CARCINOMA METAPLÁSICO TRIPLE NEGATIVO DE MAMA: PRESENTACIÓN CLÍNICA INUSUAL Y ANÁLISIS DIAGNÓSTICO
Creators
- 1. Universidad del Quindío, Armenia, Colombia
- 2. Universidad Santiago de Cali, Cali, Colombia.
- 3. Universidad Santiago de Cali, Cali, Colombia
- 4. Universidad del Cauca, Popayán, Colombia
Description
El carcinoma metaplásico de mama es una neoplasia infrecuente, que representa menos del 1% de los tumores malignos mamarios y se asocia a un comportamiento clínico agresivo. Se caracteriza por la presencia de componentes epiteliales y mesenquimales, lo que plantea un reto diagnóstico al simular lesiones mesenquimales puras como sarcomas o tumores phyllodes malignos. El subtipo fusocelular o sarcomatoide, con frecuencia triple negativo, limita las opciones terapéuticas al excluir la hormonoterapia y las terapias dirigidas anti-HER2. Se presenta el caso de una mujer de 68 años, posmenopáusica, con una masa palpable en la mama izquierda de 3,5 cm, dolor intermitente y sin cambios cutáneos. La mamografía reportó una lesión BI-RADS 5 y la biopsia con aguja gruesa mostró proliferación fusocelular sarcomatoide con diferenciación escamosa. La inmunohistoquímica confirmó positividad para citoqueratina 7 y p63, con negatividad para S100, ER, PR y HER2. Se realizó mastectomía simple con disección axilar, confirmando carcinoma metaplásico fusocelular de 3,8 cm, márgenes libres y ganglios negativos. La paciente recibió quimioterapia adyuvante con antraciclinas y taxanos, manteniéndose libre de recurrencia durante 12 meses de seguimiento. Este caso resalta la importancia del diagnóstico temprano, la integración multidisciplinaria y el manejo oportuno en una entidad rara y de mal pronóstico.
Abstract (English)
Metaplastic breast carcinoma is a rare neoplasm, accounting for less than 1% of all malignant breast tumors, and is associated with aggressive clinical behavior. It is characterized by the coexistence of epithelial and mesenchymal components, which poses a significant diagnostic challenge by mimicking purely mesenchymal lesions such as sarcomas or malignant phyllodes tumors. The spindle cell or sarcomatoid subtype, frequently triple-negative, limits therapeutic options by excluding endocrine therapy and HER2-targeted treatments. We present the case of a 68-year-old postmenopausal woman with a palpable mass in the left breast measuring 3.5 cm, associated with intermittent pain but without cutaneous changes. Mammography revealed a high-density lesion classified as BI-RADS 5. Core needle biopsy demonstrated sarcomatoid spindle cell proliferation with focal squamous differentiation. Immunohistochemistry confirmed positivity for cytokeratin 7 and p63, with negativity for S100, ER, PR, and HER2. The patient underwent a simple mastectomy with axillary dissection, confirming a 3.8 cm spindle cell metaplastic carcinoma with clear margins and no nodal metastasis. She subsequently received adjuvant chemotherapy with anthracyclines and taxanes, remaining free of recurrence during 12 months of follow-up. This case highlights the importance of early recognition, multidisciplinary integration, and timely oncologic management in metaplastic breast carcinoma, an uncommon entity with poor prognosis.
Files
sanum_v9_n4_a10.pdf
Files
(281.7 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:154f851f0206f3db2fe669f3b14b658e
|
281.7 kB | Preview Download |
Additional details
Additional titles
- Translated title (English)
- METAPLASTIC TRIPLE-NEGATIVE BREAST CARCINOMA: UNUSUAL CLINICAL PRESENTATION AND DIAGNOSTIC ANALYSIS
Identifiers
- ISSN
- 2530-5468
Dates
- Submitted
-
2025-09-11
- Accepted
-
2025-10-14
Software
- Repository URL
- https://revistacientificasanum.com/
References
- 1. Hennessy BT, Giordano S, Broglio K, Duan Z, Trent J, Buchholz TA, Babiera G, Hortobagyi GN, Valero V. Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol. 2006 Apr;17(4):605-13. doi: 10.1093/annonc/mdl006. Epub 2006 Feb 9. PMID: 16469754. 2. Bhargava A, Agrawal S. Sarcomatoid Carcinoma of the Breast: An Unusual Clinical Presentation. Cureus. 2024 Jan 21;16(1):e52696. doi: 10.7759/cureus.52696. PMID: 38384627; PMCID: PMC10879729. 3. Kurian KM, Al-Nafussi A. Sarcomatoid/metaplastic carcinoma of the breast: a clinicopathological study of 12 cases. Histopathology. 2002 Jan;40(1):58-64. doi: 10.1046/j.1365-2559.2002.01319.x. PMID: 11903598. 4. Carter MR, Hornick JL, Lester S, Fletcher CD. Spindle cell (sarcomatoid) carcinoma of the breast: a clinicopathologic and immunohistochemical analysis of 29 cases. Am J Surg Pathol. 2006 Mar;30(3):300-9. doi: 10.1097/01.pas.0000184809.27735.a1. PMID: 16538049. 5. Rakha EA, Quinn CM, Foschini MP, Muñoz Martin M, Dabbs DJ, Lakhani S, Varga Z, Pinder SE, Schmitt FC, Reis-Filho JS, Fox SB, Ellis IO, Tan PH, Mihai R. Metaplastic carcinomas of the breast without evidence of epithelial differentiation: a diagnostic approach for management. Histopathology. 2021 Apr;78(5):759-771. doi: 10.1111/his.14290. Epub 2020 Dec 16. PMID: 33113154; PMCID: PMC8492009.