Jiao Shuoying, Chen Junpeng, Shen Jiumei, Peng Ajing, Chen Ruifu, Lai Baoyong, Luo Chunhua, Fan Yingyi, Pei Xiaohua
Department of Breast, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.
Department of Breast Surgery, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China.
Front Oncol. 2024 Nov 18;14:1455893. doi: 10.3389/fonc.2024.1455893. eCollection 2024.
Triple-negative breast cancer (TNBC) is a great challenge for clinical management due to the high rate of metastatic recurrence and lack of recognised therapeutic targets, while tumour-infiltrating lymphocytes (TILs) infiltration in TNBC has been discovery provides an opportunity for immunotherapy, and studies have suggested that the level of TILs infiltration is positively correlated with TNBC survival. We found a rare case of TNBC with low TILs infiltration but good prognosis, named Tall Cell Carcinoma with Reversed Polarity (TCCRP), and we investigated it from the perspective of TILs infiltration in order to improve the clinical data of TCCRP.
a 54-year-old woman with a left breast mass, breast ultrasound showed BI-RADS IVb, puncture diagnosis of invasive ductal carcinoma, postoperative pathology showed papillary structure, cubic and high columnar arrangement of cells, nuclei far away from the base, interstitial fibroplasia, diagnosed as TCCRP. Immunohistochemistry revealed that the tumours were triple-negative breast cancer (negative for ER, PR, and HER-2), with a low Ki-67 proliferation index. TILs were < 10%, with a small infiltration of CD4 and CD8 T lymphocytes, positive expression of SMA and FAP, and IDH2, PIK3CA gene mutation. The patient underwent postoperative chemotherapy, 11 months follow-up, no recurrence and metastasis.
TCCRP is a rare TNBC with inert biological behaviours and good prognosis. We found low infiltration of TILs in the pathological tissue of this case, which may be a characteristic of TCCRP, and the presence of Cancer-Associated Fibroblasts (CAF) in the interstitium of the tumour in this case may have suppressed the anti-tumour immunity to some extent, and further studies on the immune characteristics of the tumour microenvironment (TME) in TCCRP are needed.
三阴性乳腺癌（TNBC）由于转移复发率高且缺乏公认的治疗靶点，给临床管理带来了巨大挑战，而TNBC中肿瘤浸润淋巴细胞（TILs）浸润的发现为免疫治疗提供了契机，且研究表明TILs浸润水平与TNBC生存率呈正相关。我们发现了1例TILs浸润低但预后良好的罕见TNBC病例，命名为极性反转高细胞癌（TCCRP），并从TILs浸润角度对其进行研究，以完善TCCRP的临床资料。
一名54岁女性，左乳有肿块，乳腺超声显示为BI-RADS IVb级，穿刺诊断为浸润性导管癌，术后病理显示有乳头结构，细胞呈立方状和高柱状排列，细胞核远离基底，间质纤维增生，诊断为TCCRP。免疫组化显示肿瘤为三阴性乳腺癌（雌激素受体、孕激素受体和人表皮生长因子受体2均为阴性），Ki-67增殖指数低。TILs＜10%，CD4和CD8 T淋巴细胞浸润少，平滑肌肌动蛋白和脂肪细胞型脂肪酸结合蛋白呈阳性表达，异柠檬酸脱氢酶2、磷脂酰肌醇-3激酶催化亚基α基因突变。患者术后接受化疗，随访11个月，无复发转移。
TCCRP是一种罕见的TNBC，具有惰性生物学行为和良好预后。我们发现该病例病理组织中TILs浸润低，这可能是TCCRP的一个特征，且该病例肿瘤间质中存在癌症相关成纤维细胞（CAF），可能在一定程度上抑制了抗肿瘤免疫，需要进一步研究TCCRP肿瘤微环境（TME）的免疫特征。
