9例化生性乳腺癌临床病理分析

佟经伟; 刘先富; 祝景伟; 许培权

doi:10.16766/j.cnki.issn.1674-4152.001823

9例化生性乳腺癌临床病理分析

doi: 10.16766/j.cnki.issn.1674-4152.001823

蚌埠医学院第一附属医院肿瘤外科甲乳外科二病区，安徽蚌埠 233004

基金项目:

安徽省教育厅重点课题 KJ2019A0341

详细信息

通讯作者:
许培权，E-mail: xupeiquan2003@aliyun.com

中图分类号: R737.9 R730
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-13
- 网络出版日期: 2022-02-19

Clinicopathological analysis of 9 patients with metaplastic breast carcinoma

Surgical Oncology of Thyroid and Breast (Ward 2), the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的化生性乳腺癌(MBC)是一种非常罕见的乳腺癌类型。本研究通过分析化生性乳腺癌的临床特点、病理特征和预后状况，提高对本病的认识。方法回顾分析蚌埠医学院第一附属医院2011年1月—2019年10月期间收治的9例化生性乳腺癌患者的临床病例资料，总结其病理特点、治疗方案及预后。结果 9例患者年龄46~60岁，中位年龄49岁，肿瘤直径1.0~4.5 cm，影像学检查无明显特异性，淋巴结转移者4例；临床分期：Ⅰ期3例，Ⅱ期5例，Ⅲ期1例；9例患者激素受体均阴性，1例患者CerbB-2受体阳性；8例患者行乳腺癌改良根治术，1例行乳腺单纯切除加前哨淋巴结活检术；8例患者接受了术后辅助化疗，其中，TAC方案4例、AT方案1例、PA方案1例、TP方案1例、1例患者因多西他赛过敏改为EC加卡培他滨；2例患者接受了术后放疗；1例患者因年龄及身体等原因未进行术后放化疗。3例复发，1例死亡。结论化生性乳腺癌是一种罕见的乳腺癌亚型，无特殊的影像学表现，组织成分复杂多样，激素受体及HER-2多呈阴性，具有不良的生物学行为和预后，目前尚无标准的治疗方案。因此进一步加深对化生性乳腺癌的研究或许能够发现新的、潜在有效的治疗方案，最终改善该类患者的预后。
- 化生性乳腺癌 /
- 临床特征 /
- 治疗 /
- 预后
Abstract: Objective Metaplastic breast cancinoma (MBC) is a very rare form of breast cancer. This study aimed to analyze the clinicopathologyic features and prognosis of MBC. Methods The clinicopathological data of 9 patients with MBC admitted to the First Affiliated Hospital of Bengbu Medical College from January 2011 to October 2019 were retrospectively reviewed, and the pathological characteristics, treatment and prognosis were summarized. Results All nine cases were women aged 46-60 years with median age of 49 years. The size of tumor was 1.0 to 4.5 cm, there was no obvious specificity in all imaging examination. Lymph node metastasis was found in 4 cases. Clinical stages: 3 cases of stage Ⅰ, 5 cases of stage Ⅱ and 1 cases of stage Ⅲ. All 9 cases were with negative hormone receptor, and 1 case was with positive for CerbB-2 receptor. The modified radical mastectomy was performed in 8 patients, and the simple breast resection plus sentinel lymph node biopsy was performed in 1 patient. Eight patients received postoperative adjuvant chemotherapy. Among them, there were 4 patients with chemotherapy regimen, 1 patient with AT chemotherapy regimen, 1 patient with PA chemotherapy regimen, 1 patient with TP chemotherapy regiment, 1 patient with E C chemotherapy regime plus capecitabine due to docetaxel allergy. Two patients received postoperative radiotherpy. One patient did not receive postoperative chemoradiotherapy due to age and physical reasons. Three cases had a recurrence, 1 case died from cancer. Conclusion The MBC is a rare malignant tumor of breast cancer that dose not has special imaging features, complex and diverse tissue components, negative hormone receptors and CerbB-2, and poor biological behavior and prognosis. Currently, there is no standard treatment plan. Therefore, further research on metastatic breast cancer may lead to the discovery of new and potentially effective treatment regimens, and ultimately improve the prognosis of these patients.
- Metaplastic breast cancinoma /
- Clinical features /
- Treatment /
- Prognosis

HTML全文

表 1 9例化生性乳腺癌患者病理特征

病例	年龄(岁)	肿瘤大小(cm)	淋巴结转移情况	pTNM分期	治疗方式	辅助治疗	随访情况	随访情况
1	49	3.0	2	pT2N1M0/ⅡB	改良根治	化疗+放疗	12个月	复发
2	46	3.0	5	pT2N2M0/ⅢA	改良根治	化疗	66个月	无疾病进展
3	54	3.0	0	pT2N0M0/ⅡA	单纯+前哨	化疗	25个月	去世
4	48	1.5	0	pT1N0M0/ⅠA	改良根治	化疗	66个月	无疾病进展
5	46	2.0	0	pT1N0M0/ⅠA	改良根治	化疗	39个月	无疾病进展
6	60	1.2	1	pT1N1M0/ⅡA	改良根治	无	26个月	复发
7	51	1.0	0	pT1N0M0/ⅠA	改良根治	化疗	100个月	无疾病进展
8	48	4.5	3	pT2N1M0/ⅡB	改良根治	化疗+放疗	8个月	无疾病进展
9	53	3.0	0	pT2N0M0/ⅡA	改良根治	化疗	8个月	无疾病进展

