本文报道一例乳腺化生性癌伴BRCA1基因突变患者的临床资料。患者为26岁女性,因“发现左乳腺结节1月”入院,彩超示左乳分叶状低回声结节,形态不规则,内未探及血流信号。行乳腺区段切除术,术后病理提示形态学结合免疫组化符合伴间叶分化的化生性癌,癌细胞ER(−)、PR(−)、Her-2(0),BRCA1基因突变检测结果:c.192T > G (p.C64W),突变类型为4类–疑似有害变异,术后予AC-T方案化疗6个周期,序贯奥拉帕尼使用1年,目前随访25个月,无局部复发和远处转移。This paper reports the clinical data of a case of breast metaplastic carcinoma with BRCA1 gene mutation. The patient was a 26-year-old woman who was admitted to the hospital with a left breast nodule that had been detected for one month. Ultrasound showed a lobulated hypoechoic nodule in the left breast with an irregular morphology, and no blood flow signals were detected in it. We performed segmental mastectomy for the patient, and postoperative pathology suggested that the morphology combined with immunohistochemistry was consistent with a metaplastic carcinoma with mesenchymal differentiation, and the cancer cells were ER(−), PR(−), and Her-2(0), and the results of the mutation test of the BRCA1 gene were: c.192T > G (p.C64W), and the mutation type was class 4-suspected deleterious variant. After surgery, she was given 6 cycles of chemotherapy with AC-T regimen, sequential Olaparib had been used for one year, and she was followed up for 25 months with no obvious signs of local recurrence or distant metastasis.
乳腺化生性癌(metaplastic breast carcinoma,MBC)是一类罕见的侵袭性乳腺癌,占浸润性癌总数不到1%^([1])。相较于非特殊性乳腺癌,MBC侵袭性更强且预后差。化生性癌包含多种异质性成分,病理形态多样,且具备恶性程度高、分类不统一等特点,临床极易出现误诊,提高对该病的认识有助于临床早期诊治^([2])。
目的探讨乳腺纤维瘤病样化生性癌(fibromatosis like metaplasia carcinoma,FLMC)的病理组织学特点、免疫组化表型,诊断及鉴别诊断。方法收集2016年9月~2020年4月哈尔滨医科大学附属第一医院3例女性FLMC患者,对乳腺纤维瘤病样化生性癌进行病理组织学形态、免疫组化等特点进行观察分析。结果3例患者均具有乳腺无痛、质硬肿物。组织形态学显示肿瘤细胞呈梭形,细胞密度不均,形态温和,轻-中度异形,梭形细胞弥漫或相互交错排列,间质纤维组织增生伴胶原化,肿瘤边缘区域可见呈指突状浸润周围乳腺实质及纤维脂肪组织。免疫组化梭形肿瘤细胞均表达上皮标记CK、CK5/6、34βE12、CAM5.2、CK8/18、CK7、CK14、P63、BCL2、Vimentin、SMA、β-catenin、CD10、Calponin“+”,ER、PR、C-erBb2、CD34、E-cadherin、S-100、P120、GFAP“-”。随访至今,均未见肿瘤复发及转移。结论乳腺纤维瘤病样化生性癌是一类罕见的病变,形态学温和,易误诊,免疫组化对其鉴别诊断有帮助。
