International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(15), August, 2012

Pages: 63-66

Date of Publication: 15-Aug-2012


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MATRIX PRODUCING MAMMARY CARCINOMA - A RARE BREAST TUMOUR

Author: Zankhana N Prajapati, Gunvanti B Rathod, R.N. Gonsai, T.B. Kadam

Category: Healthcare

Abstract:Matrix producing carcinoma of breast (Metaplastic carcinoma, Carcinosarcoma) is a very rare condition having incidence rate of 0.08 to 0.2% of all malignant breast lesions. In this case, a 50 years old female, admitted in Civil Hospital, Ahmedabad was presented with swelling of right breast. Mammogram and fine needle aspiration cytology suggestive of malignant lesion. Modified radical mastectomy was done and histopathological examination suggestive of matrix producing carcinoma.

Keywords: Matrix producing carcinoma of breast, Metaplastic carcinoma, Carcinosarcoma.

Full Text:

INTRODUCTION
Matrix producing carcinoma (MPC) of breast was first described by Wargotz and Norris in 1989. Matrix producing carcinoma of breast encompass a histologically diverse spectrum, subtype of metaplastic carcinoma defined as an invasive breast carcinoma with a direct transition of carcinoma to cartilaginous or osseous matrix without an intervening spindle cell component. [1] The identification of this entity is important to pathologist and surgeons both considering prognosis differ from other carcinoma of breast. This report highlights one such case with cytomorphological and histopathological correlation and differential diagnosis. Case History A 50 years old woman presented with a lump in right breast since 1 year, with history of rapid increase in its size since 2-3 months. Swelling was present in upper outer quadrant. Fine needle aspiration cytology was done which was characterised by an abundant chondroid extracellular matrix with variably admixed carcinomatous and chondroid type cells. Ductal cell carcinoma component was also seen in the form of irregular cluster of highly pleomorphic cells with high N/C (nuclei cytoplasm) ratio, hyperchromatic nuclei with prominent nucleoli. Cytodiagnosis of metaplastic carcinoma was made followed by modified radical mastectomy. On gross examination, a 4x4x4 cm3 gray white growth was defined in upper outer quadrant of breast. Base was made up of facia and adipose tissue. Multiple sections were taken. Microscopic examination showed malignant change in both epithelial and stromal component having histology of poorly differentiated invasive ductal carcinoma (figure I) with areas of ductal carcinoma in situ (DCIS) – comedo type (modified Bloom Richardson grade 3). There were also areas of necrosis and numerous abnormal mitotic activities. Stroma showed dense lymphocytic infiltrate. There was a direct transformation of carcinoma into malignant cartilaginous matrix (figure II). There was also pleomorphic undifferentiated malignant stromal component. All surgical margins, base and nipple areola were free from tumour tissue. Total 13 lymph nodes were dissected out of which 2 lymph nodes showed evidence of metastasis. With these features, a diagnosis of matrix producing carcinoma of breast was made. The tumour was ER-PR (estrogen receptor – progesterone receptor) negative. Final report was given as Matrix Producing Carcinoma, BR grade-3, TNM stage - p T2 N1 Mx.

