乳腺外实体瘤乳腺转移患者的临床病理特征和预后

Clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors

目的探讨乳腺外实体瘤乳腺转移患者的临床病理特征和预后。方法回顾性分析2001年1月至2012年12月间中国医学科学院肿瘤医院诊治的24例乳腺外实体瘤乳腺转移患者的临床资料，乳腺外原发实体肿瘤和乳腺病灶均经病理细胞学证实。结果24例患者中，女性22例，男性2例，中位年龄54岁。原发肿瘤为非小细胞肺癌10例，小细胞肺癌4例，鼻腔横纹肌肉瘤3例，嗅神经母细胞瘤3例，卵巢癌2例，恶性黑色素瘤1例，胃癌1例。15例（62．5％）患者可自行扪及乳腺结节，2例患者乳腺弥漫增大伴有炎性改变，7例（29．2％）患者在检查CT时发现乳腺结节。乳腺转移灶多为增长较快的单发结节，可以伴有腋窝淋巴结肿大，少见微小钙化，病理细胞学检查可以区分乳腺转移和原发乳腺癌，83．3％（20／24）的患者同时存在其他器官和淋巴结转移。乳腺外实体瘤乳腺转移患者的预后差，中位生存时间仅为9．2个月。结论恶性肿瘤患者出现乳腺结节均应考虑乳腺转移可能，应对乳腺结节进行病理细胞学检查以明确诊断。正确的诊断不仅可以避免不必要的乳腺切除术，更重要的是可以给予患者及时和正确的系统治疗。

Objective To discuss the clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors. Methods The databases of Cancer Hospital of Chinese Academy of Medical Sciences from January 2001 to December 2012 were reviewed. 24 patients were identified with a diagnosis of metastasis to the breast from extramammary solid tumors and their clinical data were collected and analyzed. All the primary solid tumors and breast lesions were confirmed by pathology or cytology. Results Of the 24 patients, 22 were women and two were men. The median age was 54 years. The primary malignancies included non-small cell lung cancer （n = 10）, small cell lung cancer （n = 4）, rhabdomyosarcoma （ n = 3 ） , offactory neuroblastoma （ n=3 ） , ovarian cancer （ n = 2 ） , malignant melanoma （n = 1 ） and gastric cancer （n=1 ）. 15 patients （62.5%） complainted self-palpable breast nodules, two patients manifested as diffuse swollen and red of the whole breast, 7 patients （ 29.2% ） were identified as well-defined nodules in the breast on CT images. The majority of metastases to breast presented as a solitary nodule with rapid growth, sometimes associated with axillary lymph node enlargement and occasionally with micro-calcification. Cytopathological examination could be used to differentiate the metastatic lesions from primrose breast tumors. 83.3% （20/24） of the patients were concurrently accompanied with metastases in other organs and/or lymph nodes. The metastases to the breast from extrammnmy solid tumors were associated with a poor prognosis and the median overall survival was only 9. 2 months. Conclusions Metastasis to the breast should be considered in any patient with a known primary malignant tumor history who presents with a breast lump. Pathological examination should be performed to differentiate the primary breast cancer from metastatic tumor. An accurate diagnosis of breast metastases may not only avoid unnecessary breast resection, more importantly it is crucial to determine an appropriate and systemic treatment.