Metaplastic Carcinoma of the Breast
Differential Diagnosis
- Pure sarcoma
- Phyllodes tumor
- Nodular fasciitis
- Fibromatosis
- Pleomorphic adenoma
- Carcinoma with osteoclast like giant cells
- Adenomyoepithelioma
- Pure sarcoma should be diagnosed only after thorough sectioning and with negative stains for p63, broad spectrum keratin and high molecular weight keratin
Metaplastic Carcinoma | Phyllodes Tumor |
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Spindled component may be positive for high molecular weight keratin or p63 | Stromal component negative for high molecular weight keratin and p63 |
Epithelial component is malignant | Epithelial component is benign |
Squamous differentiation may be present | No squamous differentiation |
- Nodular fasciitis is very rare in the breast and should be diagnosed only after thorough sectioning and with negative keratin stains (including high molecular weight keratin)
- Fibromatosis is very rare in the breast and should be diagnosed only after thorough sectioning and with negative keratin stains (including high molecular weight keratin)
- Pleomorphic adenoma is very rare in the breast and does not have infiltrating margins and the epithelial component is not malignant
Metaplastic Carcinoma of the Breast with Mesenchymal Differentiation | Carcinoma of the Breast with Osteoclast-like Giant Cells |
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Sarcomatous (malignant) stroma | Only giant cells, no neoplastic stroma |
May form osteoid (osteosarcoma) | No osteoid |
Metaplastic Carcinoma | Adenomyoepithelioma |
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Glandular component, if present, is histologically malignant, except in low grade spindle cell metaplastic carcinoma | Epithelial component is histologically bland |
Stromal component may be bland or histologically malignant | Stroma is histologically bland |
Stromal component may resemble a variety of sarcomas or low grade fibrous proliferation | Stroma shows myoepithelial differentiation only |
Squamous differentiation may be present | No squamous differentiation |