Terada Mitsuo, Gondo Naomi, Sawaki Masataka, Hattori Masaya, Yoshimura Akiyo, Kotani Haruru, Adachi Yayoi, Iwase Madoka, Kataoka Ayumi, Sugino Kayoko, Mori Makiko, Horisawa Nanae, Ozaki Yuri, Iwata Hiroji
Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya city, Aichi, 464-8681, Japan.
Surg Case Rep. 2019 May 10;5(1):77. doi: 10.1186/s40792-019-0635-4.
Giant cell tumor (GCT) of the breast is scarce. We report a case of GCT of the breast which was suspected as a malignant breast tumor.
A 74-year-old woman noticed a tender lump in her right breast. We suspected a malignant tumor spreading widely with axillary lymph node metastasis on clinical examination and imaging. Histological evaluation of the biopsy tissue revealed a tumor composed the proliferation of oval to spindle-shaped cells and multinucleated giant cells without malignant epithelial cells. The tumor cells stained positively for CD68 and negatively for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. The pathological findings suggested GCT, and fine needle aspiration biopsy for the axillary lymph node was negative. However, there was a gap between the clinical presentation, such as a tender mass suggesting rapid growth and multiple lymphadenopathies, and the pathological presentation of biopsy, which made us hesitate to conclude GCT as the final preoperative diagnosis. We could not rule out the possibility of malignant tumors with OGCs before surgery. We performed mastectomy and sentinel lymph node biopsy according to a surgical procedure for node-negative breast cancer with a wide ductal spread. The resected tissue histologically showed the same findings to the biopsy tissue. The definitive diagnosis of GCT of the breast was given, because the tumor lacked epithelial components, marked cellular atypia, and pleomorphism.
GCT of the breast occasionally pretends as breast malignant tumors. Complete tumor resection should be performed for local control and the definitive diagnosis.
乳腺巨细胞瘤（GCT）较为罕见。我们报告一例疑似乳腺恶性肿瘤的乳腺GCT病例。
一名74岁女性发现右乳有一个压痛性肿块。临床检查和影像学检查怀疑是一个广泛转移并伴有腋窝淋巴结转移的恶性肿瘤。活检组织的组织学评估显示，肿瘤由椭圆形至梭形细胞和多核巨细胞增殖组成，无恶性上皮细胞。肿瘤细胞CD68染色阳性，雌激素受体、孕激素受体和人表皮生长因子受体2染色阴性。病理结果提示为GCT，腋窝淋巴结细针穿刺活检为阴性。然而，临床表现（如提示快速生长的压痛性肿块和多处淋巴结病）与活检的病理表现之间存在差距，这使得我们在术前最终诊断为GCT时犹豫不决。术前我们不能排除伴有破骨样巨细胞的恶性肿瘤的可能性。我们根据伴有广泛导管扩散的淋巴结阴性乳腺癌的手术程序进行了乳房切除术和前哨淋巴结活检。切除组织的组织学表现与活检组织相同。由于肿瘤缺乏上皮成分、明显的细胞异型性和多形性，最终诊断为乳腺GCT。
乳腺GCT偶尔会伪装成乳腺恶性肿瘤。为了进行局部控制和明确诊断，应进行完整的肿瘤切除。
