Virchows Archiv

, Volume 457, Issue 3, pp 337–345 | Cite as

Myoepithelial carcinoma of the breast: a clinicopathological and immunohistochemical study of 15 diagnostically challenging cases

  • Natalia Buza
  • Nazila Zekry
  • Colette Charpin
  • Fattaneh A. Tavassoli
Original Article

Abstract

Myoepithelial carcinoma (MEC) is a rare type of breast cancer composed purely of myoepithelial cells. Most often it presents with a spindle cell morphology that can mimic several benign and malignant lesions and may be misdiagnosed by the pathologist. We report 15 cases of MEC, which were sent to our consultation practice: Five of them were initially diagnosed as benign. The patients, all female, ranged from 45 to 86 years in age (mean 69.5) and—with one exception—presented with a breast mass. The tumor size measured between 1 and 4.8 cm (mean 2.6 cm). Microscopically, the tumors had infiltrative growth pattern most frequently with thin anastomosing cords of tumor cells associated with an intimately admixed reactive spindle cell stroma. The neoplastic myoepithelial cells were emanating from the myoepithelial cell layer of entrapped ductules in every case. The nuclei showed mild to moderate pleomorphism, and the mitotic activity ranged from 0 to 9/10 high power field. Immunohistochemical stains for p63, CD10, CK903, and CK5/6 reacted strongly and diffusely with the tumor cells, and mainly the reactive stroma had weak positivity for calponin, S-100, and smooth muscle actin. Estrogen receptor, progesteron receptor, and Her2 immunostains were negative, but strong epidermal growth factor receptor expression was observed. Follow-up was available for seven patients: All of them were alive at last contact; one patient had local recurrence, and one developed pulmonary metastases. MEC is a potentially aggressive malignant neoplasm sharing many features with metaplastic carcinomas. Morphologically, it is often difficult to distinguish it from benign spindle cell proliferations.

