{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:23:33Z","timestamp":1787289813122,"version":"build-2736575974"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>\n                    Fibromatosis-like metaplastic carcinoma (FLMC) is defined as a rare histologic subtype of metaplastic carcinoma within the 2019 World Health Organization (WHO) classification framework for breast tumors. We present a case of FLMC demonstrating a notably atypical clinical presentation. A 73-year-old woman presented with a self-detected breast mass. Radiological and pathological evaluations both indicated potential malignancy. Histological examination showed a lesion composed predominantly of spindle cells and displaying an infiltrative growth pattern. Immunohistochemical staining confirmed co-expression of cytokeratin and p63 within the spindle cell component, supporting a diagnosis of FLMC. During follow-up, the patient developed local recurrence along with lymph node and distant metastases, leading to subsequent next-generation sequencing (NGS) to investigate underlying molecular alterations. Through NGS, we identified a deletion mutation in\n                    <jats:italic>PIK3R1<\/jats:italic>\n                    , a frameshift mutation in\n                    <jats:italic>RUNX1<\/jats:italic>\n                    , and\n                    <jats:italic>MYC<\/jats:italic>\n                    gene amplification. These findings provide preliminary molecular clues for the relatively aggressive biological behavior of FLMC.\n                  <\/jats:p>","DOI":"10.3389\/fonc.2026.1865144","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T04:23:44Z","timestamp":1787286224000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Fibromatosis-like metaplastic breast cancer: a case with detection of three genetic alterations, accompanied by local recurrence, lymph node metastasis, and distant metastasis"],"prefix":"10.3389","volume":"16","author":[{"given":"Xin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2013-0358-RS","article-title":"Metaplastic carcinoma of the breast","volume":"1396","author":"McKinnon","year":"2015","journal-title":"Arch Pathol Lab Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-020-00943-x","article-title":"Fibromatosis-like metaplastic carcinoma: a case report and review of the literature","volume":"151","author":"Victoor","year":"2020","journal-title":"Diagn Pathol"},{"key":"B3","article-title":"Fibromatosis-like metaplastic carcinoma of breast: a challenge for clinicopathologic diagnosis","volume":"117","author":"Zhao","year":"2018","journal-title":"Int J Clin Exp Pathol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200108000-00004","article-title":"Low-grade (fibromatosis-like) spindle cell carcinoma of the breast","volume":"258","author":"Sneige","year":"2001","journal-title":"Am J Surg Pathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1159\/000526535","article-title":"Fibromatosis-like metaplastic carcinoma: a triple-negative breast cancer with clinically indolent behavior","volume":"153","author":"Pham","year":"2022","journal-title":"Case Rep Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2022-0159-OA","article-title":"TERT promoter mutation c.-124C>T commonly occurs in low-grade fibromatosis-like metaplastic breast carcinoma","volume":"14712","author":"Webersinke","year":"2023","journal-title":"Arch Pathol Lab Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2020-207071","article-title":"High frequency of PIK3CA and TERT promoter mutations in fibromatosis-like spindle cell carcinomas","volume":"757","author":"Zhong","year":"2022","journal-title":"J Clin Pathol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202824","article-title":"Low-grade fibromatosis-like spindle cell carcinomas of the breast are molecularly exiguous","volume":"685","author":"Takano","year":"2015","journal-title":"J Clin Pathol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1111\/his.12865","article-title":"An approach to the diagnosis of spindle cell lesions of the breast","volume":"681","author":"Rakha","year":"2016","journal-title":"Histopathology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2017.05.012","article-title":"Spindle cell lesions of the breast - an approach to diagnosis","volume":"345","author":"Tay","year":"2017","journal-title":"Semin Diagn Pathol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-021-03162-x","article-title":"Spindle cell lesions of the breast: a diagnostic approach","volume":"4801","author":"Rakha","year":"2022","journal-title":"Virchows Arch"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2012.01.011","article-title":"Low-grade fibromatosis-like spindle cell metaplastic carcinoma of the breast: a case report and literature review","volume":"122","author":"Nonnis","year":"2012","journal-title":"Clin Breast Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1863123","article-title":"Clinicopathological features of inflammatory myofibroblastic tumor in the breast","volume":"2022","author":"Liu","year":"2022","journal-title":"Breast J"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/jcp-2024-209979","article-title":"Spindle cell carcinoma of the breast resembling pseudoangiomatous stromal hyperplasia","volume":"784","author":"Lee","year":"2025","journal-title":"J Clin Pathol"},{"key":"B15","article-title":"Fibromatosis of the breast. Report of two cases and review of the literature","volume":"774","author":"Ferbeyre-Binelfa","year":"2009","journal-title":"Cir