Rakha Emad A, Gill Muhammad S, El-Sayed Maysa E, Khan Marium M, Hodi Zsolt, Blamey Roger W, Evans Andrew J, Lee Andrew H S, Ellis Ian O
Department of Histopathology, School of Molecular Medical Sciences, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
Breast Cancer Res Treat. 2009 Mar;114(2):243-50. doi: 10.1007/s10549-008-0007-4. Epub 2008 Apr 11.
Although invasive ductal (IDC) and lobular (ILC) breast carcinomas are well characterised in the literature, the biological and clinical significance of mixed tumours with both ductal and lobular components has not been investigated. In the current study, we have examined a well-characterised series of breast carcinoma with a long term follow-up that comprised 140 mixed tumours, 2170 IDC and 380 pure ILC.
Mixed tumours constituted 3.6% of all cases. The majority (59%) of the mixed tumours were grade 2 compared to 33% in IDC and 88% in ILC. Positive lymph nodes (LN) were found in 41% and definite vascular invasion (VI) in 26% of the cases. DCIS was detected in 123 (89%) and LCIS in 43 (31%) (both DCIS and LCIS were found in 39 cases). The majority of tumours were predominantly (>50 of tumour area) of ductal type (57%). When compared to pure IDC, mixed tumours showed an association with lower grade, ER positivity and lower frequency of development of distant metastases. When compared to pure ILC, mixed tumours showed an association with higher grade, positive LN metastasis, VI and development of regional metastasis. After adjustment for grade most of these differences were no longer apparent. There was an association between histologic type of carcinoma in LN metastasis and the predominant histologic type of the primary tumour. Mixed tumours showed metastatic patterns similar to that of ILC with frequent metastasis to bone. No clinically meaningful differences in survival were found between these mixed carcinomas and pure IDC or ILC of the breast or between mixed tumours with predominantly ductal or lobular phenotype.
尽管浸润性导管癌（IDC）和小叶癌（ILC）在文献中已有充分描述，但兼具导管和小叶成分的混合性肿瘤的生物学及临床意义尚未得到研究。在本研究中，我们检查了一系列特征明确且有长期随访数据的乳腺癌病例，其中包括140例混合性肿瘤、2170例IDC和380例纯ILC。
混合性肿瘤占所有病例的3.6%。大多数（59%）混合性肿瘤为2级，而IDC中这一比例为33%，ILC中为88%。41%的病例发现有阳性淋巴结（LN），26%的病例有明确的血管侵犯（VI）。123例（89%）检测到导管原位癌（DCIS），43例（31%）检测到小叶原位癌（LCIS）（39例同时检测到DCIS和LCIS）。大多数肿瘤以导管型为主（肿瘤面积>50%）（57%）。与纯IDC相比，混合性肿瘤与低级别、雌激素受体（ER）阳性以及远处转移发生率较低相关。与纯ILC相比，混合性肿瘤与更高级别、阳性LN转移、VI以及区域转移的发生相关。在对级别进行调整后，这些差异大多不再明显。LN转移中癌的组织学类型与原发肿瘤的主要组织学类型之间存在关联。混合性肿瘤的转移模式与ILC相似，常转移至骨。这些混合性癌与乳腺纯IDC或ILC之间，以及主要为导管或小叶表型的混合性肿瘤之间，在生存方面未发现有临床意义的差异。
