Andreou Sonia, Soule Erik, Long Deidra, Jasra Bharti, Sharma Smita
Surgery, University of Florida College of Medicine, Jacksonville, USA.
Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA.
Cureus. 2020 May 22;12(5):e8239. doi: 10.7759/cureus.8239.
Metaplastic breast cancer is difficult to diagnose, resistant to conventional treatment, and biologically aggressive. A suspicious timeline and discordance between imaging findings and histopathologic tissue diagnosis should trigger additional workup. New, large lesions or rapidly growing lesions with complex echogenicity on ultrasound warrant correlation with image-guided biopsy for a definitive diagnosis. Lesions that appear aggressive on imaging, with negative biopsy findings, may represent false negatives due to sampling bias from intratumoral heterogeneity. In such cases, it may be advisable to obtain an excisional biopsy. These tumors are known to progress even with neoadjuvant chemotherapy. Immunotherapy, however, may be effective even for metastatic disease. A multidisciplinary approach and a high index of suspicion may, therefore, confer survival benefits in circumstances where the imaging phenotype does not fit with the timeline or pathologic diagnosis. This report describes five cases of metaplastic breast cancer diagnosed at our institution to highlight the importance of a timely and accurate diagnosis of this rare but aggressive breast malignancy.
化生性乳腺癌难以诊断，对传统治疗有抗性，且具有生物学侵袭性。可疑的病程以及影像学表现与组织病理学诊断之间的不一致应促使进行进一步检查。超声检查发现新的、较大的或快速生长且具有复杂回声性的病变，需要与影像引导下活检相关联以明确诊断。影像学表现具有侵袭性但活检结果为阴性的病变，可能由于肿瘤内异质性导致的取样偏差而出现假阴性。在这种情况下，进行切除活检可能是明智的。已知这些肿瘤即使接受新辅助化疗仍会进展。然而，免疫疗法甚至对转移性疾病可能有效。因此，在影像学表现与病程或病理诊断不符的情况下，多学科方法和高度的怀疑意识可能会带来生存益处。本报告描述了在我们机构诊断的5例化生性乳腺癌病例，以强调及时、准确诊断这种罕见但具有侵袭性的乳腺恶性肿瘤的重要性。