Cir"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.4103\/0975-7406.155898","article-title":"Myoepithelial cells in pathology","author":"Balachander","year":"2015","journal-title":"J Pharm Bioallied Sci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2010.03603.x","article-title":"Keloid type of fibromatosis-like metaplastic carcinoma of the breast with transformation into biphasic tumour in recurrences and lymph node metastases","volume":"572","author":"Lamovec","year":"2010","journal-title":"Histopathology"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2013-0555-RS","article-title":"Low-grade fibromatosis-like spindle cell carcinoma of the breast","volume":"1394","author":"Dwyer","year":"2015","journal-title":"Arch Pathol Lab Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/0046-8177(89)90065-8","article-title":"Metaplastic carcinomas of the breast. II. Spindle cell carcinoma","volume":"208","author":"Wargotz","year":"1989","journal-title":"Hum Pathol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-018-0081-z","article-title":"Genomic profiling of metaplastic breast carcinomas reveals genetic heterogeneity and relationship to ductal carcinoma","volume":"3111","author":"Krings","year":"2018","journal-title":"Mod Pathol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097-0142(19990515)85:10<2170::aid-cncr11>3.0.co;2-x","article-title":"Metaplastic breast tumors with a dominant fibromatosis-like phenotype have a high risk of local recurrence","volume":"8510","author":"Gobbi","year":"1999","journal-title":"Cancer"},{"key":"B22","article-title":"Metaplastic spindle-cell (fibromatosis-like) carcinoma of the breast--report of 4 cases","volume":"384","author":"Kinkor","year":"2002","journal-title":"Cesk Patol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7819-5-24","article-title":"Fibromatosis-like carcinoma-an unusual phenotype of a metaplastic breast tumor associated with a micropapilloma","volume":"5","author":"Rekhi","year":"2007","journal-title":"World J Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1177\/030089160909500224","article-title":"Low-grade fibromatosis-like spindle cell metaplastic carcinoma: a basal-like tumor with a favorable clinical outcome. Report of two cases","volume":"952","author":"Podetta","year":"2009","journal-title":"Tumori"},{"key":"B25","article-title":"Sarcomatoid (metaplastic) spindle cell carcinoma arising in a phylloid tumor with massive squamous metaplasia - a case report and review of the literature","volume":"483","author":"Kinkor","year":"2012","journal-title":"Cesk Patol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-014-1603-9","article-title":"Fibromatosis-like metaplastic carcinoma of the breast has a claudin-low immunohistochemical phenotype","volume":"4652","author":"Rito","year":"2014","journal-title":"Virchows Arch"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0529-5807.2017.02.011","article-title":"Fibromatosis-like metaplastic carcinoma of breast: a clinicopathological analysis of 3 cases","volume":"462","author":"Li","year":"2017","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"key":"B28","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s40792-021-01110-0","article-title":"A difficult-to-diagnose fibromatosis-like metaplastic carcinoma of the breast: a case report","volume":"71","author":"Takatsuka","year":"2021","journal-title":"Surg Case Rep"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v11.i18.4384","article-title":"Fibromatosis-like metaplastic carcinoma of the breast: two case reports","volume":"1118","author":"Bao","year":"2023","journal-title":"World J Clin cases"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2022.11.053","article-title":"Fibromatosis-like metaplastic carcinoma: a rare case report","volume":"465","author":"Wang","year":"2023","journal-title":"Asian J Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"S1015\u20119584(24)01765\u20112","DOI":"10.1016\/j.asjsur.2024.08.027","article-title":"Fibromatosis-like metaplastic carcinoma of the breast: case report","volume":"26","author":"Wu","year":"2024","journal-title":"Asian J Surg"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1177\/10668969241300498","article-title":"Fibromatosis-like metaplastic carcinoma of the breast: a challenging diagnosis with potential pitfalls","volume":"335","author":"Laokulrath","year":"2025","journal-title":"Int J Surg Pathol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.breast.2018.12.010","article-title":"Metaplastic breast cancers: genomic profiling, mutational burden and tumor-infiltrating lymphocytes","volume":"44","author":"Tray","year":"2019","journal-title":"Breast"},{"key":"B34","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.humpath.2018.11.023","article-title":"Molecular characterization of metaplastic breast carcinoma via next-generation sequencing","volume":"86","author":"Zhai","year":"2019","journal-title":"Hum Pathol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.3390\/cancers16071433","article-title":"Translational aspects in metaplastic breast carcinoma","volume":"167","author":"Barrientos-Toro","year":"2024","journal-title":"Cancers"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1865144\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T04:23:46Z","timestamp":1787286226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1865144\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":35,"alternative-id":["10.3389\/fonc.2026.1865144"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1865144","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1865144"}}