Zhong Ruiqi, Chang Ziyi, Wang Xiuhong, Zhong Dingrong
4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Pathology, China-Japan Friendship Hospital, No. 2, Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China.
BMC Womens Health. 2024 Dec 19;24(1):640. doi: 10.1186/s12905-024-03489-y.
According to previous studies, tall cell carcinoma with reversed polarity can be easily distinguished from ductal carcinoma in situ based on the absence of myoepithelium and a typical histologic feature. However, to the best of our knowledge, no cases of papillary ductal carcinoma exhibiting tall cell and reversed polarity features with intact myoepithelium have been reported, and thus its diagnosis and prognosis remain unclear.
A 54-year-old female with a palpable lump in her right breast for 3 years. There were no other symptoms found. A preoperative ultrasound examination showed an oval, well-circumscribed, anechoic cystic appearance with hypoechoic adnexal nodules, classified as 3-4a in the Breast Imaging Reporting Data System. Surgical excision revealed an in-situ breast carcinoma exhibiting a solid papillary pattern and tall cell with reversed polarity of nuclei. After thorough postoperative pathology, immunohistochemistry, and next-generation sequencing, we hypothesized that it might be a new ductal carcinoma in situ subtype with tall cells and reversed polarity of the mammary gland.
We herein present a rare case of papillary ductal carcinoma in situ with tall cell and reversed polarity morphology breast cancer, which can closely mimic tall cell carcinoma with reversed polarity and ductal carcinoma in situ. Thorough evaluations of histologic features, immunohistochemistry results, and genetic alterations are significant in identifying this rare entity. In addition, this type of breast cancer is low-malignant and has a favorable prognosis without any adjuvant therapy after complete resection.
根据以往研究，极性反转的高细胞癌可基于肌上皮的缺失和典型组织学特征与原位导管癌轻松区分。然而，据我们所知，尚无关于具有完整肌上皮的表现为高细胞和极性反转特征的乳头导管癌病例报道，因此其诊断和预后仍不明确。
一名54岁女性，右乳可触及肿块3年。未发现其他症状。术前超声检查显示为椭圆形、边界清晰的无回声囊性外观，伴有低回声附件结节，在乳腺影像报告和数据系统中分类为3 - 4a级。手术切除显示为原位乳腺癌，呈现实性乳头模式以及细胞核极性反转的高细胞。经过全面的术后病理、免疫组化和二代测序，我们推测这可能是一种新的具有高细胞和乳腺极性反转的原位导管癌亚型。
我们在此报告一例罕见的具有高细胞和极性反转形态的原位乳头导管癌病例，其可酷似极性反转的高细胞癌和原位导管癌。对组织学特征、免疫组化结果和基因改变进行全面评估对于识别这一罕见实体具有重要意义。此外，这种类型的乳腺癌恶性程度低，完全切除后无需任何辅助治疗，预后良好。
