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Peer-reviewedCC BYJournal of clinical medicine

Synchronous Metaplastic Breast Carcinoma with Mesenchymal Differentiation and Triple-Negative Invasive Papillary Carcinoma: A Case Report and Literature Review

  • Vladimir Tvrdisic1
  • Vesna Vulovic2
  • Bojan Stojanovic1,3,4
  • Marina Petronijevic5
  • Milica Dimitrijevic6
  • Emilija Subanovic7
  • Nina Radosavljevic1
  • Marko Spasic1,3
  • Bojan Milosevic1,3
  • Jasna Gacic2,8
8 affiliations
  1. 1Clinic for General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
  2. 2Department of Surgery, University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
  3. 3Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
  4. 4Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
  5. 5Center for Medical Oncology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
  6. 6Center for Plastic, Reconstructive and Aesthetic Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
  7. 7Center for Radiation Oncology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
  8. 8Department of Surgery with Anesthesiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Abstract

Background: Metaplastic breast carcinoma with mesenchymal differentiation is a rare and morphologically heterogeneous malignancy that may show a biphasic epithelial and sarcomatoid pattern historically termed “carcinosarcoma.” Its synchronous occurrence with invasive papillary carcinoma is exceptionally uncommon and may create diagnostic and therapeutic difficulties. Methods: We report the clinicopathological course of a premenopausal woman with two synchronous breast malignancies. Clinical, radiological, histopathological, and immunohistochemical findings were reviewed, including PD-L1 assessment using the 22C3 antibody, and interpreted in the context of the relevant literature. Results: Definitive surgical pathology demonstrated a 125-mm metaplastic breast carcinoma with mesenchymal differentiation showing carcinosarcoma morphology and a separate 22-mm high-grade triple-negative invasive papillary carcinoma. Sarcomatoid predominance led to the initial interpretation of malignant phyllodes tumor on core biopsy. Axillary lymph-node metastases showed papillary morphology and a concordant immunophenotype, strongly supporting their relationship to the invasive papillary carcinoma. Later supraclavicular recurrence and pulmonary metastases could not be conclusively attributed to either primary tumor. PD-L1 combined positive scores were 25 in both primary tumors and 35 in the supraclavicular metastasis. Pembrolizumab-based therapy was followed by radiological regression and clinical stability. Conclusions: This case highlights the importance of representative sampling, careful characterization of synchronous tumors, comparison of metastatic deposits with all primary lesions, and biomarker reassessment during progression. The observed response should be interpreted in the context of PD-L1-positive metastatic triple-negative breast cancer rather than as evidence of histology-specific pembrolizumab efficacy.

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Cite

BibTeXRIS
BibTeX
@article{tvrdisic2026synchronous,
  title = {{Synchronous Metaplastic Breast Carcinoma with Mesenchymal Differentiation and Triple-Negative Invasive Papillary Carcinoma: A Case Report and Literature Review}},
  author = {Vladimir Tvrdisic and Vesna Vulovic and Bojan Stojanovic and Marina Petronijevic and Milica Dimitrijevic and Emilija Subanovic and Nina Radosavljevic and Marko Spasic and Bojan Milosevic and Jasna Gacic},
  journal = {Journal of clinical medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15197705},
  url = {https://europepmc.org/article/PMC/PMC13665783},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Synchronous Metaplastic Breast Carcinoma with Mesenchymal Differentiation and Triple-Negative Invasive Papillary Carcinoma: A Case Report and Literature Review
AU  - Vladimir Tvrdisic
AU  - Vesna Vulovic
AU  - Bojan Stojanovic
AU  - Marina Petronijevic
AU  - Milica Dimitrijevic
AU  - Emilija Subanovic
AU  - Nina Radosavljevic
AU  - Marko Spasic
AU  - Bojan Milosevic
AU  - Jasna Gacic
PY  - 2026
DA  - 2026/10/01
JO  - Journal of clinical medicine
DO  - 10.3390/jcm15197705
UR  - https://europepmc.org/article/PMC/PMC13665783
AB  - Background: Metaplastic breast carcinoma with mesenchymal differentiation is a rare and morphologically heterogeneous malignancy that may show a biphasic epithelial and sarcomatoid pattern historically termed “carcinosarcoma.” Its synchronous occurrence with invasive papillary carcinoma is exceptionally uncommon and may create diagnostic and therapeutic difficulties. Methods: We report the clinicopathological course of a premenopausal woman with two synchronous breast malignancies. Clinical, radiological, histopathological, and immunohistochemical findings were reviewed, including PD-L1 assessment using the 22C3 antibody, and interpreted in the context of the relevant literature. Results: Definitive surgical pathology demonstrated a 125-mm metaplastic breast carcinoma with mesenchymal differentiation showing carcinosarcoma morphology and a separate 22-mm high-grade triple-negative invasive papillary carcinoma. Sarcomatoid predominance led to the initial interpretation of malignant phyllodes tumor on core biopsy. Axillary lymph-node metastases showed papillary morphology and a concordant immunophenotype, strongly supporting their relationship to the invasive papillary carcinoma. Later supraclavicular recurrence and pulmonary metastases could not be conclusively attributed to either primary tumor. PD-L1 combined positive scores were 25 in both primary tumors and 35 in the supraclavicular metastasis. Pembrolizumab-based therapy was followed by radiological regression and clinical stability. Conclusions: This case highlights the importance of representative sampling, careful characterization of synchronous tumors, comparison of metastatic deposits with all primary lesions, and biomarker reassessment during progression. The observed response should be interpreted in the context of PD-L1-positive metastatic triple-negative breast cancer rather than as evidence of histology-specific pembrolizumab efficacy.
SN  - 2077-0383
ER  -