Loose J H, Patchefsky A S, Hollander I J, Lavin L S, Cooper H S, Katz S M
Department of Pathology, Hahnemann University School of Medicine, Philadelphia 19102.
Am J Surg Pathol. 1992 Sep;16(9):868-76. doi: 10.1097/00000478-199209000-00005.
Adenomyoepitheliomas of the breast have been considered to have limited metastatic potential; axillary node metastasis has been reported, but there has been no report of distant metastasis. We report six cases, including two malignant adenomyoepitheliomas, one of which metastasized to the lung and brain. Patient age ranged from 26 to 63 years (mean 46). Primary tumors were solitary and measured 0.9-3.5 cm (mean 1.7). Five of six tumors presented as palpable masses. Two patients treated by local resection have no evidence of disease at 5 and 18 months' follow-up. Two patients treated by local resection had recurrences, one at 48 the other at 60 months. The fifth patient had a spindle-cell type adenomyoepithelioma diagnosed as malignant because of high mitotic rate and cytologic atypicality of the myoepithelial component. This patient was treated by mastectomy and has no evidence of disease at 18 months. The sixth patient, initially treated by local excision, had six local recurrences over 52 months treated by reexcisions, mastectomies, and radiation. A lung metastasis was resected at 54 months and brain metastases were identified at 60 months with death occurring at 64 months. Both malignant adenomyoepitheliomas had high mitotic rates [11-14/10 high-power fields (HPF)] diffusely throughout the tumors and foci of cytologically malignant cells. The malignant adenomyoepithelioma that metastasized had an infiltrative growth pattern that increased with successive local recurrences. The four other tumors had only isolated areas of mitotic activity (maximum 1-9/10 HPF) and minimal cytologic atypia. Immunohistochemistry performed on five of six cases confirmed dual epithelial/myoepithelial cell populations in all tumors examined, including the metastasis. Electron microscopic examination of the malignant adenomyoepithelioma that metastasized also confirmed dual epithelial/myoepithelial cell populations in a local recurrence and the lung metastasis. We conclude that there is a spectrum of behavior for breast adenomyoepitheliomas with potential for local recurrence and, rarely, distant metastasis.
乳腺腺肌上皮瘤一直被认为转移潜能有限；已有腋窝淋巴结转移的报道，但尚无远处转移的报告。我们报告6例病例，包括2例恶性腺肌上皮瘤，其中1例转移至肺和脑。患者年龄在26至63岁之间（平均46岁）。原发肿瘤为单发，大小为0.9 - 3.5 cm（平均1.7 cm）。6例肿瘤中有5例表现为可触及的肿块。2例行局部切除治疗的患者在随访5个月和18个月时无疾病证据。2例行局部切除治疗的患者出现复发，1例在48个月时复发，另1例在60个月时复发。第5例患者为梭形细胞型腺肌上皮瘤，因其肌上皮成分有高有丝分裂率和细胞学异型性而被诊断为恶性。该患者接受了乳房切除术，在18个月时无疾病证据。第6例患者最初接受局部切除治疗，在52个月内通过再次切除、乳房切除术和放疗治疗了6次局部复发。在54个月时切除了肺转移灶，在60个月时发现脑转移，患者于64个月时死亡。2例恶性腺肌上皮瘤在整个肿瘤中均有高有丝分裂率[11 - 14/每10个高倍视野（HPF）]以及细胞学上恶性细胞灶。发生转移的恶性腺肌上皮瘤具有浸润性生长模式，随着局部复发次数增加而加重。其他4例肿瘤仅有孤立的有丝分裂活动区域（最多1 - 9/10 HPF）且细胞学异型性极小。对6例中的5例进行的免疫组织化学检查证实，在所有检查的肿瘤（包括转移灶）中均存在双上皮/肌上皮细胞群。对发生转移的恶性腺肌上皮瘤进行的电子显微镜检查也证实，在局部复发灶和肺转移灶中存在双上皮/肌上皮细胞群。我们得出结论，乳腺腺肌上皮瘤存在一系列行为表现，有局部复发的可能，且很少发生远处转移。
