Pleomorphic carcinoma of the breast: clinicopathological analysis of 26 cases of an unusual high-grade phenotype of ductal carcinoma

• Published in: Histopathology Vol. 36; no. 6; pp. 505 - 514
• Main Authors: Silver, S A, Tavassoli, F A
• Format: Journal Article
• Language: English
• Published: Oxford, U.K. and Cambridge, USA Blackwell Science Ltd 01.06.2000; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; anaplastic carcinoma; Aneuploidy; Biological and medical sciences; Biomarkers; breast carcinoma; Breast Neoplasms - genetics; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Carcinoma, Ductal, Breast - genetics; Carcinoma, Ductal, Breast - metabolism; Carcinoma, Ductal, Breast - pathology; Diagnosis, Differential; ductal type; Female; Flow Cytometry; Gynecology. Andrology. Obstetrics; Humans; Immunohistochemistry; Keratins - analysis; Ki-67 Antigen - analysis; Lymphatic Metastasis; Mammary gland diseases; Medical sciences; Middle Aged; Mucin-1 - analysis; Neoplasm Staging; Phenotype; pleomorphic carcinoma; Receptor, ErbB-2 - analysis; Receptors, Progesterone - analysis; S100 Proteins - analysis; Tumor Suppressor Protein p53 - analysis; Tumors; Vimentin - analysis; Human; Immunohistochemistry; Flow cytometry; Carcinoma; Prognosis; Process variant; Malignant tumor; Survival; Case study; Pathology; Mammary gland diseases; Anaplastic carcinoma; Adult; Female; Clinical investigation; Mammary gland; High malignancy
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1046/j.1365-2559.2000.00924.x

Aims Pleomorphic carcinoma is a poorly described entity whose phenotype is not well recognized as within the morphological spectrum of breast carcinoma. The purpose of this report is to describe the clinicopathological features of this tumour, and to promote its recognition as an unusual high‐grade morphological variant of mammary ductal carcinoma. Methods and results Histological slides of breast carcinomas (N = 64) coded between 1978 and 1995 as having pleomorphic or anaplastic features were reviewed. Pleomorphic carcinoma (N = 26) was diagnosed when ≥ 50% of the tumour manifested a pleomorphic cell population (> sixfold variation in nuclear size). Tumours of lobular origin were excluded. All neoplasms occurred in women with a mean age of 53 years. Patients underwent biopsy and/or mastectomy (n = 24) or lumpectomy (n = 2). The tumours' mean size was 54 mm. All were high‐grade neoplasms. The pleomorphic cell population comprised 50–100% of the tumour; 31% had a prominent spindled morphology. Fifty‐eight per cent of the tumours were initially misclassified by referring pathologists as sarcomas or carcinomas, possibly metastatic. Adjacent DCIS or a transition to classic ductal carcinoma was present in 73%. Five (19%) patients were stage I and three (12%) had stage IV disease. Axillary dissections yielded ≥ 3 (mean 7.2) positive lymph nodes in 52%. Most (68%) tumours were aneuploid; a high S‐phase (> 10%) was present in 63%. All neoplasms were ER negative and all but one were PR negative. p53 expression was present in 71%; none expressed bcl‐2. c‐erbB‐2 was detected in four (19%) node‐positive and in 0 (0%) node‐negative cases (P = 0.01). Of 16 patients with follow‐up, 6 (38%) were disease‐free (mean, 74 months), four (25%) alive with disease (mean, 33 months) and six (38%) dead of disease at a mean of 22 months. Conclusions Pleomorphic carcinoma is a prognostically unfavourable lesion and represents the extreme end of the morphological spectrum of grade III infiltrating ductal carcinoma.