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表 2 9例化生性乳腺癌患者肿瘤成分及免疫组化结果

病例	肿瘤成分	免疫组化阳性抗体
1	化生性癌	CK、Vim、Ki-67(＞50%)
2	化生性癌	CK、Vim、Ki-67(80%)、p53
3	纤维瘤病样梭形细胞癌	CK、Ki-67(＞30%)、SMA、β-catenin、CKT
4	鳞状细胞癌	P53、Ki-67(5%-10%)、p63、CK5/6、CKH
5	鳞状细胞癌	P53、Ki-67(＞70%)
6	鳞状细胞癌	P53、Ki-67(30%)、CKH
7	鳞状细胞癌	P53、Ki-67(5%-10%)、CK5/6
8	鳞状细胞癌	HER-2、P53、Ki-67(50%)、p63、CK5/6、p40
9	乳腺癌肉瘤	Ki-67(＞90%)、Vim、CK、EMA、CK5/6

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参考文献(17)

[1]	EI ZEIN D, HUGHES M, KUMAR S, et al. Metaplastic carcinoma of the breast is more aggressive than triple-negative breast cancer: a study from a single institution and review of literature[J]. Clin Breast Cancer, 2017, 17(5): 382-391. doi: 10.1016/j.clbc.2017.04.009
[2]	BIAN T, LIN Q, WU Z, et al. Metaplastic carcinoma of the breast: imaging and pathological features[J]. Oncol Lett, 2016, 12(5): 3975-3980. doi: 10.3892/ol.2016.5177
[3]	张煜, 王墨培. 化生性乳腺癌的研究进展[J]. 癌症进展, 2019, 17(19): 2237-2238, 2263. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ201919002.htm
[4]	FAYAZ S, DEMIAN G A, EISSA H E, et al. Metaplastic breast carcinoma: Analysis of 31 cases from a single institute[J]. J Egypt Natl Canc Inst, 2017, 29(3): 141-145. doi: 10.1016/j.jnci.2017.05.002
[5]	周平, 林冰, 李岩岩, 等. 化生性乳腺癌的临床病理特征及预后分析[J]. 海南医学院学报, 2019, 25(15): 1152-1156. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYY201915007.htm
[6]	王东存, 陈珂瑶, 唐兆瑞, 等. 乳腺化生性癌1例报道[J]. 诊断病理学杂志, 2017, 24(7): 539-541. doi: 10.3969/j.issn.1007-8096.2017.07.017
[7]	MCMULLEN E R, ZOUMBEROS N A, KLEER C G. Metaplastic breast carcinoma: update on histopathology and molecular alterations[J]. Arch Pathol Lab Med, 2019, 143(12): 1492-1496. doi: 10.5858/arpa.2019-0396-RA
[8]	GONZÁLEZ-MARTÍNEZ S, PÉREZ-MIES B, CARRETERO-BARRIO I, et al. Molecular features of metaplastic breast carcinoma: an infrequent subtype of triple negative breast carcinoma[J]. Cancers(Basel), 2020, 12(7): 1832. http://www.researchgate.net/publication/342846669_Molecular_Features_of_Metaplastic_Breast_Carcinoma_An_Infrequent_Subtype_of_Triple_Negative_Breast_Carcinoma
[9]	穆馥婷, 李斌, 秦优优, 等. 化生性乳腺癌的临床病理特点及诊疗现状[J]. 现代肿瘤医学, 2018, 26(12): 1958-1961. doi: 10.3969/j.issn.1672-4992.2018.12.040
[10]	TRAY N, TAFF J, ADAMS S. Therapeutic landscape of metaplastic breast cancer[J]. Cancer Treat Rev, 2019, 79(9): 1145-1156. http://www.sciencedirect.com/science/article/pii/S0305737219300957
[11]	胡紫玥, 卢漫, 成雪晴, 等. 化生性乳腺癌的超声及超声造影特征分析[J]. 中国超声医学杂志, 2019, 35(9): 783-785. doi: 10.3969/j.issn.1002-0101.2019.09.005
[12]	GAHLAUT R, BENNETT A, FATAYER H, et al. Effect of neoadjuvant chemotherapy on breast cancer phenotype, ER/PR and HER2 expression-lmplications for the practising oncologist[J]. Eur J Cancer, 2016, 60(6): 40-48. http://www.researchgate.net/profile/Abeer_Shaaban/publication/299996604_Original_Research_Effect_of_neoadjuvant_chemotherapy_on_breast_cancer_phenotype_ERPR_and_HER2_expression_e_Implications_for_the_practising_oncologist/links/5707cbe308ae2eb9421bd922.pdf
[13]	刘方方, 朱慧庭. 乳腺化生性癌[J]. 现代肿瘤医学, 2016, 24(17): 2805-2807. doi: 10.3969/j.issn.1672-4992.2016.17.040
[14]	TZANNINIS I G, KOTTEAS E A, NTANASIS-STATHOPOULOS I, et al. Management and outcomes in metaplastic breast cancer[J]. Clin Breast Cancer, 2016, 16(6): 437-443. doi: 10.1016/j.clbc.2016.06.002
[15]	王丽娜, 吴军召, 黄涛, 等. 女性乳腺化生性癌32例临床病理特征及预后影响因素分析[J]. 中华肿瘤防治杂志, 2020, 27(1): 58-62, 70. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL202001014.htm
[16]	BEVERS T B, HELVIE M, BONACCIO E, et al. Breast cancer screening and diagnosis, Version 3.2018, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2018, 16(11): 1362-1389. doi: 10.6004/jnccn.2018.0083
[17]	曾静, 张希梅, 王军, 等. 乳腺化生性癌临床病理特点及预后影响因素分析[J]. 中华肿瘤防治杂志, 2018, 25(2): 118-125. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201802007.htm