CARCINOSARCOMA OF THE BREAST - A VERY RARE CASE REPORT

Background - Carcinosarcoma of the breast, often referred to as Metaplastic carcinoma of the breast, is a very rare malignancy with two distinct cell lines - ductal with sarcoma-like component. Clinically, Carcinosarcoma is an aggressive breast cancer and its prognosis is less favorable compared to the commoner infiltrating ductal or lobular carcinoma. We report, here, a patient with Carcinosarcoma breast a very rare and often a difficult diagnosis. Case Presentation - A 60 years old postmenopausal woman presented with a 6 month history of left breast swelling a slow-growing mass associated with pain lately. There was no discharge per nipple. Physical examination revealed a huge tender well defined mass in the left breast, with consistency ranging from firm to hard, along with areas of fluctuation. The mass was mobile with the breast tissue but not fixed to the pectorals. The skin over the mass was reddish, not pinchable and had a peau dorange appearance . The left axilla and supraclavicular fossa were free. So clinically, the mass was initially thought of as an Inflammatory Carcinoma of the left breast.FNAC yielded only a bloody aspirate, which was followed by an incision biopsy and that clinched the diagnosis of Metaplastic Carcinoma of the breast CarcinoSarcoma. The patient had Left Modified Radical Mastectomy, followed by Adjuvant chemotherapy. Histopathological examination confirmed the diagnosis. The patient is now free from the disease for more than a year post-operatively. Discussion - Carcinosarcoma breast has been reported to account for 0.080.2 of all breast malignancies. The true definition of Metaplastic carcinoma of the breast is a tumor of malignant epithelial tissue (carcinoma) mixed with malignant cells of mesenchymal origin (sarcoma) with apparent histologic and cytologic features present on light microscopy and immunohistochemical testing. The origin of these tumours is still being debated and are probably derived of myoepithelial cells. Generally the prognosis of these tumours is poor, with survival being measured in months. Conclusion - Carcinosarcoma accounts for 0.2 of breast malignancies and should be a differential. Very few cases have been reported in the literature. Treatment involves a multi-disciplinary approach as recommended by the NCCN guidelines.