Zhao TJ, Chen SL, Zhou YL, Jin ZJ, Huang GS. Multicomponent metaplastic breast cancer with four histological components: A case report. World J Clin Cases 2026; 14(27): 126027 [DOI: 10.12998/wjcc.126027]
Corresponding Author of This Article
Gao-Shi Huang, PhD, Department of General Surgery, The First People’s Hospital of Wuyi County, No. 2 Nanmen Street, Wuyi County, Jinhua 321200, Zhejiang Province, China. 3290029855@qq.com
Research Domain of This Article
Surgery
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case-report
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Zhao TJ, Chen SL, Zhou YL, Jin ZJ, Huang GS. Multicomponent metaplastic breast cancer with four histological components: A case report. World J Clin Cases 2026; 14(27): 126027 [DOI: 10.12998/wjcc.126027]
Ting-Jun Zhao, Shi-Lei Chen, Yun-Long Zhou, Zheng-Jia Jin, Gao-Shi Huang, Department of General Surgery, The First People’s Hospital of Wuyi County, Jinhua 321200, Zhejiang Province, China
Co-first authors: Ting-Jun Zhao and Shi-Lei Chen.
Author contributions: Zhao TJ and Chen SL contributed to data curation, writing - original draft; Zhou YL and Jin ZJ contributed to investigation; Zhou YL, Jin ZJ, and Huang GS contributed to writing - review & editing; Huang GS contributed to conceptualization and supervision.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Gao-Shi Huang, PhD, Department of General Surgery, The First People’s Hospital of Wuyi County, No. 2 Nanmen Street, Wuyi County, Jinhua 321200, Zhejiang Province, China. 3290029855@qq.com
Received: July 23, 2026 Revised: August 31, 2026 Accepted: October 9, 2026 Published online: September 26, 2026 Processing time: 82 Days and 23 Hours
Abstract
BACKGROUND
Mixed metaplastic breast cancer (MMBC) is an extremely rare subtype of breast malignancy characterized by aggressive biological behavior and a poor prognosis. Most patients with MMBC exhibit a triple-negative immunophenotype (ER-, PR-, HER2-), rendering them unresponsive to conventional endocrine therapy. Currently, no mature and effective targeted therapeutic agents are available for MMBC, and a universally accepted standard adjuvant chemotherapy regimen has not been established worldwide. Pathologically, most MMBC lesions contain only two histological components, whereas cases involving three or more distinct tumor components are extremely rare and have seldom been reported. Given its low incidence, high malignancy, limited clinical data, and lack of standardized treatment guidelines, we report a rare case of metaplastic breast cancer with three invasive components plus associated ductal carcinoma in situ (DCIS) components were identified. The patient underwent modified radical mastectomy for breast cancer and received 8 cycles of sequential chemotherapy: Pirarubicin plus cyclophosphamide, followed by docetaxel plus cisplatin. Herein, we share the relevant data regarding the patient’s diagnosis, individualized treatment, and prognosis.
CASE SUMMARY
A 60-year-old postmenopausal woman presented in August 2024 with a painless left breast mass noticed 3 days previously, without other symptoms. Preoperative ultrasonography indicated a breast lesion highly suspicious for malignancy. She underwent segmental mastectomy, and intraoperative frozen-section analysis confirmed high-grade invasive carcinoma, followed by modified radical mastectomy. Permanent pathological examination confirmed high-grade mixed metaplastic breast carcinoma. All 23 dissected axillary lymph nodes were negative for metastasis (0/23). Immunohistochemical analysis revealed a triple-negative phenotype (ER-, PR-, HER2-) and a Ki-67 index of 60%. Genetic testing identified TP53 and AKT1 mutations; however, no actionable targeted therapeutic options were identified. The patient received 8 cycles of sequential chemotherapy with Pirarubicin plus cyclophosphamide followed by docetaxel plus cisplatin, and grade 2-3 chemotherapy-related adverse reactions were alleviated with symptomatic treatment. No local recurrence or distant metastasis was observed during the 20-month postoperative follow-up, and the patient remains under regular surveillance.
CONCLUSION
This rare case of MBC with three invasive components plus associated DCIS components components expands the limited clinical evidence available for multicomponent metaplastic breast carcinoma. It also provides valuable clinical insights into the diagnosis, individualized comprehensive treatment, and long-term prognostic assessment of this rare and aggressive malignancy.
Core Tip: Metaplastic breast cancer (MMBC) is a rare breast malignancy with poor prognosis and a lack of standardized treatment strategies. We report a rare case of MMBC with three invasive components plus associated ductal carcinoma in situ components, a presentation that is seldom encountered in clinical practice. The tumor exhibits a triple-negative phenotype, a high Ki-67 proliferation index, and TP53 and AKT1 gene mutations. The patient completed 8 cycles of sequential Pirarubicin plus cyclophosphamide followed by docetaxel plus cisplatin adjuvant chemotherapy, with manageable grade 2-3 adverse reactions. No local recurrence or distant metastasis was observed during the 20-month follow-up period. This case provides clinical evidence for diagnosis, individualized therapy, and prognostic evaluation of multicomponent MMBC.
