[207] Spindle Cell (Sarcomatous) Carcinoma of the Breast: Immunohistochemical Profile and the Clinical Outcome
S Johnykutty, D Hicks, K Skinner, C Andrus, L Schiffhauer, M Worman, X Wang. U of Rochester, Rochester
Background: Spindle cell carcinoma is in the differential diagnosis for spindle cell lesions of the breast. While the basal-myoepithelial markers have been used as a tool for diagnosis, their consistency is uncertain. In addition, there is contraversy regarding the morphological grade of this lesion in regards to clinical outcome.
Design: Cases for study were identified using the following criterial: 1) spindle cells mixed with malignant epithelial component, and/or 2) at least one of the basal-myoepithelial marker showing focal expression in spindle tumor cells. Immunohistochemical stain for pan-cytokeratin, CK5/6, CK14, p63, and EGFR were performed. Clinical follow up was obtained by reviewing the charts.
Results:
tumor characteristics and outcome| case# | histologic type | tumor grade | tumor size (cm) | follow up interval (month) | status | | 1 | mixed | high | 1.5 | 25 | died of metastasis of epithelial component | | 2 | mixed | high | 3.2 | 60 | DF | | 3 | mixed | high | ND | 48 | DF | | 4 | spindle | low | 3.0 | 53 | DF (locally recurred) | | 5 | spindle | low | 2.0 | 36 | DF | | 6 | spindle | low | 1.5 | 27 | DF | | 7 | spindle | low | 4.4 | 15 | DF | | 8 | spindle | low | 1.0 | ND | died of lung cancer | | 9 | spindle | low | 2.3 | 60 | died of disease | | 10 | spindle | high | 2.8 | 86 | DF | ND: no data. DF: disease free
Immunohistochemical stain result| Case# | pan-cytokeratin | CK5/6 | CK14 | p63 | EGFR | | 1 | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | | 2 | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | spindle cell (-), epithelial cell (+) | | 3 | both cell types (+) | bothe cell types (+) | bothe cell types (+) | bothe cell types (+) | bothe cell types (+) | | 4 | + | + | + | + | focal + | | 5 | + | + | + | focal + | + | | 6 | + | + | + | + | + | | 7 | - | - | - | very focal + | + | | 8 | + | very focal + | + | very focal + | + | | 9 | very focal + | + | + | + | + | | 10 | very focal + | - | very focal + | - | + |
Conclusions: Even though the basal-myoepithelial markers showed expression in most of the spindle cell carcinomas, no single marker was consistently present. Also, the staining can be very focal in its expression within a given tumor. Caution should be applied in excluding spindle cell carcinoma purely based on negative stains, especially for core biopsies. Morphologically low grade tumors can demonstrate an aggressive clinical course. Therefore, the pathological grade of spindle cell carcinoma has limited value in predicting clinical outcome.
Category: Breast
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 36, Tuesday Afternoon
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