Keywords

Myoepithelial carcinoma Breast Spindle cell proliferation Metaplastic carcinoma 

References

  1. 1.
    Tavassoli FA, Soares J (2003) Myoepithelial lesions. In: Tavassoli FA, Devilee P (eds) Tumours of the breast and female genital organs. Pathology and genetics. WHO classification of tumours. IARC Press, Lyon, pp 86–88Google Scholar
  2. 2.
    Tavassoli FA (1991) Myoepithelial lesions of the breast. Myoepitheliosis, adenomyoepithelioma, and myoepithelial carcinoma. Am J Surg Path 15:554–568CrossRefPubMedGoogle Scholar
  3. 3.
    Ahmed A (1974) The myoepithelium in human breast carcinoma. J Pathol 113:129–135CrossRefPubMedGoogle Scholar
  4. 4.
    Barbareschi M, Pecciarini L, Cangi MG, Macrì E, Rizzo A, Viale G, Doglioni C (2001) P63, a p53 homologue, is a selective nuclear marker of myoepithelial cells of the human breast. Am J Surg Pathol 25:1054–1060CrossRefPubMedGoogle Scholar
  5. 5.
    Joshi MG, Lee AK, Pedersen CA, Schnitt S, Camus MG, Hughes KS (1996) The role of immunocytochemical markers in the differential diagnosis of proliferative and neoplastic lesions of the breast. Mod Pathol 9:57–62PubMedGoogle Scholar
  6. 6.
    Jarasch ED, Nagle RB, Kaufmann M, Maurer C, Böcker WJ (1988) Differential diagnosis of benign epithelial proliferations and carcinomas of the breast using antibodies to cytokeratins. Hum Pathol 19:276–289CrossRefPubMedGoogle Scholar
  7. 7.
    Gusterson BA, Ross DT, Heath VJ, Stein T (2005) Basal cytokeratins and their relationship to the cellular origin and functional classification of breast cancer. Breast Cancer Res 7:143–148CrossRefPubMedGoogle Scholar
  8. 8.
    Moll R, Franke WW, Schiller DL, Geiger B, Krepler R (1982) The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell 31:11–24CrossRefPubMedGoogle Scholar
  9. 9.
    Hungermann D, Buerger H, Oehlschlegel C, Herbst H, Boecker W (2005) Adenomyoepithelial tumours and myoepithelial carcinomas of the breast—a spectrum of monophasic and biphasic tumours dominated by immature myoepithelial cells. BMC Cancer 5:92CrossRefPubMedGoogle Scholar
  10. 10.
    Jones C, Foschini MP, Chaggar R, Lu YJ, Wells D, Shipley JM, Eusebi V, Lakhani SR (2000) Comparative genomic hybridization analysis of myoepithelial carcinoma of the breast. Lab Invest 80:831–836PubMedGoogle Scholar
  11. 11.
    Lakhani SR, O'Hare MJ, Monaghan P, Winehouse J, Gazet JC, Sloane JP (1995) Malignant myoepithelioma (myoepithelial carcinoma) of the breast: a detailed cytokeratin study. J Clin Pathol 48:164–167CrossRefPubMedGoogle Scholar
  12. 12.
    Han B, Mori I, Nakamura M, Wang X, Ozaki T, Nakamura Y, Kakudo K (2006) Myoepithelial carcinoma arising in an adenomyoepithelioma of the breast: case report with immunohistochemical and mutational analysis. Pathol Int 56:211–216CrossRefPubMedGoogle Scholar
  13. 13.
    Ellis IO, Schnitt SJ, Sastre-Garau X et al (2003) Invasive breast carcinoma. In: Tavassoli FA, Devilee P (eds) Tumours of the breast and female genital organs. Pathology and genetics. WHO classification of tumours. IARC Press, Lyon, pp 37–40Google Scholar
  14. 14.
    Tavassoli FA (1992) Classification of metaplastic carcinomas of the breast. Pathol Annu 27(Pt 2):89–119PubMedGoogle Scholar
  15. 15.
    Wargotz ES, Deos PH, Norris HJ (1989) Metaplastic carcinomas of the breast. II. Spindle cell carcinoma. Hum Pathol 20:732–740CrossRefPubMedGoogle Scholar
  16. 16.
    Reis-Filho JS, Milanezi F, Paredes J, Silva P, Pereira EM, Maeda SA, de Carvalho LV, Schmitt FC (2003) Novel and classic myoepithelial/stem cell markers in metaplastic carcinomas of the breast. Appl Immunohistochem Mol Morphol 11:1–8CrossRefPubMedGoogle Scholar
  17. 17.
    Leibl S, Gogg-Kammerer M, Sommersacher A, Denk H, Moinfar F (2005) Metaplastic breast carcinomas: are they of myoepithelial differentiation? Immunohistochemical profile of the sarcomatoid subtype using novel myoepithelial markers. Am J Surg Pathol 29:347–353CrossRefPubMedGoogle Scholar
  18. 18.
    Jolicoeur F, Seemayer TA, Gabbiani G, Robidoux A, Gaboury L, Oligny LL, Schurch W (2002) Multifocal, nascent, and invasive myoepithelial carcinoma (malignant myoepithelioma) of the breast: an immunohistochemical and ultrastructural study. Int J Surg Pathol 10:281–291CrossRefPubMedGoogle Scholar
  19. 19.
    Weigelt B, Kreike B, Reis-Filho JS (2009) Metaplastic breast carcinomas are basal-like breast cancers: a genomic profiling analysis. Breast Cancer Res Treat 117:273–280CrossRefPubMedGoogle Scholar
  20. 20.
    Leibl S, Moinfar F (2005) Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors? J Clin Pathol 58:700–704CrossRefPubMedGoogle Scholar
  21. 21.
    Behranwala KA, Nasiri N, A'Hern R, Gui GP (2004) Clinical presentation and long-term outcome of pure myoepithelial carcinoma of the breast. Eur J Surg Oncol 30:357–361CrossRefPubMedGoogle Scholar
  22. 22.
    Bossuyt V, Fadare O, Martel M, Ocal IT, Burtness B, Moinfar F, Leibl S, Tavassoli FA (2005) Remarkably high frequency of EGFR expression in breast carcinomas with squamous differentiation. Int J Surg Pathol 13:319–327CrossRefPubMedGoogle Scholar
  23. 23.
    Santini D, Ceccarelli C, Tardio ML, Taffurelli M, Marrano D (2002) Immunocytochemical expression of epidermal growth factor receptor in myoepithelial cells of the breast. Appl Immunohistochem Mol Morphol 10:29–33CrossRefPubMedGoogle Scholar
  24. 24.
    Tan EH, Ramlau R, Pluzanska A, Kuo HP, Reck M, Milanowski J, Au JS, Felip E, Yang PC, Damyanov D, Orlov S, Akimov M, Delmar P, Essioux L, Hillenbach C, Klughammer B, McLoughlin P, Baselga J (2010) A multicentre phase II gene expression profiling study of putative relationships between tumour biomarkers and clinical response with erlotinib in non-small-cell lung cancer. Ann Oncol 21:217–222CrossRefPubMedGoogle Scholar
  25. 25.
    Mendelsohn J, Baselga J (2006) Epidermal growth factor receptor targeting in cancer. Semin Oncol 33:369–385CrossRefPubMedGoogle Scholar
  26. 26.
    Foschini MP, Eusebi V (1998) Carcinomas of the breast showing myoepithelial cell differentiation. A review of the literature. Virchows Arch 432:303–310CrossRefPubMedGoogle Scholar
  27. 27.
    Schurch W, Potvin C, Seemayer TA (1985) Malignant myoepithelioma (myoepithelial carcinoma) of the breast: an ultrastructural and immunocytochemical study. Ultrastruct Pathol 8:1–11CrossRefPubMedGoogle Scholar
  28. 28.
    Lingamfelter D, Chen Y, Kure K, Lankachandra K (2008) Infiltrating myoepithelial carcinoma of the breast, a case report and cytologic-histologic correlation. Diagn Pathol 3:7CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Natalia Buza
    • 1
  • Nazila Zekry
    • 2
  • Colette Charpin
    • 3
  • Fattaneh A. Tavassoli
    • 1
  1. 1.Department of PathologyYale University School of MedicineNew HavenUSA
  2. 2.Newport Harbor Pathology Medical Group IncHoag HospitalNewport BeachUSA
  3. 3.Pathology Department, School of MedicineUniversity of Aix-Marseille IIMarseilleFrance

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