乳腺转移性肿瘤临床病理分析

Clinicopathological features of metastatic tumors to the breast

目的探讨乳腺转移性肿瘤的临床病理特点、诊断及鉴别诊断。方法收集2010—2020首都医科大学附属北京朝阳医院乳腺转移性肿瘤的病例共7例,完善临床资料,观察临床病理学特点,并用En Vision法进行免疫组织化学检测。结果①7例病例均为女性,发病年龄43~64岁。②7例转移性肿瘤中,均以原发肿瘤为首发症状,乳腺转移性肿瘤与原发肿瘤间隔时间1~10年,并伴有其他部位的转移。③7例病例中,2例为多发肿物,5例为单发肿物。④7例病例中,原发肿瘤的组织学类型为:肺腺癌3例,浆细胞瘤累及乳腺2例,胃腺癌1例,卵巢浆液性癌1例。其中3例可见广泛淋巴管侵犯。⑤7例均进行了乳腺癌相关标志物ER、PR、HER2、GATA3和GCDFP15免疫组织化学检测,除卵巢浆液性腺癌ER、PR阳性外,其余均阴性;3例肺腺癌转移TTF1阳性,2例浆细胞瘤CD38、CD138阳性,1例胃腺癌CK20、Villin阳性,1例卵巢浆液性癌ER、PR、WT1、PAX8、CA125阳性。结论乳腺转移性肿瘤易被误诊为原发性乳腺癌,需结合临床病史、组织形态学特点及免疫表型等进行诊断和鉴别诊断。原发性乳腺癌和乳腺转移性肿瘤的鉴别诊断对正确的治疗和预后有重要意义。

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of metastatic breast tumors. Methods Seven cases of breast metastatic tumors in Beijing Chaoyang Hospital, Capital Medical University from 2010 to 2020 were collected. The clinical data were reviewed, the clinical pathological characteristics were observed, and the EnVision method was used for immunohistochemical detection. Results All of the 7 cases were female, with the age of onset 37-80 years. Among of the 7 cases of metastatic tumor, primary tumors were the first symptom, the interval between metastatic tumors and primary tumors were 1-10 years, accompanied by metastasis of other parts. The histological types of the primary tumor were lung adenocarcinoma(3 cases), plasmacytoma involving the breast(2 cases), gastric adenocarcinoma(1 case), and ovarian serous carcinoma(1 case). Among them, 3 cases showed extensive lymphatic invasion. Immunohistochemical detection of ER, PR, HER2, GATA3 and GCDFP15 were performed in all 7 cases, and the results were negative except for ER and PR in ovarian serous carcinoma;TTF1 was positive in 3 cases of lung adenocarcinoma metastasis, CD38 and CD138 were positive in 2 cases of plasmacytoma, CK20 and villin were positive in 1 case of gastric adenocarcinoma, and ER, PR, WT1, Pax8 and CA125 were positive in 1 case of ovarian serous carcinoma. Conclusion Breast metastatic tumors are easy to be misdiagnosed as primary breast cancer. Clinical history, histomorphological characteristics and immunophenotypes are needed to make the right diagnosis. The differential diagnosis of primary breast cancer and breast metastatic tumors is important for correct treatment and prognosis.