Wargotz E S, Deos P H, Norris H J
Department of Breast and Gynecologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Hum Pathol. 1989 Aug;20(8):732-40. doi: 10.1016/0046-8177(89)90065-8.
The clinical and pathologic features of 100 examples of spindle cell carcinoma (SpCC) of the breast are reported. Eighty-three neoplasms contained overt carcinoma; 72 had infiltrating ductal or intraductal carcinoma and in 11 the carcinomatous component was purely squamous. Seventeen neoplasms lacked overt carcinoma, but were identified as SpCC by immunoreactivity for keratin and the typical bland spindle cell proliferation forming a variable complex of fibrocollagenous stroma with feathered, myxoid, angioid, and storiform patterns. Areas of epithelium merging imperceptibly with the spindle cell component were commonly observed. Sixty neoplasms were studied by immunohistochemistry for the presence of keratin, epithelial membrane antigen (EMA), vimentin, S-100, and actin. The spindle cell component in 98% of SpCC was immunoreactive for keratin. Most were also immunoreactive for vimentin and actin, and in approximately one half, S-100 immunoreactivity was noted. These findings, in conjunction with histopathologic features, and ultrastructural observations from three cases, support myoepithelium as an integral component of SpCC. The cumulative 5-year survival rate for SpCC was 64%, better than survival rates usually reported for metaplastic carcinomas. Of 47 patients with axillary dissection, only 6% had metastases to axillary lymph nodes. Development of metastasis was an ominous sign as 29 of the 30 patients who developed metastases died from tumor. Local recurrence was not as ominous as only 29% who had only local recurrence subsequently died from tumor. The difference in size between tumors that recurred (mean, 5.0 cm) and those that did not (mean 3.7 cm), and the presence or absence of complete microscopic circumscription, were both significant prognostic factors.
本文报告了100例乳腺梭形细胞癌（SpCC）的临床和病理特征。83例肿瘤含有明显的癌；72例为浸润性导管癌或导管内癌，11例癌成分仅为鳞状细胞癌。17例肿瘤缺乏明显的癌，但通过角蛋白免疫反应性及典型的温和梭形细胞增殖（形成纤维胶原性基质的可变复合物，伴有羽毛状、黏液样、血管样和席纹状模式）被鉴定为SpCC。通常可观察到上皮区域与梭形细胞成分难以察觉地融合。对60例肿瘤进行了免疫组织化学研究，检测角蛋白、上皮膜抗原（EMA）、波形蛋白、S-100和肌动蛋白的表达。98%的SpCC梭形细胞成分对角蛋白呈免疫反应性。大多数对波形蛋白和肌动蛋白也呈免疫反应性，约一半病例可检测到S-100免疫反应性。这些发现，结合组织病理学特征以及3例病例的超微结构观察结果，支持肌上皮是SpCC的一个重要组成部分。SpCC的累积5年生存率为64%，优于通常报道的化生性癌的生存率。在47例行腋窝淋巴结清扫的患者中，仅有6%发生腋窝淋巴结转移。发生转移是一个不祥之兆，因为发生转移的30例患者中有29例死于肿瘤。局部复发的预后没有那么凶险，因为仅有局部复发的患者中只有29%随后死于肿瘤。复发肿瘤（平均5.0 cm）与未复发肿瘤（平均3.7 cm）的大小差异以及是否存在完整显微镜下边界均为重要的预后因素。
