Comparative analysis of 30 cases of metaplastic carcinoma of the breast

doi:10.3969/j.issn.1674-8115.2022.01.010

Abstract

Abstract: Objective

·To comparatively analyze features of metaplastic carcinoma of the breast (MBC) images and immunological characteristics.

Methods

·The data of 30 patients with MBC treated in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to January 2021 were analyzed retrospectively, and the imaging findings and immunohistochemical results of tumors were analyzed and compared.

Results

·A total of 31 lesions were found in 30 cases of MBC, including 18 squamous cell carcinomas, 3 mixed metaplastic carcinomas, 7 mesenchymal differentiated carcinomas, 1 myoepithelial carcinoma, and 2 spindle cell carcinomas. All patients were female, aged from 33 to 89 years old, with an average age of (61.8±14.2) years. The maximum size of the tumors was 101.0 mm while the minimal was 6.6 mm, with the medium size 25.5 mm and the average size (33.1±18.5) mm. A total of 29 patients underwent ultrasound examination before operation, with a total of 30 lesions. Among them, 23 lesions were irregular-shaped (76.7%), 19 lesions were hypoechoic (63.3%), 11 lesions were mixed echogenicity (36.7%), 14 lesions were found with unclear boundary (46.7%), and 7 lesions were accompanied by small internal calcifications (23.3%). Five cases of axillary lymph nodes were found, in which 3 cases were confirmed by pathology as lymph node metastasis (10.3%). Eight patients were examined by computed radiography (CR), showing lobulated, lumpy or asymmetrical shape, with unclear boundary, and some of them were found with coarse, heterogeneous or fine sand-like calcification. Magnetic resonance imaging (MRI) showed low signal intensity on T1 weighted imaging (T1WI) and T2WI in 6 patients. After enhancement, uneven signal, obscure border, and lobulated shape were shown. The MRI images of 3 patients showed that there was the possibility of surrounding tissue invasion and axillary lymph node metastasis respectively, but ultrasound examination did not show that. Except the invasion of pectoralis major, which was confirmed by pathology, the other 2 cases were all false positive. Four cases accepted CR, MRI and ultrasound, 2 cases of small calcification were missed by MRI and 1 case of axillary lymph node was missed by ultrasound. Sixteen lesions were triple-negative (51.6%), estrogen receptor (ER)/progesterone receptor (PR) expression rate was 32.2% and the over-expression rate of human epidermal growth factor receptor 2 (HER2) was 25.8%.

Conclusion

·Ultrasound, MRI and CR can complement each other and improve the accuracy of diagnosing the malignant degree of MBC.

Key words: metaplastic carcinoma of the breast (MBC), ultrasonography, magnetic resonance imaging (MRI), computed radiography (CR), triple negative breast cancer

CLC Number:

R730.41

Cui CHEN, Ye JIN, Lin WANG, Hongli LI, Caifeng WAN, Lixin JIANG. Comparative analysis of 30 cases of metaplastic carcinoma of the breast[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 70-76.

