Haroon Saroona, Zia Shamail, Shirazi Umme Aiman, Ahmed Omer, Asghar Ishaq Azeem, Diwan Muhammad Asad, Afzal Anoshia, Irfan Muhammad, Ali Syed Jawwad, Hashmi Atif A
Pathology, King's Mill Hospital - Sherwood Forest Hospitals, National Health Service (NHS) Foundation Trust, Ashfield, GBR.
Pathology, Prince Faisal Oncology Centre, King Fahad Specialist Hospital, Buraidah, SAU.
Cureus. 2021 Apr 7;13(4):e14347. doi: 10.7759/cureus.14347.
Introduction Metaplastic breast carcinoma (MBC) is defined as breast cancer with a heterologous non-glandular component. MBC is considered a special type of breast cancer with a prognosis that is worse than invasive ductal carcinoma (IDC) of the breast. MBC is the most common breast cancer with a triple-negative profile. Therefore, in this study, we evaluated the clinicopathological parameters, recurrence and survival of MBC in our population. Methods We conducted a retrospective observational study in the Department of Histopathology at Prince Faisal Oncology Centre, Buraidah, Saudi Arabia, over a period of five years. All cases diagnosed as MBC were included in the study. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2/neu) immunohistochemistry (IHC) was performed on representative tissue blocks. Results Total 183 cases of MBCs were included in the study, out of which 120 cases were excision specimens. The mean age of the patients was 48.84±12.99 years, and the most common age group was between 36 and 50 years of age. Most of the cases were tumor (T) stage T3 (50%), and nodal metastasis was present in 40% of cases. Most cases were grade III (78.7%). ER, PR and HER2/neu positivity was noted in 15.8%, 13.1%, and 9.8% cases, respectively. Follow-up data were available for 70 cases, with a median follow-up period of 4 (1-7) years. Tumor recurrence was noted in 31.4% cases, with a survival rate of 71.4%. Squamous, chondroid, spindle cell differentiation, and matrix production were noted in 70.5%, 7.1%, 13.7%, and 2.2% cases, respectively. A significant association of squamous differentiation was noted with HER2/neu positivity. An inverse association of spindle cell differentiation was seen with axillary metastasis. Survival analysis by Kaplan-Meier revealed a significant association of survival with tumor recurrence. Conclusion MBC is an important subtype of breast cancer, histopathological identification of which is challenging, owing to varied histological differentiation. We found squamous differentiation to be the most common in MBC, which was associated with HER2/neu positivity. A high recurrence rate of MBC was also observed in our study that was significantly associated with survival.
引言
化生性乳腺癌（MBC）被定义为具有异源性非腺性成分的乳腺癌。MBC被认为是一种特殊类型的乳腺癌，其预后比乳腺浸润性导管癌（IDC）更差。MBC是最常见的三阴性乳腺癌类型。因此，在本研究中，我们评估了我们研究人群中MBC的临床病理参数、复发情况和生存率。
方法
我们在沙特阿拉伯布赖代费萨尔王子肿瘤中心组织病理学部门进行了一项为期五年的回顾性观察研究。所有诊断为MBC的病例均纳入研究。对代表性组织块进行雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2/neu）免疫组织化学（IHC）检测。
结果
本研究共纳入183例MBC病例，其中120例为切除标本。患者的平均年龄为48.84±12.99岁，最常见的年龄组为36至50岁。大多数病例为肿瘤（T）分期T3（50%），40%的病例有淋巴结转移。大多数病例为III级（78.7%）。ER、PR和HER2/neu阳性率分别为15.8%、13.1%和9.8%。70例患者有随访数据，中位随访期为4（1 - 7）年。31.4%的病例出现肿瘤复发，生存率为71.4%。分别在70.5%、7.1%、13.7%和2.2%的病例中观察到鳞状、软骨样、梭形细胞分化和基质产生。鳞状分化与HER2/neu阳性显著相关。梭形细胞分化与腋窝转移呈负相关。Kaplan - Meier生存分析显示生存与肿瘤复发显著相关。
结论
MBC是乳腺癌的一种重要亚型，由于其组织学分化多样，其组织病理学鉴定具有挑战性。我们发现鳞状分化在MBC中最常见，且与HER2/neu阳性相关。在我们的研究中还观察到MBC的高复发率，且复发率与生存率显著相关。
