Metaplastic Breast Carcinoma: Radiologic-Pathologic Correlation

Metaplastic breast carcinoma (MBC) is a rare and aggressive malignancy pathologically defined by differentiation of the neoplastic epithelium to mesenchymal-like and/or squamous components. Metaplastic breast carcinoma is typically a triple receptor negative invasive breast cancer (TNBC). There are multiple subtypes of MBC, and imaging findings are nonspecific. Classically, MBC presents in postmenopausal women as an enlarging palpable mass. At presentation, MBC is often larger than non-MBC breast cancer, and distant metastases are more common. Axillary nodal involvement is, however, less frequent. Mammography commonly demonstrates a circumscribed oval, round, or lobulated mass with or without calcifications. Spiculated masses and architectural distortion are less common than in non-MBC breast cancer. US often demonstrates a round/oval solid mass with cystic spaces due to necrosis. A T2 hyperintense mass with rim enhancement is often demonstrated on MRI. Imaging findings of MBC can mimic benign tumors, such as phyllodes and non-MBC breast cancers, and radiologists should consider MBC in the differential diagnosis of a mass with these features, especially with a clinical history of a new or enlarging palpable finding. Pathologic diagnosis is important, but accurate diagnosis on core biopsy can be limited due to the heterogeneity of this entity and dependence on sampling the metaplastic component. Data suggest that MBC confers a worse long-term prognosis than non-MBC breast cancers, including other TNBCs.