Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis

Cheah, Alison L.; Billings, Steven D.; Rowe, J. Jordi

doi:10.1016/j.pathol.2016.05.006

Cited by 26 publications

(14 citation statements)

References 150 publications

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“…3,14 The differential diagnosis of spindle cell carcinoma is similar to that of fibromatosis-like metaplastic carcinoma and includes phyllodes tumor, and primary or metastatic sarcoma. 15 When present, a carcinomatous component, including invasive ductal carcinoma or ductal carcinoma in situ, is extremely useful in this differential diagnosis. As discussed below, immunostaining plays an important role in the differential diagnosis.…”

Section: Spindle Cell Carcinomamentioning

confidence: 99%

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Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations

McMullen

Zoumberos

Kleer

2019

Archives of Pathology &Amp; Laboratory Medicine

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Context— Metaplastic carcinoma is a rare, triple-negative carcinoma of the breast that exhibits transformation of part or all of its glandular carcinomatous component into a nonglandular, or metaplastic, component. The World Health Organization currently recognizes 5 variants of metaplastic carcinoma based on their histologic appearance. Objective— To review the histologic classifications, differential diagnosis, prognosis, and recent laboratory studies of metaplastic breast carcinoma. Data Sources.— We reviewed recently published studies that collectively examine metaplastic carcinomas, including results from our own research. Conclusions.— Metaplastic breast carcinoma has a broad spectrum of histologic patterns, often leading to a broad differential diagnosis. Diagnosis can typically be rendered by a combination of morphology and immunohistochemical staining for high-molecular-weight cytokeratins and p63. Recent studies elucidate new genes and pathways involved in the pathogenesis of metaplastic carcinoma, including the downregulation of CCN6 and WNT pathway gene mutations, and provide a novel MMTV-Cre; Ccn6fl/fl knockout disease-relevant mouse model to test new therapies.

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Section: Spindle Cell Carcinomamentioning

confidence: 99%

“…The heterologous components can show a wide spectrum of atypia, ranging from bland to overtly malignant. 15,17 Although infrequent, some tumors may demonstrate osteoclast-type giant cells, often found adjacent to zones of stromal hemorrhage 15 (Figure 1, G and H).…”

Section: Spindle Cell Carcinomamentioning

confidence: 99%

Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations

McMullen

Zoumberos

Kleer

2019

Archives of Pathology &Amp; Laboratory Medicine

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“…Phagocytosis of necrotic adipocytes results in sheets of foamy (lipid-laden) macrophages, which later undergo fibrosis with peripheral dystrophic calcifications, the latter correlating with the ''eggshell'' calcifications seen on mammography. 1,5,6 CELLULAR SPINDLED HISTIOCYTIC PSEUDOTUMOR The term cellular spindled histiocytic pseudotumor (CSHPT) was first introduced by Sciallis and colleagues 7 to describe a series of breast masses comprising a moderately cellular proliferation of spindled histiocytes arranged into short fascicles and often surrounded by areas of mammary fat necrosis. The spindled histiocytes often infiltrated into surrounding breast parenchyma, leading to entrapment of normal mammary ducts ( Figure 1, A through C).…”

Section: Fat Necrosismentioning

confidence: 99%

“…The histiocytes in Rosai-Dorfman disease are positive for S100 protein in addition to CD68 and CD163, but negative for CD1a. 6 The diffuse, strong expression of S100 protein is an important diagnostic feature, particularly in cases that are not otherwise morphologically classic, and helps distinguishes it from CSHPT.…”

Section: Extranodal Rosai-dorfman Diseasementioning

confidence: 99%

Cellular Spindled Histiocytic Pseudotumor: A Benign Mimic of Spindle Cell Neoplasia of the Breast

East

Carter

Sciallis

2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Cellular spindled histiocytic pseudotumor (CSHPT) is an exuberant, dense histiocytic proliferation seen in the setting of mammary fat necrosis. CSHPT has a broad histologic differential diagnosis, including benign, malignant, and inflammatory etiologies. Objectives.— To highlight the most important histologic and immunohistochemical findings of CSHPT and provide comparisons to entities within the broad differential diagnosis. Data Sources.— Recently published literature regarding CSHPT and other diagnostic considerations. Conclusions.— CSHPT is a benign histiocytic proliferation with a broad differential diagnosis, for which comprehensive ancillary studies may be required to exclude malignant and infectious entities.

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“…Large lesions can be tethered to the skin and/or chest wall. Spindle cell carcinoma is characterized by spindle-shaped cells arranged in a variety of architectural patterns, and is a rare subtype of metaplastic carcinoma, accounting for about 0.024%-0.5%of all breast cancer [1–4]. Surgery and radiotherapy may be effective in the local control of low-grade spindle cell carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma

et al. 2016

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Spindle cell carcinoma of the breast is a rare subtype of metaplastic carcinoma, and no effective chemotherapy special for metaplastic carcinoma exists until now. As spindle cell carcinomas of the breast are typically “Triple Negative”, endocrine therapy and molecular therapy targeted to Her2 might not be favorable, resulting in poor prognosis. Apatinib is currently being tested in patients with breast or lung cancers. Here we report a successful case using Apatinib to treat spindle cell carcinoma of breast.A 52- year- old woman presented with a gradually enlarged lump in left breast, which was revealed to be a triple-negative spindle cell carcinoma, underwent a modified radical mastectomy. After the first line chemotherapy with Cyclophosphamide and Epirubicin, multiple metastases in bilateral lung and left anterior thoracic wall appeared. After disease progressed with therapy of Bevacizumab combined with Albumin-bound Paclitaxel and Cisplatin, we treated the patient with Apatinib according to her VEGFR expression, which showed nearly complete response and controllable and tolerated side effects. Next-generation sequencing analysis of the tumor specimen and real time ctDNA was performed to observe the mutated gene numbers matched with therapeutic effect. The present case can help to provide a new and effective therapy strategy to treat advanced spindle cell carcinoma.

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Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis

Cited by 26 publications

References 150 publications

Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations

Metaplastic Breast Carcinoma: Update on Histopathology and Molecular Alterations

Cellular Spindled Histiocytic Pseudotumor: A Benign Mimic of Spindle Cell Neoplasia of the Breast

Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma

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