Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA; Department of Pathology, West China 4th Hospital, Sichuan University, Chengdu, 610041, China.
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, K1H 8M5, Canada.
Hum Pathol. 2022 Jul;125:59-67. doi: 10.1016/j.humpath.2022.04.009. Epub 2022 Apr 18.
The aim of this study was to review the clinicopathologic characteristics of metastatic nonhematopoietic malignancies to the breast, in order to identify salient features for practicing pathologists that are useful in distinguishing metastatic lesions from primary breast neoplasms. A total of 238 cases were identified during the period from January 2005 to January 2015. Clinicopathologic features of these cases were retrospectively reviewed. Primary tumors included melanoma (99, 42%), serous carcinoma (35, 15%), neuroendocrine neoplasm (32, 13%), sarcoma (23, 10%), and adenocarcinoma from various organs (47, 20%), and 2 others. Most metastases were unilateral (223, 94%) and unifocal (206, 87%) and were detected radiographically (167, 70%). Concurrent ipsilateral axillary metastasis occurred in 33 (14%) patients. Among 238 cases, 41 had metastatic disease to the breast concurrently or preceding the primary cancer diagnosis. Notably, in 39 (16%) cases, breast metastasis was the first clinical presentation of disease, and 16 (41%) of these cases were initially misdiagnosed as breast primaries. In contrast, with a known history of nonmammary primary tumors, only 4 of 197 (2%) cases were misdiagnosed (p < 0.0001). Metastatic tumors share many overlapping features with breast primary carcinomas. However, cases with a well-circumscribed tumor, lack of in situ component, estrogen receptor/progesterone receptor negativity, and unusual morphologic features should raise the consideration of metastatic disease. While clinical history is paramount for correct diagnosis, metastasis to the breast as the first clinical presentation is not uncommon.
本研究旨在回顾转移性非血液恶性肿瘤至乳腺的临床病理特征，以便为病理医生提供有助于鉴别转移病灶与乳腺原发性肿瘤的特征。在 2005 年 1 月至 2015 年 1 月期间共确定了 238 例病例。回顾性分析这些病例的临床病理特征。原发性肿瘤包括黑色素瘤（99 例，42%）、浆液性癌（35 例，15%）、神经内分泌肿瘤（32 例，13%）、肉瘤（23 例，10%）和来自各种器官的腺癌（47 例，20%），以及其他 2 例。大多数转移灶为单侧（223 例，94%）和单灶性（206 例，87%），并通过影像学检测到（167 例，70%）。33 例（14%）患者同侧腋窝同时存在转移。在 238 例病例中，有 41 例同时或先于原发性癌症诊断存在乳腺转移。值得注意的是，在 39 例（16%）病例中，乳腺转移是疾病的首发临床表现，其中 16 例（41%）最初被误诊为乳腺原发性肿瘤。相比之下，在有已知非乳腺原发性肿瘤病史的情况下，仅 197 例中的 4 例（2%）被误诊（p<0.0001）。转移性肿瘤与乳腺原发性癌有许多重叠的特征。然而，具有边界清楚的肿瘤、缺乏原位成分、雌激素受体/孕激素受体阴性和不常见形态特征的病例应引起转移性疾病的考虑。虽然临床病史对正确诊断至关重要，但以乳腺转移为首发表现的情况并不少见。
