Breast carcinoma with osteoclastic giant cells
Invasive ‘carcinoma with osteoclast-like giant cells‘ is a rare type of breast cancer characterized by giant-sized, multinucleated cells. In fact, the osteoclastic giant cells are not actually part of the ‘carcinoma‘, but are more-or-less just passengers which can occur in pretty much any type of breast carcinoma, developing adjacent to malignant neoplastic cells, or within the ‘spaces‘ that they create. Other historical names for this type of breast cancer include osteoclast-like multinucleated giant cells (OMGCs), and carcinoma with stromal multinucleated giant cells.
This page is kind of getting a little somewhat “old”, however it still has great material and I would still use it. I wanted to let you know that I have created a newer version of this page with more up-to-date information on Giant Cells Associated with Breast Cancer, as well as the Rare Types.
Comprising between 0.5% to 1.2% of breast carcinomas, carcinoma with osteoclastic giant cells derives its name due to the similarity in appearance of malignant cells to ‘osteoclasts‘, which are associated with bone formation and maintainance. Osteoclasts are large multinucleate cells (cells with more than one nucleus) that are responsible for bone resorption. Osteoclasts and osteoblasts are instrumental in controlling the amount of bone tissue: osteoblasts form bone, osteoclasts resorb bone.
Osteoclasts are very large cells, 40 micrometer in diameter, and often contain 15-20 nuclei. However, breast cancer with osteoclastic giant cells has nothing to do with bone cells, and just borrows the name due similarity of appearance.
The age range for developing breast carcinoma with osteoclastic giant cells is wide, between 30 and 85 generally, with an average age of development in the mid 40s to early 50s. There is no clinically significant difference between breast carcinoma with osteoclastic giant cells and other generic types of invasive ductal carcinoma, though the prognosis for breast carcinoma with osteoclastic giant cells is generally quite good.
Infiltrating lobular, cribriform, squamous, papillary, apocrine, mucinous, and metaplastic carcinomas have all been found with osteoclast-like giant cells. Studies have shown conclusively that the giant cells are of mesenchymal origin and have nothing to do with epithelial cell growth at all. The presence of giant cells associated with the carcinoma does not seem to alter the prognosis.
Osteoclastic giant cell breast cancers often display evidence of hemosiderin
The giant cells associated with this type of breast cancer likely originate from the fusion of histiocytic type mononucleated stromal cells, but this hypothesis has yet to be formally confirmed. The development of the giant cells often begins in the breast stroma, immediately ‘adjacent‘ to nests of malignant breast carcinoma cells, or within ‘lumens‘ (spaces) formed by carcinoma cells.
Breast carcinoma with osteoclastic giant cells is also frequently associated with prominent thin walled blood vessels and hemosiderin. Hemosiderin is an ‘iron-storage complex‘ that often forms after bleeding. It is a byproduct formed when macrophages (white blood cells) engulf and degrede the hemoglobin of red blood cells released due to bleeding.
Clinical and mammographic characteristics of Breast carcinoma with osteoclastic giant cells
Tumors formation in breast carcinoma with osteoclastic giant cells tends to occur in the upper-outer quadrant of the breast, though they can develop in all quadrants. Mammographic findings tend to show a benign-looking well-defined, dense tumor, possibly irregularly shaped. Ultrasound images of breast carcinoma with osteoclastic giant cells tend to show a well-circumscribed and often partially lobulated hypoechoic mass, often with similarities in appearance to phyllodes tumor. Mammogram and ultrasound images of breast carcinoma with osteoclastic giant cells can also be suggestive of a benign lesion like a cyst or fibroadenoma.
Histological characteristics of Breast carcinoma with osteoclastic giant cells
When bisected, the dark brown or red-brown appearance of breast carcinoma with osteoclastic giant cells tissue is striking, and bears a resemblance to metastatic melanoma. Microscopically, these tumors are often composed of a dominant sarcomatous stromal component containing osteoclast-like giant cells and a minor component of intraductal carcinoma. Signs of recent and past haemorrhage are almost always present in the highly vascularized stroma surrounding breast carcinoma with osteoclastic giant cells.
Multinucleated giant cells associated with the carcinoma may have anywhere from 3-50 nuclei, however there is generally no mitotic activity within the giant cells. The giant cells are also variable in size. Nuclei tend to be monomorphous, oval, eccentric hyperchromatic figures and there may or may not be prominent nucleoli.
Immunohistochemical markers associated with Breast carcinoma with osteoclastic giant cells
Breast carcinoma with osteoclastic giant cells will tend to show histological evidence of hemorrhage and infiltration of inflammatory cells in the stroma. The osteoclast-like giant cells tend to stain positive for CD68 and LCA, and often overexpress vascular endothelial growth factor (VEGF).
The osteoclastic giant cells will typically test negative for keratin, EMA, CEA, GCDFP15, S100, Factor VIIIRa. Evidence of estrogen receptors in tumors of breast carcinoma with osteoclastic giant cells tends to be absent, while presence of progesterone receptors tends to be variable.
Prognosis for Breast carcinoma with osteoclastic giant cells
There is no specific prognosis for carcinoma of the breast featuring osteoclastic giant cells, as they may develop alongside any type of common or uncommon breast carcinoma. However, follow-up data in some recent studies on women with breast cancer with osteoclastic giant cells have shown that a five year survival rate of over 85%.
For further reading, I suggest you visit this page on the histological workup for breast cancer diagnosis and treatment.
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