Metaplastic breast cancer: Clinical presentation, treatment results and prognostic factors.
Abstract No: 233 Citation:Proc Am Soc Clin Oncol 22: page 58, 2003 (abstr 233) Author(s):A. D. Al Sayed, King Faisal Specialist Hospital and Research Center, Riyadh, VA, Saudi Arabia

Metaplastic breast cancer is a rare form of breast cancer containing a mixture of epithelial and mesenchymal elements. Conflicting data exist about response to treatment and outcome in the literature. Purpose: to describe the clinical characteristics, outcome and prognosis of all patients (pts) with primary metaplastic breast cancer treated at a single institution over a period of 9 years. Methods: A retrospective study was conducted to review all pts with metaplastic breast cancer between 1994-2002. Results: Eighteen female pts were included in the analysis. The median age was 48 years (range, 14-56). Nine (50%) were pre-menopausal. The median duration of symptoms was 8.5 months. Median tumor size: 8.5 cms (range, 3-22). Stage distribution: IIA (2) IIB (4) IIIA (2) IIIB (8) and IV (2). Pathology: spindle cell differentiation (6), squamous metaplasia (3), osseous/chondroid differentiation (3) and mixed elements differentiation (6) pts. Estrogen and progesterone receptors were negative in 13, positive in 2 and unknown in 3 pts. Surgical treatment included modified radical mastectomy in 11, simple mastectomy in 3 and lumpectomy with axillary lymph node dissection in 3 pts. Of 7 pts received neo-adjuvant chemotherapy (CT), 4 responded while 3 pts progressed. Ten pts received adjuvant CT. Seven received loco regional radiation therapy and 3 received Tamoxifen. Twelve relapsed with a median time of relapse of 10.4 months (range, 2-28 m). Sites of relapse: local (9), lung (7) and bone (2). With a median follow up of 20.5 m (range, 4.8-83m), the 4-year event free survival (EFS) and overall survival (OS) were 13.5% and 34 %. In univariate analysis use of adjuvant CT was significant prognostic factor in EFS and OS while tumor size correlated with EFS. Conclusions: Our experience concurs with previous reports of metaplastic breast cancer, as an aggressive form of breast cancer associated with poorer outcome, tends to be receptor negative and preferentially metastasizes to the lung, a clinical behavior similar to soft tissue sarcomas. Best therapeutic approach is yet to be defined.

Metaplastic carcinomas of the breast.

Chao TC, Wang CS, Chen SC, Chen MF. J Surg Oncol. 1999 Aug;71(4):220-5.

Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine, and Chang Gung Memorial Hospital, Taipei, Taiwan. ischen01@ms15.hinet.net

BACKGROUND AND OBJECTIVES: Metaplastic carcinomas of the breast are rare neoplasms. The purpose of the present study is to better characterize the clinical course, treatment, and prognostic factors of metaplastic breast carcinomas. METHODS: Data of 14 patients with metaplastic breast carcinoma were retrospectively reviewed. The follow-up period ranged from 2 months to 10 years, 10 months (median 4.3 years). RESULTS: The patients' ages ranged from 38 to 66 years (median 50.5 years). The tumors were 2.5 to 18 cm (median 4.8 cm) in size. Seven patients had axillary nodal metastases at the time of diagnosis. Estrogen and progesterone receptors were positive in only one tumor. Twelve patients underwent modified radical mastectomy and two patients underwent incisional biopsy. Adjuvant chemotherapy was administered to six patients, and radiotherapy to two patients after mastectomy. Two patients received preoperative chemotherapy. Seven patients were living without evidence of disease at a median of 7.3 years after surgery. A patient died of ovarian carcinoma without recurrence or metastasis of breast cancer. Metastases occurred in five patients at 4 to 16 months (median 8 months) after initial treatment. Duration of symptoms, TNM stage, tumor size, and axillary nodal status were significant prognostic factors of survival. CONCLUSIONS: The patients with metaplastic breast carcinomas may have a favorable prognosis.

