Metaplastic breast cancer: a comparison between the most common histologies with poor immunohistochemistry factors.

BACKGROUND: Metaplastic carcinoma of the breast (MCB) is a rare histological type of breast cancer. This study aimed to determine whether MCB exhibits shorter overall survival (OS) and disease-free survival (DFS) compared with other histologies that are considered unfavorable. METHODS: We retrospectively analyzed 157 clinical file records of the Mexico City-based National Institute of Cancerology and compared the clinical characteristics and treatment of 24 patients with MCB, 37 patients with triple-negative invasive lobular carcinoma (TN-ILC), 48 patients with high-grade invasive ductal carcinoma (HG-IDC), and 48 patients with triple-negative invasive ductal carcinoma (TN-IDC), paired by clinical stage and age. We performed a comparative analysis and analyzed OS and DFS using a log-rank test. RESULTS: In patients with MCB, the 5-year DFS was 52.1% (mean, 48.52 months; 95%: 35.32-61.72), and the 5-year OS was 72.2% (mean, 59.77 months; 95% CI: 48.55-71.00). No differences were observed in the DFS of MCB compared with each of the other histologies (MCB vs. HG-IDC, p = 0.865; MCB vs. TN-IDC, p = 0.966, and MCB vs. TN-ILC, p = 0.132). Moreover, no differences were observed when comparing the OS of MCB with that of each of the other histologies (MCB vs. HG-IDC, p = 0.246; MCB vs. TN-IDC, p = 0.255, and MCB vs. TN-ILC, p = 0.387). CONCLUSIONS: Neither OS nor DFS differ between patients with MCB and those with other histologies with unfavorable immunohistochemical factors.

[Metaplastic breast cancer: clinical factors]. / Cáncer de mama metaplásico: descripción de factores clínicos.

BACKGROUND: metaplastic breast carcinoma (MBC) is uncommon, characterized by a heterogeneous mixture of histologic characteristics. OBJECTIVE: evaluate clinical and pathological characteristics in a population of patients with MBC in a reference center. MATERIALS AND METHODS: retrospective analysis of cases diagnosed with MBC at INCAN database from 2005-2011 was performed. Univariate assessment of clinical variables and their impact on disease free survival(DFS) and overall survival (OS) were evaluated. RESULTS: the records of 20 patients were identified. Median age was 49.5 (range: 33-75). Clinical stages at diagnosis were 6 I-II (30%) and 14 III-IV (70%). Three year OS was 52.1%. Patients< 40 years had an OS of 32.8 months vs. ≥ 40 years of 17.8 (p = 0.097). OS in stage I-II was 13.5 months vs. 23.3 months in III-IV (p = 0.99). Those who received neoadjuvant therapy had an OS of 26.57 vs. 14.36 in those who did not(p = 0.54). Those who received adjuvant therapy had an OS of 31.2 months vs. 11.15 in those who did not (p = 0.036). CONCLUSIONS: MBC has bad prognosis, nevertheless, age < 40 years and hormone receptor positivity, as well as adjuvant treatment seems to be factors that have an influence OS.

[Breast fibromatosis: a lesion mimicking cancer]. / Fibromatosis de mama: una lesión simuladora de cáncer.

BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.

Fibromatosis de mama: una lesión simuladora de cáncer / Breast fibromatosis: a lesion mimicking cancer

BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.