Figures/Tables 4

TrendMD

References 21

1	ZEIN DEI, HUGHES M, KUMAR S, et al. Metaplastic carcinoma of the breast is more aggressive than triple-negative breast cancer: a study from a single institution and review of literature[J]. Clin Breast Cancer, 2017, 17(5): 382-391.
2	LAKHANI S R. WHO classification of tumours of the breast[M]. 4th. Lyon: International Agency for Research on Cancer, 2012.
3	ONG C T, CAMPBELL B M, THOMAS S M, et al. Metaplastic breast cancer treatment and outcomes in 2500 patients: a retrospective analysis of a national oncology database[J]. Ann Surg Oncol, 2018, 25(8): 2249-2260.
4	颜红菊, 许晓静, 谭艳娟, 等. 化生性乳腺癌的多模态超声特征[J]. 医学影像学杂志, 2018, 28(6): 945-949.
5	ADLER D D, CARSON P L, RUBIN J M, et al. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings[J]. Ultrasound Med Biol, 1990, 16(6): 553-559.
6	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志, 2019, 29(8): 609-680.
7	HUVOS A G, LUCAS J C JR, FOOTE F W JR. Metaplastic breast carcinoma. Rare form of mammary cancer[J]. N Y State J Med, 1973, 73(9): 1078-1082.
8	HARDY B M, CORTINA C S, JAVIDIPARSIJANI S, et al. Hypercalcemia in metaplastic squamous cell carcinoma of the breast[J]. Am J Case Rep, 2019, 20: 366-369.
9	GREENBERG D, MCINTYRE H, BIERRE T. Metaplastic breast cancer[J]. Australas Radiol, 2004, 48(2): 243-247.
10	LANGLANDS F, CORNFORD E, RAKHA E, et al. Imaging overview of metaplastic carcinomas of the breast: a large study of 71 cases[J]. Br J Radiol, 2016, 89(1064): 20140644.
11	CHOI B B, SHU K S. Metaplastic carcinoma of the breast: multimodality imaging and histopathologic assessment[J]. Acta Radiol Stock Swed, 2012, 53(1): 5-11.
12	姜珊珊, 张乃千, 佟凌霞. 乳腺化生性癌的超声表现与临床病理特点[J]. 中国实验诊断学, 2020, 24(10): 1637-1639.
13	BAE S Y, LEE S K, KOO M Y, et al. The prognoses of metaplastic breast cancer patients compared to those of triple-negative breast cancer patients[J]. Breast Cancer Res Treat, 2011, 126(2): 471-478.
14	贾懿, 詹维伟, 朱樱. 化生性乳腺癌的影像学诊断研究[J]. 医学影像学杂志, 2019, 29(5): 779-782.
15	RAKHA E A, TAN P H, VARGA Z, et al. Prognostic factors in metaplastic carcinoma of the breast: a multi-institutional study[J]. Br J Cancer, 2015, 112(2): 283-289.
16	LUINI A, AGUILAR M, GATTI G, et al. Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature[J]. Breast Cancer Res Treat, 2007, 101(3): 349-353.
17	ZHANG Y Q, LV F, YANG Y L, et al. Clinicopathological features and prognosis of metaplastic breast carcinoma: experience of a major Chinese Cancer Center[J]. PLoS One, 2015, 10(6): e0131409.
18	TZANNINIS I G, KOTTEAS E A, NTANASIS-STATHOPOULOS I, et al. Management and outcomes in metaplastic breast cancer[J]. Clin Breast Cancer, 2016, 16(6): 437-443.
19	SALEMIS NS. Metaplastic carcinoma of the breast with mesenchymal differentiation (carcinosarcoma). A unique presentation of an aggressive malignancy and literature review[J]. Breast Dis, 2018, 37(3): 169-175.
20	HU Q, CHEN W X, ZHONG S L, et al. Current progress in the treatment of metaplastic breast carcinoma[J]. Asian Pac J Cancer Prev, 2013, 14(11): 6221-6225.
21	KRINGS G, CHEN Y Y. Genomic profiling of metaplastic breast carcinomas reveals genetic heterogeneity and relationship to ductal carcinoma[J]. Mod Pathol, 2018, 31(11): 1661-1674.

Item	Squamous cell carcinoma （n=18）	Carcinoma with mesenchymal differentiation （n=6）	Spindle cell carcinoma （n=2）	Myoepithelial carcinoma （n=1）	Mixed metaplastic carcinoma （n=3）	Total/n（%）
Shape
Regular	2	3	0	1	1	7 （23.3）
Irregular	16	3	2	0	2	23 （76.7）
Margin
Clear	7	5	1	1	2	16 （53.3）
Not clear	11	1	1	0	1	14 （46.7）
Echo
Hypoechoic	14	3	1	0	1	19 （63.3）
Hybrid echo	4	3	1	1	2	11 （36.7）
Calcification
Tiny	5	2	0	0	0	7 （23.3）
Coarse	0	0	0	0	0	0 （0）
None	13	4	2	1	3	23 （76.7）
Axillary lymph node
Swollen	5	0	0	0	0	5 （16.7）
Normal	13	6	2	1	3	25 （83.3）

Item	Squamous cell carcinoma （n=18）	Carcinoma with mesenchymal differentiation （n=6）	Spindle cell carcinoma （n=2）	Myoepithelial carcinoma （n=1）	Mixed metaplastic carcinoma （n=3）	Total/n（%）
Shape
Regular	2	3	0	1	1	7 （23.3）
Irregular	16	3	2	0	2	23 （76.7）
Margin
Clear	7	5	1	1	2	16 （53.3）
Not clear	11	1	1	0	1	14 （46.7）
Echo
Hypoechoic	14	3	1	0	1	19 （63.3）
Hybrid echo	4	3	1	1	2	11 （36.7）
Calcification
Tiny	5	2	0	0	0	7 （23.3）
Coarse	0	0	0	0	0	0 （0）
None	13	4	2	1	3	23 （76.7）
Axillary lymph node
Swollen	5	0	0	0	0	5 （16.7）
Normal	13	6	2	1	3	25 （83.3）

