Inoue Yuzuru, Joden Fumi, Yabuki Kei, Sato Nagahiro, Minagawa Noritaka, Katsuki Takefumi, Sato Norihiro, Nagata Takahisa, Shibao Kazunori, Matsuyama Atsuji, Aoki Takatoshi, Hirata Keiji
Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health.
Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health.
J UOEH. 2017;39(2):167-173. doi: 10.7888/juoeh.39.167.
A 61-year-old woman was referred to our hospital because of a right breast mass. A 19 mm hard mass was palpable in the A area of the right breast. A contrast-enhanced MRI showed rim enhancement at the peripheral region of the tumor, which was thought to represent the carcinoma component mainly at the periphery and the matrix component inside the tumor. A low density mass with rim enhancement at the peripheral region was observed in a contrast-enhanced CT, the same as in the MRI. Neither axillary lymph node metastasis nor distant metastasis was observed. A core needle biopsy of the tumor lead to a diagnosis of matrix-producing carcinoma (MPC). A breast-conserving mastectomy with sentinel lymph nodes biopsy was performed on the right breast MPC (T1c, N0, M0 Stage I). Histopathologically, the tumor demonstrated overt carcinoma with direct transition to a cartilaginous or osseous matrix and lacked an intervening spindle cell component. Immunohistochemistry showed estrogen receptor (ER) (-), progesterone receptor (PgR) (-), human epidermal growth factor receptor 2 (HER2) (-), and Ki67 index of 50%, so-called triple negative breast cancer. The tumor was also positive for SRY-related HMG box-9 (SOX9), which is a useful marker of chondroid differentiation in normal and neoplastic tissues. The patient lived free from recurrence for 5 years, even though her adjuvant therapy was only radiation therapy without adjuvant chemotherapy. MPC is an uncommon and relatively rare variant of metaplastic carcinoma, and the prognosis for patients with MPC is poorer than that for patients with ordinary breast cancer. Here we report a case of MPC of the breast with characteristic rim enhancement in contrast-enhanced MRI and CT. The intrinsic subtype and prognosis of MPC is controversial, and then we may need more experience with MPC cases.
一名61岁女性因右侧乳腺肿块被转诊至我院。在右侧乳腺A区可触及一个19毫米的硬块。对比增强MRI显示肿瘤周边区域呈环状强化,这被认为主要代表肿瘤周边的癌成分和肿瘤内部的基质成分。对比增强CT显示在周边区域有一个低密度肿块伴环状强化,与MRI所见相同。未观察到腋窝淋巴结转移及远处转移。对肿瘤进行粗针穿刺活检,诊断为产基质癌(MPC)。对右侧乳腺MPC(T1c,N0,M0 Ⅰ期)行保乳乳房切除术及前哨淋巴结活检。组织病理学检查显示,肿瘤呈现明显的癌,直接转变为软骨或骨基质,且缺乏中间的梭形细胞成分。免疫组化显示雌激素受体(ER)(-)、孕激素受体(PgR)(-)、人表皮生长因子受体2(HER2)(-),Ki67指数为50%,即所谓的三阴性乳腺癌。肿瘤SRY相关高迁移率族蛋白盒9(SOX9)也呈阳性,SOX9是正常和肿瘤组织中软骨样分化的有用标志物。尽管患者的辅助治疗仅为放疗,未进行辅助化疗,但她5年无复发存活。MPC是化生性癌中一种不常见且相对罕见的变异类型,MPC患者的预后比普通乳腺癌患者差。在此我们报告一例乳腺MPC病例,其在对比增强MRI和CT上具有特征性的环状强化。MPC的内在亚型和预后存在争议,因此我们可能需要更多MPC病例的经验。