Yu Lin, Yang Wen-Tao, Cai Xu, Lu Hong-Fen, Fan Yue-Zhen, Shi Da-Ren
Department of Pathology, Cancer Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Bing Li Xue Za Zhi. 2009 Oct;38(10):657-62.
To study the clinicopathologic features and immunophenotype of centrally necrotizing carcinoma (CNC) of breast; and to study its relationship with basal-like breast cancer.
The clinical and pathologic characteristics of 35 cases of CNC were analyzed. Immunohistochemical study for estrogen receptor, progesterone receptor, HER2, CK8/18, 34betaE12, CK5/6, CK14, CK17, smooth muscle actin, p63, vimentin and epidermal growth factor receptor was performed using EnVision method. The surival information of 10 case were obtained.
The age of patients with CNC ranged from 30 to 82 years (mean = 54.2 years). Macroscopically, all tumors were relatively circumscribed, with a mean diameter of 2.4 cm. Histologically, there was a prominent central, necrotic or acellular zone surrounded by a narrow rim of viable tumor cells. The central necrotic foci had the following morphologic patterns: (1) coagulative tumor necrosis associated with various degree of fibrosis or hyaline degeneration (24 cases), (2) predominance of fibrous and scar tissue, with small amount of necrotic debris (8 cases), and (3) infarction (3 cases). The peripheral zone of tumor cells showed features of grade 3 invasive ductal carcinoma in 32 cases and grade 2 in 3 cases. Twenty cases of CNC were associated with ductal carcinoma in-situ. A component of invasive micropapillary carcinoma was identified in 5 cases. Peripheral lymphocytic infiltrates were seen in 17 cases. Immunohistochemical study of 31 cases showed that the expression rate of basal-like markers (83.9%, 26 cases) was higher than that of myoepithelial markers (38.7%, 12 cases). The percentage of basal-like subtype (64.5%, 20 cases) was higher than luminal-A (9.7%, 3 cases), luminal-B (9.7%, 3 cases), HER2 over-expression (12.9%, 4 cases) and null (3.2%, 1 case) subtypes. In 20 cases of basal-like carcinoma, the expression ratio of CK5/6 was highest amongst basal-like markers (18 cases), the other markers ratios of CK17, CK14 and epidermal growth factor receptor were 8/10, 14/19 and 8/16, respectively. Follow-up data were available in 10 patients. The follow-up duration ranged from 15 to 42 months (mean = 21.5 months). The median disease-free and overall survivals were 14.0 and 18.0 months, respectively. Disease progression (as defined by the presence of recurrence, metastasis or tumor-related death) occurred in 9 patients. The mean and median time to disease progression was 16.6 and 13.0 months, respectively.
CNC is a rare subtype of breast carcinoma and has distinctive, easily discernible morphologic features. The majority of CNC exhibits basal-like immunophenotype and carries a poor prognosis. CNC is the typical representative of basal-like breast cancer.
研究乳腺中央坏死性癌（CNC）的临床病理特征及免疫表型，并探讨其与基底样乳腺癌的关系。
分析35例CNC的临床和病理特征。采用EnVision法对雌激素受体、孕激素受体、HER2、CK8/18、34βE12、CK5/6、CK14、CK17、平滑肌肌动蛋白、p63、波形蛋白和表皮生长因子受体进行免疫组织化学研究。获取10例患者的生存信息。
CNC患者年龄为30至82岁（平均54.2岁）。大体上，所有肿瘤边界相对清晰，平均直径2.4 cm。组织学上，有一个明显的中央坏死或无细胞区，周围环绕着一层狭窄的存活肿瘤细胞。中央坏死灶有以下形态学模式：（1）凝固性肿瘤坏死伴不同程度的纤维化或玻璃样变性（24例），（2）以纤维和瘢痕组织为主，伴有少量坏死碎片（8例），（3）梗死（3例）。肿瘤细胞外周区32例表现为3级浸润性导管癌特征，3例表现为2级特征。20例CNC伴有导管原位癌。5例中发现有浸润性微乳头状癌成分。17例可见外周淋巴细胞浸润。31例免疫组织化学研究显示，基底样标志物的表达率（83.9%，26例）高于肌上皮标志物（38.7%，12例）。基底样亚型的比例（64.5%，20例）高于腔面A型（9.7%，3例）、腔面B型（9.7%，3例）、HER2过表达型（12.9%，4例）和三阴型（3.2%，1例）。在20例基底样癌中，CK5/6在基底样标志物中的表达率最高（18例），其他标志物CK17、CK14和表皮生长因子受体的表达率分别为8/10、14/19和8/16。10例患者有随访数据。随访时间为15至42个月（平均21.5个月）。无病生存期和总生存期的中位数分别为14.0个月和18.0个月。9例出现疾病进展（定义为复发、转移或肿瘤相关死亡）。疾病进展的平均时间和中位数时间分别为16.6个月和13.0个月。
CNC是一种罕见的乳腺癌亚型，具有独特、易于识别的形态学特征。大多数CNC表现为基底样免疫表型，预后较差。CNC是基底样乳腺癌的典型代表。
