Madan Atul K, Ternovits Craig, Huber Samantha A, Pei Leo A, Jaffe Bernard M
Department of Surgery, Tulane University School of Medicine, and Department of Pathology, Louisiana State University Medical Center, New Orleans, LA 70112, USA.
Surgery. 2002 Nov;132(5):889-93. doi: 10.1067/msy.2002.126013.
Although primary breast cancer is common, metastatic disease to the breast, especially primary gastrointestinal cancer, is rare. Routine pathologic examination may be helpful in determining the true diagnosis, but can be misleading.
To determine whether a signet ring carcinoma was a primary malignancy of the gastrointestinal tract metastatic to the breast or vice versa, histochemical analysis was performed for Her-2/NEU, gross cystic disease fluid protein-15, estrogen receptor, progesterone, carcinoembryonic antigen, cytokeratin 7, and cytokeratin 20.
Positive staining for carcinoembryonic antigen and cytokeratin 20 (and negative staining for the breast cancer antigens), and the clinical criteria favors the diagnosis of gastrointestinal carcinoma metastatic to the mammary gland.
Because the prognosis of therapy for metastatic cancer to the breast differs from that of primary breast cancer, it is imperative that the correct diagnosis be established. Immunohistochemistry for carcinoembryonic antigen and cytokeratin 20 are particularly useful. Metastatic gastrointestinal carcinoma to the breast is a rare lesion but needs to be at least included in the differential diagnosis of breast masses, especially in patients with a history of gastrointestinal cancer.
尽管原发性乳腺癌很常见，但转移至乳腺的疾病，尤其是原发性胃肠道癌，却很罕见。常规病理检查可能有助于确定真正的诊断，但也可能产生误导。
为确定印戒细胞癌是转移至乳腺的原发性胃肠道恶性肿瘤，还是相反情况，对人表皮生长因子受体2（Her-2/NEU）、巨大囊肿病液体蛋白-15、雌激素受体、孕激素、癌胚抗原、细胞角蛋白7和细胞角蛋白20进行了组织化学分析。
癌胚抗原和细胞角蛋白20呈阳性染色（而乳腺癌抗原呈阴性染色），且临床标准支持诊断为转移至乳腺的胃肠道癌。
由于乳腺转移癌的治疗预后与原发性乳腺癌不同，因此必须确立正确的诊断。癌胚抗原和细胞角蛋白20的免疫组织化学检查特别有用。转移至乳腺的胃肠道癌是一种罕见病变，但至少需要纳入乳腺肿块的鉴别诊断中，尤其是有胃肠道癌病史的患者。
