|Year : 2017 | Volume
| Issue : 3 | Page : 113-114
Carcinosarcoma of the Breast: A retrospective observational study
Deepti Sharma, Garima Singh
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||15-Sep-2017|
Room No 271, Second Floor, New OPD Block, VMMC and Safdarjung Hospital, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Background: Carcinosarcoma of the breast is an extremely rare breast condition, accounting for 0.1% of all breast malignancies. Limited data are available in English literature on this issue due to paucity of cases. Hence, we retrieved data of carcinosarcoma of breast for evaluation of clinicopathological characteristics, treatment, and outcome of this emerging issue. Materials and Methods: A retrospective observational study was conducted from January 2011 to December 2015 in our Department of Radiotherapy. A total of four patients were identified during this period for analysis in this study. Various parameters such as age, clinical features, clinical stage, and the treatment received by the patients were recorded and analyzed for outcome. Results and Discussion: Median age at the time of presentation was 42 years (range 28–46 years). Seventy five percent females were post-menopausal. The most common symptom was slowly growing lump in the breast. All of the patients, except one, were negative for oestrogen receptor/progesterone receptor (ER/PR) and human epidermal growth factor receptor 2 (HER2/neu) receptors. All patients underwent surgery followed by adjuvant therapy,except one. Median follow-up was 23 months (range 2–66 months). Conclusion: Carcinosarcoma of the breast is a rare entity with poor outcome. There are no specific treatment guidelines. Surgery is the main treatment modality, and it should be followed by adjuvant chemo and radiotherapy.
Keywords: Aggressive, biphasic, carcinosarcoma, triple negative
|How to cite this article:|
Sharma D, Singh G. Carcinosarcoma of the Breast: A retrospective observational study. Adv Hum Biol 2017;7:113-4
| Introduction|| |
Carcinosarcoma of the breast is an extremely rare breast condition, accounting for 0.1% of all breast malignancies. It has biphasic differentiation of cells with epithelial and mesenchymal characteristics and believes to be of myoepithelial origin or differentiation. Clinically, carcinosarcoma of the breast is an aggressive breast cancer with high potential for loco-regional and distant metastasis.,,
| Materials and Methods|| |
We conducted a retrospective study in the Department of Radiation-Oncology of our institute, in which patient's record from January 2011 to December 2015 was evaluated for carcinosarcoma of the breast. A total of four patients were identified during the period. Various parameters such as age, clinical features, receptor status and the treatment received by the patients were recorded for analysis.
| Results|| |
Median age at the time of presentation was 42 years (range 28–46 years). Out of four patients, one was premenopausal and three were post-menopausal. The most common symptom was slowly growing lump in the breast with no associated complaints of bleeding or discharge from the nipple. The median tumour size was 6.5 cm (range 5–17 cm). Out of four, one patient also presented with axillary lymph node. On histopathology, all were diagnosed with carcinosarcoma. Three of the patients underwent Modified Radical Mastectomy with axillary lymph node dissection and one underwent lumpectomy with axillary lymph node dissection. Two patients were pathologically T2 and two were pT3. In one of the patients, 4 out of 22 lymph nodes were positive, and others have pathologically negative lymph nodes. All of the patients, except one, were negative for oestrogen receptor/progesterone receptor (ER/PR) and human epidermal growth factor receptor 2 (HER2/neu) receptors, in which tumour was weakly positive for ER. Immunohistochemistry was done in two patients; both were positive for vimentin and cytokeratin.
Three patients received adjuvant six cycles of chemotherapy (adriamycin and ifosfamide) and three out of four patients received radiation therapy of 50 Gy in 25 fractions as one patient developed local recurrence within 1½ months of surgery and was referred for mastectomy. Patients were kept on follow-up. Median follow-up was 23 months (range 2–66 months). Two of the patients have completed more than 3 years of follow-up without any recurrence, and one has developed local recurrence.
| Discussion|| |
Carcinosarcoma of the breast is a rare but aggressive entity of breast cancer., Clinical features usually mimic that of infiltrating ductal carcinoma (IDC) of breast, but usually, the tumour size of carcinosarcoma is more as compared to IDC. As compared to IDC, the incidence of lymph node involvement is also very less. On sonography, finding is similar to IDC, except there are more of solid-cystic component.
Carcinosarcoma of the breast is a biphasic tumour with both epithelial and mesenchymal component. Usually, these cancers are negative for ER/PR and HER2/neu. In the present series, one of the cases was weakly positive for ER. In a case report by Hamre et al., the tumour was also weakly positive for ER. Esses et al. had shown in their study that HER-1/epidermal growth factor receptor (EGFR) protein is expressed in majority of these tumours and may serve as a potential therapeutic target for EGFR inhibitors.
As carcinosarcoma of breast is a rare entity, therefore, there is no specific treatment protocol. Surgery either mastectomy or breast conservation therapy with axillary lymph node dissection is the mainstay of treatment. Complete axillary clearance is required as there are cases in which there is metastasis to axillary lymph nodes. In the present series also, one out of four patients had positive axillary lymph nodes. Because of aggressive nature of carcinosarcoma, the role of adjuvant chemo-radiotherapy has been defined. Hamre et al. demonstrated the benefit of chemotherapy in the case of carcinosarcoma with axillary lymph node involvement. Tseng and Martinez had revealed that adjuvant radiotherapy provides statistically significant overall and disease-specific survival. In the present study also, post-operative radiation therapy was given to three of the patients and is also planned for the fourth patient after re-surgery.
Carcinosarcoma of breast is an aggressive tumour with poor outcome as compared to IDC of breast. Factors such as tumour size, high grade, atypia and pleomorphic spindle cells, negative for ER/PR are usually linked to poor prognosis. Hennessy et al. also demonstrated a 5-year overall survival of 0.73, 0.59, 0.44 and 0.00 for Stage I, II, III, IV of carcinosarcoma, respectively. In the present study, median follow-up is 23 months.
| Conclusion|| |
Carcinosarcoma of the breast is a rare entity with poor outcome. There are no specific treatment guidelines. Surgery is the main treatment modality, and it should be followed by adjuvant chemo-radiotherapy. Further multi-institutional studies are required to evaluate the role of new therapies such as anti-EGFR to improve survival.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hennessy BT, Giordano S, Broglio K, Duan Z, Trent J, Buchholz TA, et al.
Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol 2006;17:605-13.
Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI. Carcinosarcoma of the breast: Two case reports and review of the literature. Cases J 2009;2:15.
Ilhan E, Vardar E, Ozkok G, Sezgin A, Sahin S, Teker K, et al.
A rare tumour of the breast: Carcinosarcoma. J Clin Med Res 2010;2:96-8.
Hamre MC, Eschbacher JM, Hahn F, Hu T. A rare case of breast carcinosarcoma with lymphatic metastasis. Med Stud Res J 2013;3:9-12.
Stefaniuk CM, Jones T. Double feature: Carcinoma and sarcoma present in a single breast tumor. Case Rep Oncol Med 2012;2012:232851.
Atahan K, Gur S, Tarcan E. Carcinosarcoma of the breast. J Breast Health 2007;3:85-6.
Donegan WL. Sarcoma of the breast. Major Probl Clin Surg 1979;5:504-42.
Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA. Metaplastic carcinoma of the breast clinical presentation, treatment results and prognostic factors. Acta Oncol 2006;45:188-95.
Tseng WH, Martinez SR. Metaplastic breast cancer: To radiate or not to radiate? Ann Surg Oncol 2011;18:94-103.