{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:32:32Z","timestamp":1791250352671,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001006","name":"Breast Cancer Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001006","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Although rare, malignant sarcomatoid breast tumours without evidence of epithelial differentiation comprise a diagnostic challenge with management implications. Earlier studies have generally considered these to be primary breast sarcomas; however, supporting evidence is lacking and management remains variable. This study aimed to provide an evidence\u2010based approach to improve the consistency of diagnosis and management for such cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>A large series (<jats:italic>n<\/jats:italic>\u00a0=\u00a0140) of metaplastic breast carcinoma (MBC) diagnosed in Nottingham over 18\u00a0years was analysed. Only cases with available data on immunohistochemical expression of cytokeratins (CKs) were included. The prevalence and pattern of expression for various CKs were assessed and details of tumours negative for CKs were collected. A diagnostic approach based on our experience is provided. Forty\u2010seven cases (34%) showed foci of conventional type invasive breast carcinoma or ductal carcinoma <jats:italic>in situ<\/jats:italic> (DCIS), while 93 cases (66%) were diagnosed as MBC based on morphology and\/or CK expression. Ninety\u2010seven cases (69%) were negative for one or more CKs, with 18 cases (13%) negative for five or more CKs. Eight cases (6%) lacked expression of all CKs tested. Further examination showed evidence of carcinomatous nature in five cases, and three were diagnosed as MBC following extensive diagnostic work\u2010up and based on our experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study suggests that MBC represents a spectrum of neoplasms, with some lacking CK expression. Sarcomatoid neoplasms of the breast lacking evidence of carcinomatous morphology and CK expression may represent an extreme end of differentiation that can be considered as carcinomas rather than sarcomas for management purposes (following extensive work\u2010up).<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14290","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T21:06:35Z","timestamp":1603919195000},"page":"759-771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Metaplastic carcinomas of the breast without evidence of epithelial differentiation: a diagnostic approach for management"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5009-5525","authenticated-orcid":false,"given":"Emad A","family":"Rakha","sequence":"first","affiliation":[{"name":"Department of Histopathology The University of Nottingham and the Nottingham University Hospitals NHS Trust Nottingham City Hospital Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecily M","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of Histopathology St Vincent\u2019s University Hospital University College Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pia","family":"Foschini","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences Section of Anatomic Pathology at Bellaria Hospital University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mu\u00f1oz Martin","sequence":"additional","affiliation":[{"name":"Department of Histopathology The University of Nottingham and the Nottingham University Hospitals NHS Trust Nottingham City Hospital Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Dabbs","sequence":"additional","affiliation":[{"name":"John A. 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