Department of Pathology, University of Medicine and Pharmacy of Targu Mures, Romania.
Pathol Res Pract. 2012 Oct 15;208(10):604-9. doi: 10.1016/j.prp.2012.07.005. Epub 2012 Aug 24.
The aim of this paper was to assess whether the morphological appearance (i.e. histological tumor type and histological grade) of simultaneous invasive breast carcinoma foci is heterogeneous, since it is known that adjuvant therapy is established according to these parameters. Patients with simultaneous breast tumors in which only the features of the largest neoplastic focus are reported could thus be undertreated. A retrospective study of 418 cases of breast carcinomas was conducted over a 3-year period. The histological tumor types and histological grades of multifocal/multicentric carcinomas in each tumor focus were compared, and mismatches among foci were recorded. Ninety-one of the 418 cases reviewed had multiple carcinomas (21.77%). A comparison between multiple synchronous tumor foci revealed that their histological type was different in 12.08% of the cases. Mismatches among foci were also observed in 9.89% of the cases when evaluating the histological grade, and 5 out of 9 additional tumor foci with a different grade from the largest (index) tumor (55.55%) displayed a higher grade compared to the index tumor. Since the histological tumor type and histological grade of the individual foci may vary considerably within the same tumor and the additional foci may be of higher grade than the index tumor, we believe that reporting morphologic parameters with more unfavorable characteristics in addition to the parameters of the index tumor is imperative.
本文旨在评估同时性浸润性乳腺癌病灶的形态学外观(即组织学肿瘤类型和组织学分级)是否存在异质性,因为已知辅助治疗是根据这些参数确定的。如果仅报告最大肿瘤病灶的特征,那么同时存在多个乳腺肿瘤的患者可能会接受不充分的治疗。本研究回顾性分析了 3 年内 418 例乳腺癌病例。比较了每个肿瘤病灶的多灶性/多中心性乳腺癌的组织学肿瘤类型和组织学分级,并记录了病灶之间的不匹配情况。在回顾的 418 例病例中,有 91 例(21.77%)存在多个癌。对多个同步肿瘤病灶的比较显示,其组织学类型在 12.08%的病例中存在差异。在评估组织学分级时,病灶之间也存在 9.89%的不匹配情况,并且在 9 个额外的肿瘤病灶中,有 5 个(55.55%)与最大(指数)肿瘤的分级不同,其分级高于指数肿瘤。由于同一肿瘤内各个病灶的组织学肿瘤类型和组织学分级可能存在很大差异,并且额外的病灶可能比指数肿瘤具有更高的分级,因此我们认为除了报告指数肿瘤的形态学参数外,还必须报告具有更不利特征的形态学参数。