Subtype	Shape， signal and echo			Margin			Calcification			BI-RADS category			Swollen axillary lymph node
Subtype	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound
Squamous cell carcinoma	Irregularly high density	Cyst-like mass with thick wall， low T1WI and T2WI signals； multiregional non-mass-like enhancement	Irregular shape， hybrid echoic	Not clear	Not clear	Not clear	Multiple and tiny	None	Multiple and tiny	5	5	5	Both sides	Both sides	Right side
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	4c	5	5	None	None	None
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； early enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	0	5	5	None	None	None
Spindle cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	Tiny	None	Multiple and tiny	4c	5	4a	None	None	None

Subtype	Shape， signal and echo			Margin			Calcification			BI-RADS category			Swollen axillary lymph node
Subtype	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound
Squamous cell carcinoma	Irregularly high density	Cyst-like mass with thick wall， low T1WI and T2WI signals； multiregional non-mass-like enhancement	Irregular shape， hybrid echoic	Not clear	Not clear	Not clear	Multiple and tiny	None	Multiple and tiny	5	5	5	Both sides	Both sides	Right side
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	4c	5	5	None	None	None
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； early enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	0	5	5	None	None	None
Spindle cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	Tiny	None	Multiple and tiny	4c	5	4a	None	None	None

[1]	SUN Lei, DAI Shifeng, CHEN Yuhua, XU Xinyi, JIANG Kele, LI Xiaowen, LI Chengjing, WU Tingting. Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 684-692.
[2]	LI Zhuohang, YU Xindi, REN Jingya, SHEN Jia, DONG Suzhen, WANG Wei. Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 753-759.
[3]	LUO Rui, YANG Gongxin, SHI Huimin, HAN Yongshun, HE Yining, TIAN Zhen, WU Yingwei. Study of imaging characteristics of Kimura disease in the head and neck [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(9): 1182-1189.
[4]	HUANG Qin, HUANG Ying, LI Wen. Timing of ultrasonography in the diagnosis of fallopian tubal heterotopic pregnancy [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(12): 1545-1551.
[5]	LU Xiaobing, YUE Jiang, HE Shengyun, DONG Ying, LU Qing, MA Jing. Effect of intramuscular adipose tissue in the skeletal muscle of thigh on glucose metabolism in male patients with obesity [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1169-1174.
[6]	CHEN Jiaye, ZHANG Huifeng, LU Wenxian, PENG Daihui. Research progress of brain magnetic resonance imaging related to suicide in bipolar disorder patients [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(7): 939-944.
[7]	LIU Siyu, WU Bing, LI Xiaomin, ZHAO Lulu, CHEN Jun, AI Songtao. Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(8): 1095-1102.
[8]	CHEN Liqi, XUE Zhuowei, WU Qingkai. Review of MRI-based three-dimensional digital model reconstruction of female pelvic floor organs [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(3): 381-386.
[9]	Xuehong WANG, Xuzhuo CHEN, Yi MAO, Da SHEN, Shanyong ZHANG. Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(2): 173-177.
[10]	WEI Yifan, ZHU Yueniu, KONG Xiangmei, XU Yaya, ZHU Xiaodong. Effects of early mechanical ventilation on the morphology and function of the diaphragm in children [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1712-1719.
[11]	Yihuan WANG, Ruokun LI, Huanhuan CHONG, Fuhua YAN. Research progress of Gd-EOB-DTPA-enhanced magnetic resonance imaging in the evaluation of biological behavior of hepatocellular carcinoma [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 130-134.
[12]	Yan-jie JI, Hao LUO, Hai-yan CAI, Xin-yu LIU, Shi-jia JIN, Shen-yue SU, Han-zhang XU, Hu LEI, Ying-li WU. Inhibition of CDDO-ME on ubiquitin-specific protease 2a activity and cell proliferation in triple negative breast cancer cells [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1025-1032.
[13]	JI Ying-ying, XUE Bin, HUANG Yue, ZHANG Jian-wei. Efficacy and safety of oral midazolam in combination with intranasal dexmedetomidine for paediatric magnetic resonance imaging sedation [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(8): 1098-1102.
[14]	YANG Tao, CHEN Jun, FANG Yi-ru. Advances in magnetic resonance imaging study of bipolar Ⅰdisorder [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(12): 1660-1664.
[15]	YUE Xiu-hui, KONG Wei-dan, REN Ji-liang, YUAN Ying#, TAO Xiao-feng#. Value of 3.0-T MR diffusion-weighted imaging combined with dynamic contrast-enhanced imaging in differentiating benign and malignant thyroid nodules [J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2020, 40(10): 1393-1397.