Machalekova Katarina, Kajo Karol, Bencat Marian
Department of Pathology, Cancer Institute of St. Elisabeth, Heydukova 10, 812 50 Bratislava, Slovakia ; BB BIOCYT, Namestie L. Svobodu 1, 974 01 Banska Bystrica, Slovakia.
Case Rep Pathol. 2012;2012:387045. doi: 10.1155/2012/387045. Epub 2012 Sep 20.
A 56-year-old woman noticed a palpable mass in her left breast during self-examination. Patient was admitted to our hospital and malignant bifocal tumour was diagnosed by ultrasonography, digital mammography, magnetic resonance, and core-cut biopsy. The patient underwent planned conservative surgery (biquadrantectomy) with a sentinel node examination, but after results of the frozen section with positive resection margins and positive sentinel lymph nodes subsequent mastectomy with axillary lymph node dissection were realized. Histology in the resection specimen revealed two isolated and distinct tumours. One of the lesions represented conventional invasive ductal carcinoma of histological grade 3, and the second tumour was evaluated as invasive lipid-rich carcinoma, containing tumour cells with clear and foamy cytoplasm. Lipids in neoplastic cells were detected by Oil Red O staining and ultrastructural examination. Immunohistochemical analysis of both carcinomas was almost identical with negative steroid receptors, positive staining of HER-2, and p53 and with high proliferation activity (Ki-67). Mastectomy specimen contained residual foci of invasive ductal carcinoma and dissected axillary lymph nodes were free of metastasis. Patient underwent first cycles of chemotherapy with paclitaxel and Herceptin together with local radiotherapy and two month after surgery is without any evidence of the disease.
一名56岁女性在自我检查时发现左乳有一个可触及的肿块。患者入院后，通过超声检查、数字乳腺摄影、磁共振成像和芯针活检诊断为恶性双灶性肿瘤。患者接受了计划中的保乳手术（双象限切除术）并进行了前哨淋巴结检查，但在冰冻切片结果显示切除边缘阳性和前哨淋巴结阳性后，随后进行了乳房切除术及腋窝淋巴结清扫术。切除标本的组织学检查显示有两个孤立且不同的肿瘤。其中一个病变为组织学3级的传统浸润性导管癌，第二个肿瘤被评估为富含脂质的浸润性癌，肿瘤细胞的细胞质清晰且呈泡沫状。通过油红O染色和超微结构检查检测到肿瘤细胞中的脂质。两种癌的免疫组织化学分析几乎相同，类固醇受体均为阴性，HER-2、p53呈阳性染色，且增殖活性高（Ki-67）。乳房切除标本中含有浸润性导管癌的残留病灶，切除的腋窝淋巴结无转移。患者接受了紫杉醇和赫赛汀联合的第一轮化疗以及局部放疗，术后两个月无任何疾病迹象。
