Department of Pathology, Chiangmai University, Thailand.
Breast Cancer. 2010;17(1):35-41. doi: 10.1007/s12282-009-0174-0.
To classify high-nuclear-grade breast cancer (BC) into typical medullary carcinoma (TMC), atypical medullary carcinoma (AMC), and non-medullary carcinoma (NMC), and luminal A, luminal B, and HER2, and to correlate these tumors with other prognostic factors.
A retrospective study reviewing high-nuclear-grade BCs. The patients' age, histologic types, various histologic features, axillary lymph node (ALN) status, and results of immunohistochemical (IHC) study were recorded and analyzed.
One-hundred and eighty-one cases of high-nuclear-grade BCs were reviewed and categorized into IDC, NOS (140, 77.3%), TMC (1, 0.6%), AMC (21, 11.6%), and others (19, 10.5%). The median age was younger in AMC than in NMC patients. NMC patients had a higher incidence of LVI and ALN metastasis with involvement of more than four lymph nodes (p = 0.006) whereas AMC patients had a higher mitotic index. Forty-six (35.9%) cases were triple-negative (TN), including 1 (100%), 7 (53.9%) and 38 (33.3%) cases of TMC, AMC, and NMC, respectively. AMC had a significantly lower number of node metastases (p = 0.006) than NMC; whereas TN had higher MI (p = 0.001) than non-TN. The non-TN group was subclassified into luminal A, luminal B, and HER2. Of these, TN and luminal B occurred at younger age (p = 0.01) whereas TN and luminal A had a higher mitotic count. TN had lower incidence of LNM including higher number of LNM.
Overall, AMC-TN group showed a basal-like prognostic factor expression. NMC may be separated into TN and non-TN, with possibly different behavior. These sub-groupings should continue to be used. Interestingly, luminal A in our study tended to correlate with poor prognostic factors, thus, luminal A with high nuclear grade may not be representative of the usual luminal group profiles.
将高核级乳腺癌（BC）分为典型髓样癌（TMC）、非典型髓样癌（AMC）和非髓样癌（NMC），以及 luminal A、luminal B 和 HER2，并将这些肿瘤与其他预后因素相关联。
回顾性研究高核级 BC。记录并分析患者的年龄、组织学类型、各种组织学特征、腋窝淋巴结（ALN）状态和免疫组织化学（IHC）研究结果。
共回顾分析 181 例高核级 BC，分为 IDC，NOS（140 例，77.3%）、TMC（1 例，0.6%）、AMC（21 例，11.6%）和其他（19 例，10.5%）。AMC 患者的中位年龄较 NMC 患者年轻。NMC 患者 LVI 和 ALN 转移发生率较高，且淋巴结转移超过 4 个（p = 0.006），而 AMC 患者有较高的有丝分裂指数。46 例（35.9%）为三阴性（TN），包括 TMC、AMC 和 NMC 分别为 1（100%）、7（53.9%）和 38（33.3%）例。与 NMC 相比，AMC 的淋巴结转移数明显减少（p = 0.006）；而 TN 的 MI 较高（p = 0.001）。非 TN 组进一步分为 luminal A、luminal B 和 HER2。其中，TN 和 luminal B 发生在较年轻的年龄（p = 0.01），而 TN 和 luminal A 有较高的有丝分裂计数。TN 的 LNM 发生率较低，包括 LNM 数量较少。
总体而言，AMC-TN 组表现出基底样预后因素表达。NMC 可能分为 TN 和非 TN，其行为可能不同。这些亚组应继续使用。有趣的是，我们研究中的 luminal A 与不良预后因素相关，因此，高核级的 luminal A 可能不能代表通常的 luminal 组特征。
