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Metaplastic spindle cell breast tumors arising within papillomas, complex sclerosing lesions, and nipple adenomas.
Mod Pathol. 2003 Sep; 16(9):893-901.MP

Abstract

Micropapillomas/papillomas and complex sclerosing lesions of the breast have been associated with a slightly increased risk for subsequent carcinoma, although benign squamous metaplasia and reactive hypercellular stroma are seen within these lesions. There are few reports of these fibrosclerotic lesions associated with metaplastic tumors. Here we describe a series of metaplastic tumors arising within fibrosclerotic breast lesions. Thirty-three metaplastic tumors associated with fibrosclerotic lesions were selected from a breast pathology consultative practice. Relevant clinical and pathological features were reviewed. Representative sections were evaluated immunohistochemically for expression of cytokeratins, vimentin, and smooth muscle and muscle-specific actins. Both the metaplastic component (spindled and squamous cells) and the glandular elements were graded. The metaplastic tumors arose within papillomas (20 cases), complex sclerosing lesions (7 cases), both papilloma and complex sclerosing lesions (3 cases), and nipple adenoma (3 cases). A majority of the metaplastic tumors showed a dominant spindle cell component with various degrees of atypia, ranging from fibromatosis-like (16 cases) to low-grade (13 cases), intermediate-grade (2 cases), and high-grade (2 cases) fibrosarcoma phenotype. Squamous metaplasia was present in 25 cases, and low-grade glandular elements, in 21 cases. Eleven tumors had a low-grade adenosquamous growth pattern. Ductal carcinoma in situ was present in 7 cases, and invasive mammary carcinoma, in 5 cases. The very low-grade tumors were histologically similar to limited areas of stromal reaction and myofibroblastic proliferation, seen in partially sclerotic micropapillomas/papillomas and complex sclerosing lesions, but usually more cellular. Cytokeratin positivity (13+/13 tested) supports the metaplastic nature of the more plump spindled cells. The spindle cells were also positive for vimentin (8+/8 tested) and smooth muscle (2+/5 tested) and muscle-specific actins (6+/6 tested). Spindle cell metaplastic tumors, from fibromatosis-like to fibrosarcoma, may arise within a variety of fibrosclerotic breast lesions.

Authors+Show Affiliations

Department of Pathology, Division of Anatomic Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

13679453

Citation

Gobbi, Helenice, et al. "Metaplastic Spindle Cell Breast Tumors Arising Within Papillomas, Complex Sclerosing Lesions, and Nipple Adenomas." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 16, no. 9, 2003, pp. 893-901.
Gobbi H, Simpson JF, Jensen RA, et al. Metaplastic spindle cell breast tumors arising within papillomas, complex sclerosing lesions, and nipple adenomas. Mod Pathol. 2003;16(9):893-901.
Gobbi, H., Simpson, J. F., Jensen, R. A., Olson, S. J., & Page, D. L. (2003). Metaplastic spindle cell breast tumors arising within papillomas, complex sclerosing lesions, and nipple adenomas. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 16(9), 893-901.
Gobbi H, et al. Metaplastic Spindle Cell Breast Tumors Arising Within Papillomas, Complex Sclerosing Lesions, and Nipple Adenomas. Mod Pathol. 2003;16(9):893-901. PubMed PMID: 13679453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metaplastic spindle cell breast tumors arising within papillomas, complex sclerosing lesions, and nipple adenomas. AU - Gobbi,Helenice, AU - Simpson,Jean F, AU - Jensen,Roy A, AU - Olson,Sandra J, AU - Page,David L, PY - 2003/9/19/pubmed PY - 2004/4/30/medline PY - 2003/9/19/entrez SP - 893 EP - 901 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 16 IS - 9 N2 - Micropapillomas/papillomas and complex sclerosing lesions of the breast have been associated with a slightly increased risk for subsequent carcinoma, although benign squamous metaplasia and reactive hypercellular stroma are seen within these lesions. There are few reports of these fibrosclerotic lesions associated with metaplastic tumors. Here we describe a series of metaplastic tumors arising within fibrosclerotic breast lesions. Thirty-three metaplastic tumors associated with fibrosclerotic lesions were selected from a breast pathology consultative practice. Relevant clinical and pathological features were reviewed. Representative sections were evaluated immunohistochemically for expression of cytokeratins, vimentin, and smooth muscle and muscle-specific actins. Both the metaplastic component (spindled and squamous cells) and the glandular elements were graded. The metaplastic tumors arose within papillomas (20 cases), complex sclerosing lesions (7 cases), both papilloma and complex sclerosing lesions (3 cases), and nipple adenoma (3 cases). A majority of the metaplastic tumors showed a dominant spindle cell component with various degrees of atypia, ranging from fibromatosis-like (16 cases) to low-grade (13 cases), intermediate-grade (2 cases), and high-grade (2 cases) fibrosarcoma phenotype. Squamous metaplasia was present in 25 cases, and low-grade glandular elements, in 21 cases. Eleven tumors had a low-grade adenosquamous growth pattern. Ductal carcinoma in situ was present in 7 cases, and invasive mammary carcinoma, in 5 cases. The very low-grade tumors were histologically similar to limited areas of stromal reaction and myofibroblastic proliferation, seen in partially sclerotic micropapillomas/papillomas and complex sclerosing lesions, but usually more cellular. Cytokeratin positivity (13+/13 tested) supports the metaplastic nature of the more plump spindled cells. The spindle cells were also positive for vimentin (8+/8 tested) and smooth muscle (2+/5 tested) and muscle-specific actins (6+/6 tested). Spindle cell metaplastic tumors, from fibromatosis-like to fibrosarcoma, may arise within a variety of fibrosclerotic breast lesions. SN - 0893-3952 UR - https://www.unboundmedicine.com/medline/citation/13679453/Metaplastic_spindle_cell_breast_tumors_arising_within_papillomas_complex_sclerosing_lesions_and_nipple_adenomas_ L2 - https://doi.org/10.1097/01.MP.0000085027.75201.B5 DB - PRIME DP - Unbound Medicine ER -