Metaplastic breast cancer: prognosis and response to systemic therapy.

Rayson D, Adjei AA, Suman VJ, Wold LE, Ingle JN. Ann Oncol. 1999 Apr;10(4):413-9.

Division of Medical Oncology, Mayo Clinic and Foundation, Rochester, MN, USA.

BACKGROUND: Metaplastic breast cancer is a rare disease with little information available to guide therapy. The goals of this study were to describe the patient characteristics, systemic therapies and clinical outcomes of all patients with primary metaplastic breast cancer treated at Mayo Clinic between 1976 and 1997. PATIENTS AND METHODS: Patients were identified through the medical index of Mayo Clinic. Clinical information was abstracted from the medical record of each patient. A literature search using MEDLINE and CANCERLIT for the years 1966-1997 was performed to identify all previously reported case series in the English language containing 10 or more patients. RESULTS: Twenty-seven patients were identified with a median age at diagnosis of 59 years (range 39-90 years). The median tumor size was 3.4 cm (range 0.5-7.0 cm). One patient had metastatic disease at presentation. Twenty-three patients had information available on nodal status, estrogen receptor (ER) and progesterone receptor (PR) status. Twenty patients (87%) were node-negative and three patients (13%) were both ER and PR positive. Disease-free survival (DFS) and overall survival (OS) were assessed for those who presented with local-regional disease. The three-year DFS was 40% (95% CI: 23%-73%) and the three-year OS was 71% (95% CI: 51%-97%). In univariate analysis, those patients 60 years of age or older at diagnosis were found to have an increased DFS (P = 0.011). Among those with prior estrogen use, both DFS (P = 0.022) and OS (P = 0.003) were decreased. Thirteen patients (50%) developed metastases with a median DFS time of 2.4 years. Ten different chemotherapy regimens were utilized for metastatic disease and one partial response was observed. There were no responses to tamoxifen in four patients with metastatic disease. Median survival after the development of metastases was eight months. CONCLUSIONS: Despite presenting more commonly as node-negative disease, DFS and OS in metaplastic breast cancer is decreased compared to typical adenocarcinomas. Systemic therapy also appears to be less effective. Patients with metaplastic breast cancer, particularly those with metastatic disease could be appropriate candidates for innovative therapeutic regimens.

Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells.

Wargotz ES, Norris HJ.   Hum Pathol. 1990 Nov;21(11):1142-50.

Division of Pathology, Maryland Medical Laboratories, Doctor's Hospital, Lanham 20706.

The clinical and pathologic features of 29 examples of mammary metaplastic carcinoma with osteoclastic giant cells (OGC) in the stroma are reported. A bland spindle cell or sarcomatous component dominated these neoplasms, although infiltrating duct carcinoma was present in 23 cases, and intraductal carcinoma was present in six cases. In all 29 neoplasms, the carcinoma was admixed or contiguous with the stroma. Osteoclastic giant cells were admixed within the cellular stroma, and were intimately associated with prominent thin-walled vessels. Hemorrhage and hemosiderin deposition were common. Osteoclastic giant cells were immunoreactive for vimentin and, to a lesser extent, actin, and uniformly not immunoreactive for keratins, confirming their mesenchymal nature. The stromal component of 63% of neoplasms tested was immunoreactive for keratin, 33% was immunoreactive for epithelial membrane antigen, 54% reacted for S-100 protein, 84% reacted for actin, and 100% was immunoreactive for vimentin. Nineteen neoplasms had osteoid, bone, or cartilage, but these were a prominent component in only five neoplasms and OGC were not limited to these areas. The disease-specific cumulative 5-year survival rate for patients with metaplastic carcinoma with OGC was 68%, similar to rates for patients with matrix-producing carcinoma (68%), spindle cell carcinoma (64%), and squamous carcinoma of ductal origin (63%), but notably different from that of patients with carcinosarcoma (49%). Of 17 women with axillary node dissection, only two had metastases. Eleven women developed distant metastases, most commonly to the lungs. Metastasis present at or following initial surgery was an ominous sign, as all 11 women with metastases died from tumor. Size and microscopic circumscription were significant factors in predicting disease progression.

