Pleomorphic carcinoma with osteoclastic giant cells of the breast: Immunohistochemical differentiation between coexisting neoplastic and reactive giant cells

Abstract

Herein is described a unique case of breast carcinoma with two different types of giant cells noted in both cytological and histological specimens. A 51-year-old Japanese woman noticed a hard mass in the upper outer quadrant of her left breast. Aspiration cytology exhibited numerous anaplastic giant cells; the cytological diagnosis was high-grade ductal carcinoma, although a few osteoclastic giant cells were also observed. A left simple mastectomy and sentinel lymph node biopsy were performed. Histologically, approximately 90% of the tumor was composed of giant cells; conventional invasive ductal carcinoma and ductal carcinoma in situ were found focally at the periphery of the tumor. The main part of the tumor contained both anaplastic, neoplastic giant cells and non-neoplastic, osteoclastic giant cells that were distinguishable from nuclear atypism. The presence of the two types of giant cells was also confirmed on immunohistochemistry using a histiocytic marker (CD68) and two epithelial markers (AE1/AE3 and CAM5.2). Based on the latest World Health Organization classification, the diagnosis was pleomorphic carcinoma with osteoclastic giant cells. To the authors' knowledge there has been no previous report on this subject except for a single case mentioned in Rosen's Breast Pathology.

Pleomorphic carcinoma of the breast with expression of macrophage markers: Report of two cases

“…In the latest WHO edition, pleomorphic breast carcinoma is described as a variant of grade 3 infiltrating ductal carcinoma of the breast 2 . The distinctive feature of pleomorphic carcinoma is the predominance of multinucleated giant cell tumor estimated at 50% of the tumor population 2–4 . This subtype was described by Silver and Tavassoli in 2000 with the identification of some of the morphological features in a series of 26 cases 3 .…”

“…Recently, a case of pleomorphic carcinoma of the breast displaying two types of giant cells, i.e. those that are part of the tumor and those that are reactive macrophages, has been reported 4 . This is a report of two cases of breast pleomorphic carcinoma in which we analyzed, first, the subtype of expression of breast cancer by immunohistochemical (IHC) markers, second, whether the giant cells show a tumoral and epithelial or macrophagic phenotype and, finally, whether despite the fact that these epithelial cells are tumoral, some of them are positive for macrophage markers.…”

Combined hepatocellular carcinoma and osteoclast‐like giant cell tumor of the liver: Possible clue to histogenesis

“…Also, Kurokawa et al. described a unique case of breast carcinoma with two different types of giant cells: neoplastic giant cells and non‐neoplastic giant cells 8 …”

“…GCT or undifferentiated carcinoma with osteoclast‐like giant cells (OGC) have been reported in organs other than the bone, although they are very rare. Thus far, this type of tumor has been reported in the pancreas, 1–5 mammary glands, 6–8 thyroid glands, 9,10 liver, 1,11–24 ovaries, 25,26 colon, 27 lung, 28 salivary glands, 29 gallbladder, 30 stomach, 31,32 and endometrium 33,34 . Among them, tumors in the pancreas are predominant.…”

The Grossly “Rusty” Tumor of Breast

“…OGCs share multiple antigenic determinants with osteoclasts, macrophages, and platelets. 5 IC-OGCs commonly display a luminal phenotype, with luminal A subtype as the major group. 6 Aberrations observed in array-based comparative genomic hybridization studies of IC-OGC 7 support the classification of the tumor in the "no special type" category in the latest World Health Organization Breast Tumor Classification.…”