Choi Bo Bae, Shu Kwang Sun
Department of Radiology, Chungnam National University Hospital, Daejeon, Korea.
Acta Radiol. 2012 Feb 1;53(1):5-11. doi: 10.1258/ar.2011.110341. Epub 2011 Nov 16.
Metaplastic carcinomas are ductal carcinomas that display metaplastic transformation of the glandular epithelium to non-glandular mesenchymal tissue. Metaplastic carcinoma has a poorer prognosis than most other breast cancers, so the differential diagnosis is important. Although many clinical and pathologic findings have been reported, to our knowledge, few imaging findings related to metaplastic carcinoma have been reported.
To investigate whole-breast imaging findings, including mammography, sonography, MRI, and pathologic findings, including immunohistochemical studies of metaplastic carcinomas of the breast.
We analyzed 33 cases of metaplastic carcinoma between January 2001 and January 2011. Mammography, ultrasonography, and MRI were recorded retrospectively using the American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) lexicon. Immunohistochemical studies of estrogen receptor (ER), progesterone receptor (PR), p53, and C-erbB-2 were performed.
The most common mammographic findings were oval shape (37%), circumscribed margin (59%), and high density (74%). The most common sonographic findings were irregular shape (59.4%), microlobulated margin (41%), complex echogenicity (81%), parallel orientation (97%), and posterior acoustic enhancement (50%). Axillary lymph node metastases were noted for 25% of the sonographic examinations. On MRI, the most common findings of margin and shape were irregularity (57% and 52.4%, respectively). High signal intensity was the most common finding on T2-weighted images (57%). Immunohistochemical profile was negative for ER (91%, 29/32) and PR (81%, 26/32).
Metaplastic carcinomas might display more benign features and less axillary lymph node metastasis than IDC. High signal intensity on T2 MRI images and hormone receptor negativity would be helpful in differentiating this tumor from other breast cancers.
化生性癌是一种导管癌，其腺上皮显示出向非腺性间叶组织的化生转变。化生性癌的预后比大多数其他乳腺癌更差，因此鉴别诊断很重要。尽管已经报道了许多临床和病理表现，但据我们所知，与化生性癌相关的影像学表现报道较少。
研究全乳影像学表现，包括乳腺钼靶摄影、超声检查、磁共振成像（MRI），以及病理表现，包括乳腺化生性癌的免疫组织化学研究。
我们分析了2001年1月至2011年1月期间的33例化生性癌病例。使用美国放射学会（ACR）乳腺影像报告和数据系统（BI-RADS）词典对乳腺钼靶摄影、超声检查和MRI进行回顾性记录。对雌激素受体（ER）、孕激素受体（PR）、p53和C-erbB-2进行免疫组织化学研究。
最常见的乳腺钼靶表现为椭圆形（37%）、边界清晰（59%）和高密度（74%）。最常见的超声表现为不规则形状（59.4%）、微叶状边缘（41%）、复杂回声（81%）、平行方向（97%）和后方回声增强（50%）。25%的超声检查发现腋窝淋巴结转移。在MRI上，边缘和形状最常见的表现为不规则（分别为57%和52.4%）。T2加权图像上最常见的表现为高信号强度（57%）。免疫组织化学特征显示ER（91%，29/32）和PR（81%，26/32）为阴性。
与浸润性导管癌（IDC）相比，化生性癌可能表现出更多的良性特征和更少的腋窝淋巴结转移。MRI T2图像上的高信号强度和激素受体阴性有助于将这种肿瘤与其他乳腺癌区分开来。