IBCC: Breast-Preserving Therapy Effective for Metaplastic Breast Carcinoma

By Alison Palkhivala

BANFF, AB -- August 6, 2003 -- Metaplastic carcinoma of the breast can be treated effectively with breast-preserving therapy, according to a 15-year retrospective analysis presented at the Second Annual Future of Breast Cancer : An International Breast Cancer Congress, held here July 31^st to August 3^rd.

Kenneth Lodin, MD, and colleagues from Kaiser Permanente Medical Center, Los Angeles, California, United States, treated 19 patients with metaplastic carcinoma of the breast with breast-preserving therapy between 1987 and 2002.

Patients ranged in age from 26 to 76 years, with a mean age of 52. Mean tumor size was 3.0 cm, and each patient received a radiation dose that ranged between 5000 and 6000 cGy, with a mean dose of 5215 cGy. Eighteen patients underwent pathological examination of their lymph nodes; 17% of these patients had positive nodes; 22% were estrogen-receptor positive; and all patients received tamoxifen. Eleven patients received adjuvant chemotherapy, and adriamycin was used in 10 of these patients.

After a follow-up period that ranged from 6 to 176 months (mean 37 months), 2 of the 19 patients developed local recurrences. One of these recurrences occurred at 19 months and the other occurred at 21 months, both were isolated recurrences that were successfully salvaged with mastectomy. Four of the 19 patients developed distant recurrences, all between months 19 and 35, three of which were node negative. The tumor size of these recurrences averaged 2.1 cm.

The authors of this analysis concluded, "breast-preserving therapy appears to be a reasonable option for patients with metaplastic carcinoma." They added that further follow-up and additional patients are needed to validate these preliminary results.


Breast Conservation with Metaplastic Carcinoma: the Kaiser Experience. Poster 8]

Metaplastic breast cancer: clinical presentation and outcome Abstract No: 1988 Author(s):Sophie Piperno Neumann, Institut Curie, Paris, France. Abstract:

BACKGROUND: Metaplastic breast cancer is a rare disease with little information regarding standard therapy. Previous reports have suggested a high risk of recurrence following primary therapy as well as a poor prognosis for this histological subtype. The aims of this retrospective study were to describe patientÆs characteristics, systemic therapies and clinical outcomes of all patients with primary metaplastic breast cancer treated at Institut Curie between 1992 and 2001. PATIENTS AND METHODS: Patients were identified through the Pathological index of Institut Curie. Clinical information was abstracted from the computerized clinical records of each patient RESULTS: 24 patients were identified with a median age at diagnosis of 51 years (range 38-77 years). Pathological diagnosis included : spindle cell differentiation 15 cases, squamous metaplasia 5 cases and chondroid metaplasia 4 cases. One patient had metastatic disease at presentation. 23 patients had information available on nodal status, 21 on estrogen receptor (ER) and progesterone receptor (PR) status. The median tumor size was 4 cm (range 0-30 cm). 15 patients (65%) were node-negative, 19 patients (90 %) were ER negative and 15(71%) PR negative, 15 were both ER and PR negative. Surgical treatment included: mastectomy 14 cases, tumorectomy 10 cases. 18 patients received an anthracyclin based therapy, 4 were treated with tamoxifen, 20 patients received radiation therapy. Four patients relapsed, (1 local recurrence, 2 local and metastatic, 1 metastatic). Disease-free survival (DFS) and overall survival (OS) were measured for those who presented with local-regional disease. The median follow up was 14 months. The 3-year DFS was 71% and the 3 year OS was 72%. Survival data will be updated for the meeting. CONCLUSIONS: In the current retrospective study and in contrast with previous reports, patients with metaplastic breast cancer do not appear to have a high risk of recurrence and to be more aggressive than classical adenocarcinoma of the breast. However we confirm that these patients were frequently node-negative, ER or PR negative.