| Summary: | Introduction: Metaplastic breast carcinoma is an uncommon malignancy that consti-tutes < 5% of all breast cancers. There are 5 subtypes which are spindle cell, squamous cell, carci-nosarcoma, matrix-producing and metaplastic with osteoclastic giant cells. Spindle cell carcinoma represents approximately <0.3% of invasive breast carcinomas. It is typically a triple-negative cancer with distinct pathological characteristics, but relatively a non-conclusive on imaging findings. Case Report: An elderly lady presented with an enlarging painful left breast lump for one year. Pal-pable left breast lump was found on clinical examination. Mammography demonstrated a high den-sity, oval lesion with a partially indistinct margin. Corresponding ultrasound showed a large irregular heterogeneous lesion with solid-cystic areas. Histopathology showed atypical spindle-shaped cells that stained positive for cytokeratins and negative for hormone and human epidermal growth factor receptors, which favoured spindle cell metaplastic carcinoma. Left mastectomy and axillary dissection were performed, and the final diagnosis was consistent with metaplastic spindle cell car-cinoma. Conclusion: Spindle cell carcinoma of the breast is a rare and aggressive histological type of carci-noma, which may present with benign features on imaging. Tissue diagnosis is essential for prompt diagnosis with multidisciplinary team discussion to guide management and improve patient’s out-comes. © 2022 Bentham Science Publishers.
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