Abstract
A 42-year-old female visited the hospital because of a right breast tumor. On the first visit she had already massive local lymph nodes involvements and multiple bone metastases (T3N2M1, stage IV). Irradiation and chemoendocrine therapy were repeatedly performed after standard radical mastectomy, but the patient died of far advanced distant metastases at 19th month after the onset. Histological examination of the resected tumor revealed a variety of features, i.e., papillo-tubular growth, sarcomatous growth mainly composed of spindle cells, and the transition between the two. Thus, the tumor was diagnosed as papillo-tubular carcinoma with spindle cell metaplasia. Immunohistochemical stainings of the tumor showed that vimentin existed only in the sarcomatous region, and keratin was not detected in the tumor. The prognosis of patients with spindle cell carcinoma (so-called carcinosarcoma) is thought to be similar with that of common type of breast carcinoma, but it is still in controversy. Therefore, we investigated the relation between the prognosis and the existence of vimentin as a marker of sarcomatous change of the tumor in 65 patients with breast carcinoma. Vimentin was immunohistochemically detected in 7 carcinomas, in which a decrease in keratin was observed. Such findings indicated a decrease of feature of epitherial cell in the vimentin-positive carcinomas. Four out of the 7 patients with vimentin-positive tumor had metastatic lesions, and showed a poor prognosis compared to that of vimentin-negative patients.
