title: Spindle cell carcinoma of the breast: a case series of a rare histological subtype.
abstract: OBJECTIVE
  Spindle cell carcinoma (SpCC) represents <0.5% of breast cancers. We report the 15-year experience of SpCC at the Nottingham Breast Unit.
  
  
  METHODS
  Histopathology and case notes of metaplastic carcinomas with predominant spindle cell differentiation were analysed for patient demographics, tumour pathology, c-erb B-2 oestrogen (ER) and progesterone (PR) receptor status and radiology. Treatment, recurrence and survival rates were also analysed.
  
  
  RESULTS
  Nineteen patients with SpCC were identified. The median age was 68 years (range 27-92). Large ill-defined mass was the only consistent radiological features suggesting SpCC. Mean tumour size was 53 mm, (range 16-200 mm). Fifteen tumours were grade 3 and four were grade 2. Six out of 15 patients with axillary surgery had positive lymph nodes (40%). All tumours were oestrogen (ER) and progesterone (PR) negative. One tumour was focally c-erb B-2 positive in the non-spindle cell component. Median Nottingham Prognostic Index was 5.2 (range 3.6-6.6). Primary treatment was surgical in 89%. Adjuvant chemotherapy was given in four cases. The median disease free interval was 7 (range 2-109) months. Twelve cases recurred (63.2%). The main sites of metastasis were the lungs (9 cases), bone (6) and liver (1). Eleven cases have died of breast cancer (58%). Median survival was 18 months (range 4-109).
  
  
  CONCLUSIONS
  SpCC is an aggressive histological type of carcinoma of the breast. Omitting node sampling may result in significant under-staging. Negative ER, PR and c-erb B-2 status limits treatment options.
authors.affiliation: Department of Surgery, Nottingham City Hospital Breast Unit, Hucknall Road, Nottingham NG5 1PB, UK. hamed4khan@aol.com
authors.forename: H N
authors.initials: HN
authors.lastname: Khan
authors.forename: L
authors.initials: L
authors.lastname: Wyld
authors.forename: B
authors.initials: B
authors.lastname: Dunne
authors.forename: A H S
authors.initials: AH
authors.lastname: Lee
authors.forename: S E
authors.initials: SE
authors.lastname: Pinder
authors.forename: A J
authors.initials: AJ
authors.lastname: Evans
authors.forename: J F R
authors.initials: JF
authors.lastname: Robertson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000628:therapy; D002277:Carcinoma / Q000737:chemistry / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor