Metaplastic carcinoma of the breast Clinical presentation, treatment results and prognostic factors

Figures & data

Table I.  Characteristics of 19 patients with metaplastic carcinoma of the breast.

Characteristics	Number
Age (years)
Median (range)	48 (14–58)
< 50 y	13
≥ 50 y	6
Menopausal status
Pre menopause	12
Post menopause	7
Family history of breast cancer
Positive	4
Negative	15
Duration of symptoms (months)
Median (range)	8 (1–24)
Presenting signs
Mass	16
Mass + nipple discharge	2
Inflammatory	1
Tumor size (cm)
Median (range)	9 (3–18)
<10 cm	11
≥10 cm	8
TNM Stage
II A	4
II B	4
III A	2
III B	6
III C	1
IV	2
Histologic subtype
Purely Epithelial
Squamous	1
Adenocarcinoma with spindle cell differentiation	5
Adenosquamous	3
Mixed Epithelial and Mesenchymal
Carcinoma with chondroid metaplasia	3
Carcinoma with osseous metaplasia	2
Carcinosarcoma	5
Estrogen/Progesterone receptor status
Positive	2
Negative	15
Unknown	2

Table II.  Therapy, response, outcome and survival for 19 patients with metaplastic carcinoma of the breast.

No	Age	Tumor Size (cm)	TNM Stage	Pathology	NA-CT & Response	P-CT	Surgery	A-CT	XRT	OR	Relapse	Status	Survival months
1	50	7	T3N1M0	Carcinoma + SpCd	-	-	MRM	AC×4	-	CR	No	ANED	63
2	36	18	T4N1M1	Carcinoma + CH-M	-	FAC×6 TP×4	MRM	-	-	PR	NA	DOD	16.3
3	45	15	T4N1M0	Carcinosarcoma, leiomyosarcoma	AP×3 PR	-	MRM	-	-	CR	Yes	DOD	17.3
4	14	10	T4N0M0	Carcinosarcoma, fibrosarcoma	-	-	L + AND	AC×4	-	CR	Yes	ANED	59
5	51	10	T4N2M0	Adenosquamous	TP/AC×5 NR	-	MRM	-	-	CR	Yes	DOD	13
6	37	9	T4N1M0	Carcinosarcoma, fibrosarcoma	TP×5 NR	-	SM	-	Yes	CR	Yes	DOD	36.5
7	36	4	T2N1M0	Adenosquamous	-	-	L + AND	FAC×6	Yes	CR	Yes	ANED	83
8	56	12	T4N3M0	Carcinosarcoma, high grade sarcoma	FAC×6 PR	-	SM	-	Yes	CR	Yes	DOD	60
9	48	3	T2N1M0	Carcinoma + SpCd	-	-	L +AND	AC×4	Yes	CR	Yes	ANED	39
10	43	8	T4N0M0	Carcinoma + OS-M	-	-	MRM		-	CR	Yes	DOD	7.7
11	49	5	T2N0M0	Carcinoma + SpCd	-	-	MRM	CMF×9	-	CR	Yes	DOD	32.3
12	41	11	T3N0M0	Squamous	-	-	MRM	FAC×3	-	CR	Yes	DOD	20.7
13	50	10	T2N0M0	Carcinoma + SpCd	-	-	MRM	AC×4	Yes	CR	Yes	DOD	10.6
14	57	5	T2N0M0	Carcinosarcoma, fibrosarcoma	-	-	MRM	-	Yes	CR	Yes	ANED	21
15	45	15	T4N2M1	Adenosquamous	-	FAC×2 TP×2	Biopsy	-	-	PD	NA	DOD	5.6
16	58	9	T4N0M0	Carcinoma + SpCd	-	-	SM	-	-	CR	No	ANED	17
17	47	6	T3N0M0	Carcinoma + CH-M	-	-	MRM	AC×4	Yes	CR	No	ANED	16
18	48	4	T2N0M0	Carcinoma + OS-M	-	-	L + AND	-	-	CR	No	ANED	13
19	48	8	T3N1M0	Carcinoma + CH-M	FAC×2 NR	-	MRM	T×4	Yes	CR	No	ANED	21

Abbreviations: SpCd: spindle cell differentiation; CH-M: chondroid metaplasia; OS-M: osseous metaplasia; NA-CT: neo-adjuvant chemotherapy; P-CT: palliative chemotherapy; A-CT: adjuvant chemotherapy; XRT: radiotherapy; OR: overall response; MRM: modified radical mastectomy; SM: simple mastectomy; L: lumpectomy; AND: axillary node dissection; AP: adriamycin, cisplatin; TP: paclitaxel, cisplatin; AC: adriamycin, cyclophosphamide; FAC: 5-fluorouracil, adriamycin, cyclophosphamide; CMF: cyclophosphamide, methotrexate, 5-fluorouracil; CR: complete response, PR: partial response; NR: no response; PD: progressive disease; NA: not applicable; DOD: dead of disease; ANED: alive with no evidence of disease.

Table III.  Patterns of first relapse in 12 patients

Site	Number
Local	5
Local + Lung	2
Lung	2
Lung + Bone	2
Lung + Pleural nodules + Pleural effusion	1

Figure 1.  Overall Survival and Event Free Survival

Figure 2.  Event Free Survival According to Tumor Size

Table IV.  Literature review of metaplastic breast carcinoma clinical series.

Authors/Year of Publication/(Study Period)	No of Patients	Median Age (years)	Median Tumor Size (cm)	Stage III/IV (%)	MR-RM No (%)	Adjuvant CT/RT No	Node Positive (%)	ER-PR Negative (%)	Relapse No & Site	Median FU Months	OS %	DFS %
Pitts et al. 1991, (23 years)	34	60	3.8	NR	30 (88)	7/3	7/29 (24)	11/16 (69)	12 L: 7; M: 12	54*	47 5y	43 5y
Gutman et al. 1995, (44 years)	50	50	5	17/3 (40)	31 (62)	19/17	9/44 (21)	21/24 (88)	23 L: 9; M: 19	27	43 5y	32 5y
Rayson et al. 1999, (22 years)	27	59	3.4	NR/1	18 (67)	9/5	3/23 (13)	20/23 (87)	13 L: 4; M: 13	21*	71 3y	40 3y
Chao et al. 1999, (15 years)	14	50	4.8	3/1 (29)	12 (86)	6/2	7/14 (50)	10/11 (91)	5 M: 5	52	64 5y	NR
Neumann et al. 2002, (10 years)	24	51	4	NR/1	14 (58)	18/20	8/23 (35)	15/21 (71)	4 L: 3; M: 3	14	72 3y	71 3y
Al Sayed et al. Current study (10 years)	19	48	9	9/2 (58)	11 (58)	9/8	8/15 (53)	15/17 (88)	12 L: 7; M: 7	21^†	48 3y	15 3y

MR-RM: modified radical or radical mastectomy; CT: chemotherapy; RT: radiotherapy; ER/PR: estrogen receptors, progesterone receptors.

OS: overall survival; DFS: disease free survival; L: local; M: distant metastases; * FU data provided for patients with no evidence of recurrent disease; NR: not reported; ^† FU and survival data of 17 patients with loco-regional disease at diagnosis.