Janschek E, Kandioler-Eckersberger D, Ludwig C, Kappel S, Wolf B, Taucher S, Rudas M, Gnant M, Jakesz R
Department of Surgery, University of Vienna, Austria.
Breast Cancer Res Treat. 2001 May;67(1):1-8. doi: 10.1023/a:1010661514306.
Previous cancer in one breast is a strong known risk factor for cancer in the contralateral breast. Differences in tumor histology and nuclear grading are applied to distinguish between a metastatic spread and a second primary cancer, although cancers of the breast often share the same histological features. Comparison of genetic alterations in paired tumors may provide the most reliable approach for discerning clonal relationships, hence uncovering the presence or absence of multiple primary cancers. We compared tumors from 33 patients with cancer in both breasts for mutations in the p53 gene. With this molecular approach, we were able to define the relationship within paired tumors in 13 patients. The paired tumors of two patients shared the same mutation, revealing the second lesion in one case as a contralateral metachronous lymph node metastasis appearing 29 months after first surgery, and in the other as a spread to the opposite breast. In 11 patients, mutations were either discordant or solely present in one of the lesions, confirming the diagnosis of bilateral breast cancer. Histopathological evaluation had failed to provide firm diagnosis in nine out of 11 instances on account of concordances in pathological parameters such as histological type and grading. In our study, we could show that bilateral breast malignancies most frequently represent two primary breast cancers. We could also demonstrate that contralateral breast cancer spread does occur. Standard pathological assessment allowed a firm diagnosis only in the presence of different histological types.
一侧乳房既往患癌是对侧乳房患癌的一个已知的重要风险因素。尽管乳腺癌通常具有相同的组织学特征，但仍应用肿瘤组织学和核分级的差异来区分转移扩散和第二原发性癌症。比较配对肿瘤中的基因改变可能为辨别克隆关系提供最可靠的方法，从而揭示是否存在多个原发性癌症。我们比较了33例双侧乳腺癌患者肿瘤的p53基因的突变情况。通过这种分子方法，我们能够确定13例患者配对肿瘤之间的关系。两名患者的配对肿瘤具有相同的突变，其中一例显示第二个病灶是首次手术后29个月出现的对侧异时性淋巴结转移，另一例是转移至对侧乳房。在11例患者中，突变不一致或仅存在于其中一个病灶中，从而确诊为双侧乳腺癌。由于组织学类型和分级等病理参数一致，在11例中有9例组织病理学评估未能提供确切诊断。在我们的研究中，我们可以表明双侧乳腺恶性肿瘤最常见的是两个原发性乳腺癌。我们还可以证明对侧乳腺癌转移确实会发生。标准病理评估仅在存在不同组织学类型时才能做出确切诊断。
