Metaplastic breast carcinomas are enriched in markers of tumor-initiating cells and epithelial to mesenchymal transition

Yanhong Zhang, Kathy A. Toy, Celina G. Kleer

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Metaplastic breast carcinomas constitute a distinct aggressive form of invasive breast cancer with histological evidence of epithelial to mesenchymal transition toward spindle, chondroid, or osseous cell types. During tumorigenesis, epithelial to mesenchymal transition promotes invasion and metastasis and has been linked to the presence of stem cells. We hypothesized that metaplastic carcinomas may express epithelial to mesenchymal transition markers and may be enriched in tumor-initiating cells specifically in the non-glandular metaplastic elements. In 27 primary metaplastic carcinomas of the breast we tested the expression of epithelial to mesenchymal transition inducers ZEB1 and E-cadherin and the presence of tumor-initiating cells by using aldehyde dehydrogenase-1 (ALDH-1) and CD44 +/CD24 -/low immunohistochemistry. Of the 27 metaplastic carcinomas, 20 (74%) had squamous and/or spindle areas and 7 (26%) had heterologous elements (6 chondroid and 1 osseous). ALDH-1-positive and CD44 +/CD24 -/low-expressing cells were detected in the non-glandular metaplastic components (Fishers exact, P=0.0017). E-cadherin expression was reduced or absent (aberrant) in all metaplastic components whereas it was normal in the glandular areas. On the contrary, overexpression of ZEB1 was detected in 41% (11 of 27) of the non-glandular, metaplastic components, and in none of the glandular areas. The presence of tumor-initiating cells, aberrant E-cadherin, and ZEB1 upregulation was associated in over 90% of the spindle areas and heterologous elements (χ 2 test, P<0.05). We provide first in situ evidence that epithelial to mesenchymal transition inducers and tumor-initiating cells are present specifically in the non-glandular components of metaplastic carcinomas.

Original languageEnglish (US)
Pages (from-to)178-184
Number of pages7
JournalModern Pathology
Issue number2
StatePublished - Feb 2012


  • aldehyde dehydrogenase
  • CCN6
  • E-cadherin
  • epithelial to mesenchymal transition
  • metaplastic breast cancer
  • WISP3
  • ZEB

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Fingerprint Dive into the research topics of 'Metaplastic breast carcinomas are enriched in markers of tumor-initiating cells and epithelial to mesenchymal transition'. Together they form a unique fingerprint.

Cite this