis. Breast Cancer Res Treat 117:273–280
Turner NC, Reis-Filho JS, Russell AM, Springall RJ, Ryder K, Steele D, Savage K, Gillett CE, Schmitt FC, Ashworth A, Tutt AN (2007) BRCA1 dysfunction in sporadic basal-like breast cancer. Oncogene 26:2126–2132
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This study was supported by Cancer Center Support Grant # CA16672 from the NCI.
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Lester, T.R., Hunt, K.K., Nayeemuddin, K.M. et al. Metaplastic sarcomatoid carcinoma of the breast appears more aggressive than other triple receptor-negative breast cancers. Breast Cancer Res Treat 131, 41–48 (2012). https://doi.org/10.1007/s10549-011-1393-6
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DOI: https://doi.org/10.1007/s10549-011-1393-6