Peri-Operative Challenges in Management of a Huge Metaplastic Breast Carcinoma in a Young Woman – A Case Report

Ahmad Sufi Mustaqim Nordin, Norlia Abdullah, Gillian Marie Caunter, Nurwahyuna Rosli, Aida Widure Mustapha Mohd Mustapha, Kok Wang Tan, Maya Mazuwin Yahya

Abstract


Metaplastic breast carcinoma is an uncommon and biologically diverse subtype of invasive carcinoma, contributing to less than 1% of cases. It is characterised by malignant epithelial components admixed with squamous, spindle, chondroid or osseous elements. These tumours frequently grow rapidly to become very large and have high-grade histology, leading to diagnostic confusion with malignant phyllodes tumour or primary breast sarcoma. We reported a 36-year-old woman with a huge metaplastic breast carcinoma complicated by ulceration and secondary infection. Imaging demonstrated a massive heterogeneous cystic–solid mass with enlarged axillary nodes. Core biopsy revealed a malignant spindle cell tumour and immunohistochemistry showed cytokeratin and p63 positivity, confirming it to be a  metaplastic carcinoma. She underwent  a mastectomy, axillary dissection and immediate bipedicle transversus rectus abdominis myocutaneous flap reconstruction for closure of the large post-mastectomy defect. Intra-operatively,  it was complicated by 3.5 L  blood loss requiring a large amount of transfusion. The final pathology demonstrated a high-grade metaplastic carcinoma, Grade 3 Triple Negative, with spindle and squamous elements, clear surgical margins with no nodal metastasis.


Keywords


Mastectomy; metaplastic breast carcinoma; spindle cell; squamous; TRAM flap

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References


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DOI: http://dx.doi.org/10.17576/JSA.2026.1602.04

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