Abstract
Invasive carcinoma of no special type (NST) with osteoclast-like giant cells (OGCs) represents a unique type of breast neoplasm, characterized by the presence of multinucleated OGCs and a vascularized, hemorrhagic stroma. Because of its rarity, the literature regarding this tumor remains limited and a detailed immunophenotype of this tumor has not been established as yet. We report a clinicopathological and immunohistochemical study of 42 patients with invasive carcinoma NST with OGCs. Macroscopically, these tumors presented as a well-delimited red-brown mass. A remarkable feature of the tumor was the presence of OGCs in the fibroblastic or hemorrhagic vascular stroma, as well as in the adjacent tumor nests or glandular lumina. The number of OGCs varied from 8 to 105 per 10 high-power fields with an average of 48. The tumors were well to moderately differentiated. Cribriform architecture was observed in 27 tumors (63 %). All of the 36 available tumors were of luminal phenotype, according to the Ki67 labeling index 89 % luminal A and 11 % luminal B. With a mean follow-up time of 46.4 months, lung metastasis was found in 2 patients (5 %) at 7 and 11 years after the operation, respectively. None of the other cases had presented with evidence of recurrence or metastasis. To the best of our knowledge, this is the largest reported series of invasive carcinoma NST with OGCs as yet. Our study revealed that invasive carcinoma NST with OGCs exhibit a luminal phenotype with luminal A subtype as the major group.
Similar content being viewed by others
References
Agnantis NT, Rosen PP (1979) Mammary carcinoma with osteoclast-like giant cells. A study of eight cases with follow-up data. Am J Clin Pathol 72:383–389
Rosen PP (2001) Mammary carcinoma with osteoclast-like giant cells, in Rosen’s breast pathology. Lippincott Williams & Wilkins, Philadelphia, pp 518–526
Fisher ER, Palekar AS, Gregorio RM, Paulson JD (1983) Mucoepidermoid and squamous cell carcinomas of breast with reference to squamous metaplasia and giant cell tumors. Am J Surg Pathol 7:15–27
Kobayashi S, Tobioka N, Samoto T et al (1984) Breast cancer with osteoclast-like multinucleated giant cells. Acta Pathol Jpn 34:1475–1484
Dey P, Karmakar T (1993) Aspiration cytology of breast carcinoma with multinucleated osteoclast-like giant cells. Cytopathology 4:382–383
Pettinato G, Manivel JC, Picone A, Petrella G, Insabato L (1989) Alveolar variant of infiltrating lobular carcinoma of the breast with stromal osteoclast-like giant cells. Pathol Res Pract 185(388–94):394–396
Takahashi T, Moriki T, Hiroi M, Nakayama H (1998) Invasive lobular carcinoma of the breast with osteoclastlike giant cells. A case report. Acta Cytol 42:734–741
Iacocca MV, Maia DM (2001) Bilateral infiltrating lobular carcinoma of the breast with osteoclast-like giant cells. Breast J 7:60–65
Wargotz ES, Norris HJ (1990) Metaplastic carcinomas of the breast: V. Metaplastic carcinoma with osteoclastic giant cells. Hum Pathol 21:1142–1150
Peison B, Benisch B, Chung-Loy H (1991) Pure squamous cell carcinoma of the breast. N J Med 88:273–275
Herrington CS, Tarin D, Buley I, Athanasou N (1994) Osteosarcomatous differentiation in carcinoma of the breast: a case of 'metaplastic' carcinoma with osteoclasts and osteoclast-like giant cells. Histopathology 24:282–285
Jogai S, Al-Jassar A, Amir T, Temmim L (2004) Metaplastic mammary carcinoma with osteoclastic giant cells: a cytological mimicker of fibroadenoma. Cytopathology 15:334–336
Lee JS, Kim YB, Min KW (2004) Metaplastic mammary carcinoma with osteoclast-like giant cells: identical point mutation of p53 gene only identified in both the intraductal and sarcomatous components. Virchows Arch 444:194–197
Kurokawa K, Mouri Y, Asano A et al (2009) Pleomorphic carcinoma with osteoclastic giant cells of the breast: immunohistochemical differentiation between coexisting neoplastic and reactive giant cells. Pathol Int 59:91–97
Phillipson J, Ostrzega N (1994) Fine needle aspiration of invasive cribriform carcinoma with benign osteoclast-like giant cells of histiocytic origin. A case report. Acta Cytol 38:479–482
Ng WK (2001) Fine needle aspiration cytology of invasive cribriform carcinoma of the breast with osteoclast-like giant cells: a case report. Acta Cytol 45:593–598
Cai G, Simsir A, Cangiarella J (2004) Invasive mammary carcinoma with osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy: review of the cytologic literature and distinction from other mammary lesions containing giant cells. Diagn Cytopathol 30:396–400
Krishnan C, Longacre TA (2006) Ductal carcinoma in situ of the breast with osteoclast-like giant cells. Hum Pathol 37:369–372
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474
Tavassoli FA (2003) Invasive ductal carcinoma, not otherwise specified (NOS). World Health Organization Classification of Tumours. Pathology and genetics of tumor of the breast and female genital organs. International Agency for Research on Cancer, Lyon
Bloom HJ, Richardson WW (1957) Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer 11:359–377
Hammond ME, Hayes DF, Dowsett M et al (2010) American society of clinical oncology/college of American pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28:2784–2795
Hammond ME, Hayes DF, Wolff AC (2011) Clinical notice for American society of clinical oncology-college of American pathologists guideline recommendations on ER/PgR and HER2 testing in breast cancer. J Clin Oncol 29:e458
Cheang MC, Chia SK, Voduc D et al (2009) Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 101:736–750
Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ (2011) Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747
Rosen PP (2009) Mammary carcinoma with osteoclast-like giant cells, in Rosen's breast pathology, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 572–580
Holland R, van Haelst UJ (1984) Mammary carcinoma with osteoclast-like giant cells. Additional observations on six cases. Cancer 53:1963–1973
Richter G, Uleer C, Noesselt T (2011) Multifocal invasive ductal breast cancer with osteoclast-like giant cells: a case report. J Med Case Rep 5:85
Tavassoli FA, Norris HJ (1986) Breast carcinoma with osteoclastlike giant cells. Arch Pathol Lab Med 110:636–639
Athanasou NA, Wells CA, Quinn J, Ferguson DP, Heryet A, McGee JO (1989) The origin and nature of stromal osteoclast-like multinucleated giant cells in breast carcinoma: implications for tumour osteolysis and macrophage biology. Br J Cancer 59:491–498
Cai N, Koizumi J, Vazquez M (2005) Mammary carcinoma with osteoclast-like giant cells: a study of four cases and a review of literature. Diagn Cytopathol 33:246–251
Gjerdrum LM, Lauridsen MC, Sorensen FB (2001) Breast carcinoma with osteoclast-like giant cells: morphological and ultrastructural studies of a case with review of the literature. Breast 10:231–236
Gupta RK, Wakefield SJ, Holloway LJ, Simpson JS (1988) Immunocytochemical and ultrastructural study of the rare osteoclast-type carcinoma of the breast in a fine needle aspirate. Acta Cytol 32:79–82
Jacquet SF, Balleyguier C, Garbay JR et al (2010) Fine-needle aspiration cytopathology—an accurate diagnostic modality in mammary carcinoma with osteoclast-like giant cells: a study of 8 consecutive cases. Cancer Cytopathol 118:468–473
Kajo K, Machalekova K, Kviatkovska Z (2006) Mammary carcinoma with osteoclast-like giant cells—report of two cases. Cesk Patol 42:71–75
Mukkamala A, Blight C, Azher Q, Danish R (1999) Breast carcinoma with osteoclastic giant cells. Breast J 5:149–150
Nielsen BB, Kiaer HW (1985) Carcinoma of the breast with stromal multinucleated giant cells. Histopathology 9:183–193
Pantanowitz L, Harton A, Fraser JL (2001) Breast carcinoma with osteoclast-like giant cells. Breast J 7:199
Perez-Alonso P (2012) Breast carcinoma with osteoclast-like giant cells diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 40:148–149
Saimura M, Fukutomi T, Tsuda H, Tanaka SA, Nanasawa T (1999) Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature. Breast Cancer 6:121–126
Shishido-Hara Y, Kurata A, Fujiwara M, Itoh H, Imoto S, Kamma H (2010) Two cases of breast carcinoma with osteoclastic giant cells: are the osteoclastic giant cells pro-tumoural differentiation of macrophages? Diagn Pathol 5:55
Stewart CJ, Mutch AF (1991) Breast carcinoma with osteoclast-like giant cells. Cytopathology 2:215–219
Stratton A, Plackett TP, Belnap CM, Lin-Hurtubise KM (2010) Infiltrating mammary carcinoma with osteoclast-like giant cells. Hawaii Med J 69:284–285
Sugano I, Nagao K, Kondo Y, Nabeshima S, Murakami S (1983) Cytologic and ultrastructural studies of a rare breast carcinoma with osteoclast-like giant cells. Cancer 52:74–78
Viacava P, Naccarato AG, Nardini V, Bevilacqua G (1995) Breast carcinoma with osteoclast-like giant cells: immunohistochemical and ultrastructural study of a case and review of the literature. Tumori 81:135–141
Vicandi B, Jimenez-Heffernan JA, Lopez-Ferrer P et al (2004) Fine needle aspiration cytology of mammary carcinoma with osteoclast-like giant cells. Cytopathology 15:321–325
Volpe R, Carbone A, Nicolo G, Santi L (1983) Cytology of a breast carcinoma with osteoclastlike giant cells. Acta Cytol 27:184–187
Reale D, Guarino M, Bianchini E et al (1993) Infiltrating lobular carcinoma of the breast, alveolar variant, with stromal reactive osteoclast-like giant cells. Description of a case. Pathologica 85:525–532
Fadare O, Gill SA (2009) Solid neuroendocrine carcinoma of the breast with osteoclast-like giant cells. Breast J 15:205–206
Pagani A, Iandolo M (2008) Invasive breast carcinoma with features of neuroendocrine carcinoma and carcinoma with osteoclastic cells: fine-needle aspiration cytology and histology of two cases. Pathologica 100:176–180
Pettinato G, Petrella G, Manco A, di Prisco B, Salvatore G, Angrisani P (1984) Carcinoma of the breast with osteoclast-like giant cells. Fine-needle aspiration cytology, histology and electron microscopy of 5 cases. Appl Pathol 2:168–178
Milentijevic MJ, Basic M, Petrovic A (2011) Multinucleated stromal giant cells in adenoid cystic carcinoma of the breast: a case report and literature review. Vojnosanit Pregl 68:178–180
Shabb NS, Tawil A, Mufarrij A, Obeid S, Halabi J (1997) Mammary carcinoma with osteoclastlike giant cells cytologically mimicking benign breast disease. A case report. Acta Cytol 41:1284–1288
Perou CM, Sorlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752
Sorlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A 98:10869–10874
Disclosure/conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhou, S., Yu, L., Zhou, R. et al. Invasive breast carcinomas of no special type with osteoclast-like giant cells frequently have a luminal phenotype. Virchows Arch 464, 681–688 (2014). https://doi.org/10.1007/s00428-014-1573-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-014-1573-y