Final Diagnosis -- Carcinosarcoma


FINAL DIAGNOSIS:

CARCINOSARCOMA (HIGH GRADE MALIGNANT PHYLLOIDES TUMOR WITH HIGH GRADE MAMMARY CARCINOMA)

DISCUSSION:

Several entities were considered in the differential diagnosis, including metaplastic carcinoma, malignant phylloides tumor and malignant adenomyoepithelioma. Metaplastic carcinoma would be unlikely, given the absence of cytokeratin reactivity in the stromal component. However, metaplastic carcinomas are variable in cytokeratin reactivity and require a panel of markers to rule out this neoplasia.

The relatively even distribution of the glandular and stromal component favors the diagnosis of malignant phylloides tumor, but the glandular architecture was not " phylloides-like". The positivity for vimentin in both component suggests but does not prove common histogensis for the glandular and mesenchymal elements.

Absence of myosin reactivity and intact adenomyoepithelioma growth patten where myoepithelial cells encircle glands make a diagnosis of malignant adenomyoepithelioma less likely. Hence, a diagnosis of carcinosarcoma or high grade malignant phylloides tumor with high grade mammary carcinoma was made.

Carcinosarcoma are biphasic malignant tumor where both epithelial and mesenchymal elements orginate from a single totipotent stem cell.

REFERENCES:

  1. Kuo SH, Chen CL, Huang CS, Cheng AL : Metaplastic carcinoma of the breast: analysis of eight Asian patients with special emphasis on two unusual cases presenting with inflammatory-type breast cancer. Anticancer Res 2000 May-Jun;20(3B):2219-22
  2. Hopkins ML, McGowan TS, Rawlings G, Liu FF, Fyles AW, Yeoh JL, Manchul L, Levin W; Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol 1994 Jun;56(2):108-12
  3. McGowan TS, Cummings BJ, O'Sullivan B, Catton CN, Miller N, Panzarella T; An analysis of 78 breast sarcoma patients without distant metastases at presentation. Int J Radiat Oncol Biol Phys 2000 Jan 15;46(2):383-90
  4. Wada H, Enomoto T, Tsujimoto M, Nomura T, Murata Y, Shroyer KR; Carcinosarcoma of the breast: molecular-biological study for analysis of histogenesis. Hum Pathol 1998 Nov;29(11):1324-8
  5. Teixeira MR, Qvist H, Bohler PJ, Pandis N, Heim S; Cytogenetic analysis shows that carcinosarcomas of the breast are of monoclonal origin. Genes Chromosomes Cancer 1998 Jun;22(2):145-51
  6. Nishimura R, Hasebe T, Imoto S, Mukai K; Malignant phyllodes tumour with a noninvasive ductal carcinoma component. Virchows Arch 1998 Jan;432(1):89-93
  7. McGregor GI, Knowling MA, Este FA; Sarcoma and Cystosarcoma phyllodes tumors of the breast--a retrospective review of 58 cases. Am J Surg 1994 May;167(5):477-80
  8. Alexiev B, Popov A; Carcinosarcoma of the breast Immunohistochemical and ultrastructural studies. Zentralbl Pathol 1992;138(1):71-4

Contributed by Deepak Mohan, MD and Dilip Gupta, MD, MIAC




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