摘要
目的:探讨乳腺梭形细胞癌的生物学特点和预后。方法:分析15例乳腺梭形细胞癌的临床病理特征及预后。结果:患者为成年女性,年龄40～96岁,中位年龄68岁。肿瘤直径1.5～15cm。所有病例临床为乳腺原发肿瘤,形态上≥80%区域为梭形(肉瘤样)形态,并显示细胞角蛋白阳性和(或)与导管原位癌密切相关。免疫组织化学染色显示40%的病例中,瘤细胞不同程度地呈平滑肌肌动蛋白、细胞角蛋白14和p63阳性,因此表现出肌上皮的分化。13例呈完全的梭形(肉瘤样)形态特征,2例找到高级别浸润性导管癌成分(其含量占全部肿瘤的≤20%)。14例有随访资料(随访时间1～120个月;中位数20个月)。13例行腋窝淋巴结清除的病例中,仅1例见淋巴结转移。3例术后局部复发。42.9%(6/14)见结外转移,最多见为肺转移。35.7%(5/14)术后1～46个月死亡(中位生存期11.5个月)。结论:乳腺梭形细胞癌为高度侵袭性肿瘤,易发生结外转移。纯粹的梭形细胞癌较之普通型乳腺导管癌的淋巴结转移率要低得多。
OBJECTIVE：To evaluate the biological potential and prognosis of spindle cell （sarcomatoid） carcinoma of the breast.METHODS：Fifteen cases of spindle cell （sarcomatoid） carcinoma of the breast were reviewed. Their histopathologic features were defined and the clinical outcome in 14 cases were correlated with these findings.RESULTS：All the patients were adult females ranging from 40 to 96 years old. The tumor size ranged from 1.5 to 15 cm. All the cases were of breast origin,showing ≥80% spindled/sarcomatoid morphology,and demonstrating keratin positivity and/or close association with ductal carcinoma in situ. The immunohistochemical studies showed the evidence suggesting myoepithelial differentiation as exhibited by immunoreactivity for smooth muscle actin,cytokeratin 14,and p63 in a subset of cases （40%）. Thirteen cases exhibited pure spindled or sarcomatoid morphology of variable appearance and nuclear grade,whereas 2 contained high-grade invasive ductal carcinoma comprising ≤20% of the tumor mass. The follow-up data were available on 14 patients （range,1-120 months; median,20 months）. Of 13 cases in which axillary nodes were biopsied,definitive nodal metastases were identified in only 1 （7.7%）. Three patients developed local recurrences. Extranodal metastases occurred in 6 of 14 patients （42.9%）,most commonly to the lungs. Five of 14 patients （35.7%） died of disease at a median interval of 11.5 months （range,1-46 months）.CONCLUSIONS：Based on this series,spindle cell/sarcomatoid carcinoma of the breast is a highly aggressive neoplasm with a high rate of extranodal metastases. Purely spindled/sarcomatoid tumors have a significantly lower rate of nodal metastases than conventional ductal breast carcinomas.
出处
《中华肿瘤防治杂志》
CAS
2009年第24期1945-1948,共4页
Chinese Journal of Cancer Prevention and Treatment
关键词
乳腺肿瘤/病理学
癌
梭形细胞
化生
breast neoplasms/pathology
carcinoma
spindle cell
metaplastic
