Metaplastic breast carcinoma composed of epithelial–myoepithelial carcinoma and squamous cell carcinoma: A case report

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Rationale:Metaplastic breast carcinomas are a group of breast malignancies with varying histomorphological characteristics and prognoses. The tumor composed of epithelial -myoepithelial carcinoma and squamous cell carcinoma was not reported previously.Patient concerns:An 81-year-old woman presented with a palpable nodule in the left breast for 4 days. The ultrasonography showed multinodular growth and focally indistinct borders. Owing to her advanced age and possible early clinical staging, primary tumor resection was performed. One year later, a small and slow growing subcutaneous nodule was found under the incision of the left breast. Ultrasonography revealed an irregular, cystic and solid, hypoechoic mass with circumscribed borders.Diagnoses:Microscopic examination of the primary tumor revealed epithelial -myoepithelial carcinoma and squamous cell carcinoma. The former had a variety of architecture patterns, including nests, lobulations, papillary and tubular structures, and the latter showed varying morphological features, from squamous pearls to spindle cells. The recurrent tumor showed only epithelial -myoepithelial carcinoma with more aggressively malignant features than those seen in the primary tumor.Interventions:An extensive resection of the left breast mass was performed for the recurrent tumor. The patient did not receive any adjuvant chemotherapy or radiation therapy because of the patient's advanced age.Outcomes:The patient has been followed up for 1.5 years after second surgery without evidence of tumor recurrence and metastasis.Lessons:Wide local excision with adequate margins is recommended for elderly patients with metaplastic breast carcinoma composed of epithelial -myoepithelial carcinoma and squamous cell carcinoma.

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