DISCUSSION
Matrix producing carcinoma is a very rare breast neoplasm accounting for less than 0.2% of all breast malignancies. [2] It is a unique subtype of metaplastic carcinoma, characterised by the existence of ductal carcinomatous component with a direct transition to areas showing cartilaginous or osseous differentiation, lacking an interspersed spindle cell component. [1] Wargotz and Norris [1] first described this entity in their study of 26 cases of metaplastic carcinomas. They found that carcinomatous component was moderately to poorly differentiate with a frequent association of intraductal component. The nature of matrix was variable, ranging from bland cartilage to a typical chondroid to osteoid to overt bone formation. The matrix was made up of acid mucopolysaccharides that stained metachromatically with Alcian blue and Aldehyde fuschin and was resistant to hyaluronidase and diastase. It is generally hormone receptor negative and present with larger tumour size, less nodal involvement and higher tumour grade compared with invasive ductal carcinoma. So matrix producing carcinoma is generally treated more aggressively. [3] Ultra-structural analysis of matrix producing carcinoma supports the evidence that the tumour cells are of epithelial & myoepithelial derivation. [1] Myoepithelial cells differentiate along mesenchymal lines and produce a gamut of matricial appearance. After the advent of immunohistochemistry (IHC), it is now accepted that metaplasia of epithelial elements of carcinoma gives these lesions pseudosarcomatous appearance. [4] Giemsa stained smears demonstrate the extracellular metachromatic stromal elements more clearly than papanicolau stained smears. [5] The spectrum of differential diagnosis to be considered which included number of benign and malignant entities like- malignant fibroepithelial lesions with myxochondroid stroma and true sarcoma of breast with cartilaginous metaplasia. [6] Metaplastic carcinoma is a heterogeneous group of tumour that also includes low grade fibromatosis like spindle cell carcinoma, sarcomatoid carcinoma, metaplastic carcinoma with osteoclastic giant cells, adenosquamous carcinoma. The heterologous chondroid component of matrix producing carcinoma can be present in 2 patterns. One displays a typical structure of low grade cartilage and second shows epithelial tumour cells embedded in homogenous eosinophilic extracellular matrix giving appearance of chondroid aura. [7] Cartilaginous metaplasia may be uncommonly seen in other mammary tumors like fibroadenoma, phyllodes tumour and pleomorphic adenoma. The unequivocal presence of carcinoma is helpful distinguishing feature in such cases. In the original description of matrix producing carcinoma by Wargotz and Norris, [1] the authors concluded that the outcome of patients with matrix producing carcinoma is not significantly different from those with invasive ductal carcinomas of similar grade and stage. However one more recent study by Down-Kelly Erinn DO et al. [8] suggests that Matrix producing carcinomas are more aggressive tumours. Study also tells that they examined cases of matrix producing carcinoma diagnosed and evaluated whether the local and distant recurrence rates for matrix producing carcinoma were significantly different from those of invasive ductal carcinomas. They also evaluated that specific histological characteristics of matrix producing carcinoma were associated with tumour recurrence.

CONCLUSION
In summary, diagnosis of matrix producing carcinoma is important though it is a rare variety of metaplastic carcinoma because it is an aggressive variant with increased loco regional and distant tumour recurrence compared with invasive ductal carcinomas.

References:

1. Wargotz E, Norris H. Metaplastic carcinoma of breast: matrix producing carcinoma. Histopathology 2001; 39:518-83.

2. Feder JM, de paredes ES, Hogge JP, Wilken JJ. Unusual breast lesions radiological and pathological correlation. Radiographics 1999; 19:11-26.

3. Ninomiyo J, Oyama I, Horiguchi J, Koilbuchi Y, Yashida T, Ijima K et al. Two cases of breast cancer with cartilaginous and osseous metaplasia. British Journal of Cancer 2005: 12; 52-6.

4. Saxena S, Bansal A, Mohil RS, Bhatnagar D. Metaplastic carcinoma of breast: A rare breast tumour. Indian Journal of pathology and microbiology, 2004; 47:217-20.

5. Straalhof D, yakimets WW, Mourad WA. FNAC of sarcomatoid carcinoma of breast: A cytological overlooked neoplasm. Diagnostic cytopathology, 1997; 16:242-6.

6. Fulciniti F, Mansueto G, Vetrani A, Accurso A, Fortunato A, Palmbini L. Metaplastic breast carcinoma on FNAC samples: A report of three cases. Diagnostic cytopathology, 2005; 33:205- 9.

7. Kinkor Z, Boudova L, Ryska A, Kajok, Svee A. Matrix producing carcinoma of breast with myoepithelial differentiation. Ceska Gynekol, 2004; 69:229-36.

8. Down-Kelly Erinn DO et al. Matrix producing carcinoma of breast – An aggressive subtype of a Metaplastic carcinoma, The American Journal of Surgical Pathology, April 2009, Volume 33, Issue 4, Page 534 – 541.


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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
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A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
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A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
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A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
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A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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