Wargotz E S, Norris H J
Department of Breast and Gynecologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Cancer. 1989 Oct 1;64(7):1490-9. doi: 10.1002/1097-0142(19891001)64:7<1490::aid-cncr2820640722>3.0.co;2-l.
The clinical and pathologic features of 70 examples of carcinosarcoma (CS) of the breast are reported. Thirty-three neoplasms had infiltrating carcinoma, seven had in situ carcinoma, and 28 had both admixed or contiguous with the sarcomatous component. Squamous carcinoma, present in 15 neoplasms, was the exclusive epithelial component of two. The admixed carcinoma often appeared distinct from the sarcoma component; however, at high magnification transitional differentiation zones and more subtle merging of infiltrating carcinoma with sarcoma were present in most neoplasms. A total of 40 neoplasms were studied by immunohistochemistry for keratins, EMA, vimentin, S-100 protein, and actin. The sarcomatous component in 55% of CS was immunoreactive for keratin, and 98% were immunoreactive for vimentin. A majority were also immunoreactive for actin (77%), and S-100 protein (55%). Ultrastructural examination of the sarcoma in eight neoplasms yielded variable nonspecific findings compatible with sarcoma. These findings indicate biphasic differentiation by cells possessing epithelial and mesenchymal characteristics and suggest myoepithelial origin or differentiation. The cumulative 5-year survival rate for CS was 49%, worse than for other forms of metaplastic carcinoma. The respective 5-year survivals for TNM clinical Stages I, II, and III were 100%, 63%, and 35%. Of patients with axillary dissection, 26% had metastases to axillary lymph nodes with carcinoma as the most frequent component to metastasize. Metastasis was an ominous sign as 33 of 34 patients who developed metastases died from tumor. Local recurrence was not as ominous as 40% who had only local recurrence subsequently died from tumor. Size and microscopic circumscription were also significant prognostic factors.
本文报告了70例乳腺癌肉瘤（CS）的临床和病理特征。33例肿瘤为浸润性癌，7例为原位癌，28例同时存在浸润性癌与肉瘤成分混合或相邻的情况。15例肿瘤中存在鳞状细胞癌，其中2例鳞状细胞癌是唯一的上皮成分。混合性癌通常与肉瘤成分明显不同；然而，在高倍镜下，大多数肿瘤中存在移行分化区以及浸润性癌与肉瘤更细微的融合。共有40例肿瘤进行了角蛋白、上皮膜抗原（EMA）、波形蛋白、S-100蛋白和肌动蛋白的免疫组织化学研究。55%的CS肉瘤成分对角蛋白呈免疫反应性，98%对波形蛋白呈免疫反应性。大多数对肌动蛋白（77%）和S-100蛋白（55%）也呈免疫反应性。对8例肿瘤的肉瘤进行超微结构检查，结果显示出与肉瘤相符的各种非特异性表现。这些发现表明具有上皮和间充质特征的细胞发生了双向分化，并提示肌上皮起源或分化。CS的5年累积生存率为49%，比其他类型的化生性癌更差。TNM临床分期I、II和III期的5年生存率分别为100%、63%和35%。在接受腋窝清扫的患者中，26%发生腋窝淋巴结转移，其中癌是最常见的转移成分。转移是一个不祥之兆，因为34例发生转移的患者中有33例死于肿瘤。局部复发不像转移那么不祥，仅有局部复发的患者中有40%随后死于肿瘤。肿瘤大小和显微镜下边界也是重要的预后因素。
