Bellino Roberto, Arisio Riccardo, D'Addato Francesco, Attini Rossella, Durando Antonio, Danese Saverio, Bertone Elena, Grio Ruggero, Massobrio Marco
Department of Gynaecology and Obstetrics, Sant'Anna Hospital, University of Turin, Italy.
Anticancer Res. 2003 Jan-Feb;23(1B):669-73.
Metaplastic breast carcinomas are rare neoplasms showing both carcinomatous and sarcomatous elements. In this report we describe eleven cases of metaplastic breast carcinoma focusing on pathological features and the clinical behaviour of six patients with breast carcinoma with chondroid metaplasia (MCC). We collected eleven cases from 1996 to 2001: immunohistochemical tests were performed in order to obtain data on estrogen and progesterone receptors and the production of p53 gene and HER/2 neu. Neoangiogenesis was studied counting vessels immunohistochemically-stained with CD31 antibody. Six cases showed chondroid metaplasia, three cases were spindle cell carcinoma and two were metaplastic squamous carcinoma. The majority of patients (64%) had pT2 tumors without axillary node metastases: only two cases with spindle or squamous metaplasia showed nodal involvement. Fifty percent of MCC were pT1b-c tumors: no axillary metastases were observed. Vascular invasion was observed in all squamous and spindle cell types and in 66% of MCC: estrogen and progesterone receptors were absent in 90% of the tumors. Immunohistochemical staining for HER2/neu was detected in 72% of spindle cell and squamous carcinomas and in 33% of MCC. Three cases staining highly for p53 were chondroid carcinomas: the staining was uniform both in carcinomatous and in sarcomatous tissue. The majority of metaplastic carcinomas had high angionesis. One patient with a chondroid metaplastic carcinoma was found to be a carrier of a BRCA1 mutation similar to the one responsible for sickle cell disease, possibly altering the spatial structure of the gene product. Only six patients had follow-up periods longer than 36 months: five women were alive and disease-free: one patient with pT2N1 squamous metaplastic carcinoma died of disease 14 months after diagnosis. The six women with MCC were alive and disease-free. Surgical and adjuvant treatment should follow the guidelines for the other most common breast cancers even if the need for chemotherapy is unknown due to the absence of large series randomized or observational data.
化生性乳腺癌是一种罕见的肿瘤，兼具癌性和肉瘤性成分。在本报告中，我们描述了11例化生性乳腺癌病例，重点关注6例伴有软骨样化生的乳腺癌（MCC）患者的病理特征和临床行为。我们收集了1996年至2001年的11例病例：进行了免疫组织化学检测，以获取雌激素和孕激素受体以及p53基因和HER/2 neu表达的数据。通过对用CD31抗体免疫组织化学染色的血管进行计数来研究新生血管形成。6例显示软骨样化生，3例为梭形细胞癌，2例为化生性鳞状细胞癌。大多数患者（64%）患有pT2期肿瘤且无腋窝淋巴结转移：只有2例梭形或鳞状化生患者出现淋巴结受累。50%的MCC为pT1b - c期肿瘤：未观察到腋窝转移。在所有鳞状和梭形细胞类型以及66%的MCC中观察到血管侵犯：90%的肿瘤中雌激素和孕激素受体缺失。HER2/neu免疫组织化学染色在72%的梭形细胞和鳞状细胞癌以及33%的MCC中检测到。3例p53染色强阳性的病例为软骨样癌：在癌性和肉瘤性组织中染色均均匀。大多数化生性癌具有高血管生成。1例伴有软骨样化生的癌患者被发现是一种与镰状细胞病相关的BRCA1突变携带者，可能改变了基因产物的空间结构。只有6例患者的随访期超过36个月：5名女性存活且无疾病：1例pT2N1鳞状化生性癌患者在诊断后14个月死于疾病。6例患有MCC的女性存活且无疾病。即使由于缺乏大型随机或观察性数据而化疗需求未知，手术和辅助治疗也应遵循其他最常见乳腺癌的指南。
