PDF(Pubmed)
Abstract：
BACKGROUND: Metaplastic breast carcinomas are a rare variant group of breast carcinomas. They are usually high-grade and triple-negative tumors. They often present with large primary tumor sizes. However, the involvement of axillary lymph nodes is infrequent at the time of diagnosis. Metaplastic breast carcinomas are associated with a worse prognosis and a poorer response to chemotherapy in comparison with other non-metaplastic triple-negative breast cancers. Up until this point, there are no specific treatment recommendations for metaplastic breast carcinomas beyond those intended for invasive breast cancer in general.
METHODS: A 40-year-old woman complained of a palpable mass in her left axilla. On ultrasonography, the mass was solid, spindle-shaped, hypoechoic with regular borders, and exhibited decreased vascularity. At first, the mass appeared to be of a muscular origin. There was not any clinical nor ultrasonic evidence of a primary breast tumor. On magnetic resonance imaging, the axillary mass was a well-defined with regular borders, measuring 24 × 35 mm. Needle biopsy showed a spindle cell tumor with mild to moderate atypia. The subsequent surgical resection revealed a spindle cell neoplasm within a lymph node, favoring a metastatic origin of the tumor. The tumor cells lacked expression of estrogen, progesterone, and HER2 receptors. PET-CT scan indicated pathological uptake in the left breast. Accordingly, the patient was diagnosed with metaplastic breast cancer that had metastasized to the axillary lymph node. She commenced a combined chemotherapy regimen of doxorubicin and cyclophosphamide. After six treatment cycles, she underwent left modified radical mastectomy with axillary lymph node dissection. Pathological examination of the specimens revealed a total burn-out tumor in the breast due to excellent treatment response. There were no residual tumor cells. All dissected lymph nodes were free of tumor. At the one-year follow-up, the patient showed no signs of tumor recurrence.
CONCLUSIONS: This report sheds light on a distinctive presentation of metaplastic breast carcinoma, emphasizing the need for vigilance in diagnosing this rare and aggressive breast cancer variant. In addition, the patient\'s remarkable response to chemotherapy highlights potential treatment avenues for metaplastic breast cancer.
METHODS: A 40-year-old woman complained of a palpable mass in her left axilla. On ultrasonography, the mass was solid, spindle-shaped, hypoechoic with regular borders, and exhibited decreased vascularity. At first, the mass appeared to be of a muscular origin. There was not any clinical nor ultrasonic evidence of a primary breast tumor. On magnetic resonance imaging, the axillary mass was a well-defined with regular borders, measuring 24 × 35 mm. Needle biopsy showed a spindle cell tumor with mild to moderate atypia. The subsequent surgical resection revealed a spindle cell neoplasm within a lymph node, favoring a metastatic origin of the tumor. The tumor cells lacked expression of estrogen, progesterone, and HER2 receptors. PET-CT scan indicated pathological uptake in the left breast. Accordingly, the patient was diagnosed with metaplastic breast cancer that had metastasized to the axillary lymph node. She commenced a combined chemotherapy regimen of doxorubicin and cyclophosphamide. After six treatment cycles, she underwent left modified radical mastectomy with axillary lymph node dissection. Pathological examination of the specimens revealed a total burn-out tumor in the breast due to excellent treatment response. There were no residual tumor cells. All dissected lymph nodes were free of tumor. At the one-year follow-up, the patient showed no signs of tumor recurrence.
CONCLUSIONS: This report sheds light on a distinctive presentation of metaplastic breast carcinoma, emphasizing the need for vigilance in diagnosing this rare and aggressive breast cancer variant. In addition, the patient\'s remarkable response to chemotherapy highlights potential treatment avenues for metaplastic breast cancer.
摘要：
背景：化生性乳腺癌是一种罕见的乳腺癌变异型。它们通常是高级别和三阴性肿瘤。它们通常表现为较大的原发性肿瘤大小。然而,在诊断时，腋窝淋巴结的累及很少见。与其他非化生性三阴性乳腺癌相比，化生性乳腺癌的预后较差，对化疗的反应较差。在这之前，除了一般用于浸润性乳腺癌的治疗外,对于化生性乳腺癌没有具体的治疗建议.
方法：一名40岁女性主诉左腋窝有明显肿块。在超声检查中，质量是坚实的，纺锤形,带有规则边界的低回声，并表现出血管减少。起初,肿块似乎是肌肉起源的。没有任何原发性乳腺肿瘤的临床或超声证据。在磁共振成像上，腋窝肿块轮廓分明，边界规则，测量24×35毫米。穿刺活检显示梭形细胞肿瘤，轻度至中度异型。随后的手术切除显示淋巴结内有梭形细胞肿瘤，有利于肿瘤的转移起源。肿瘤细胞缺乏雌激素的表达，黄体酮,和HER2受体。PET-CT扫描提示左乳病理摄取。因此，该患者被诊断为化生性乳腺癌，已转移到腋窝淋巴结。她开始了阿霉素和环磷酰胺的联合化疗方案。经过六个治疗周期，她接受了左改良根治术和腋窝淋巴结清扫术。标本的病理学检查显示，由于出色的治疗反应，乳房中的肿瘤完全烧尽。没有残留的肿瘤细胞。所有解剖的淋巴结均无肿瘤。在为期一年的随访中，患者没有肿瘤复发的迹象。
结论：本报告揭示了化生性乳腺癌的独特表现，强调在诊断这种罕见和侵袭性乳腺癌变异时需要保持警惕。此外,患者对化疗的显著反应凸显了化生性乳腺癌的潜在治疗途径。
方法：一名40岁女性主诉左腋窝有明显肿块。在超声检查中，质量是坚实的，纺锤形,带有规则边界的低回声，并表现出血管减少。起初,肿块似乎是肌肉起源的。没有任何原发性乳腺肿瘤的临床或超声证据。在磁共振成像上，腋窝肿块轮廓分明，边界规则，测量24×35毫米。穿刺活检显示梭形细胞肿瘤，轻度至中度异型。随后的手术切除显示淋巴结内有梭形细胞肿瘤，有利于肿瘤的转移起源。肿瘤细胞缺乏雌激素的表达，黄体酮,和HER2受体。PET-CT扫描提示左乳病理摄取。因此，该患者被诊断为化生性乳腺癌，已转移到腋窝淋巴结。她开始了阿霉素和环磷酰胺的联合化疗方案。经过六个治疗周期，她接受了左改良根治术和腋窝淋巴结清扫术。标本的病理学检查显示，由于出色的治疗反应，乳房中的肿瘤完全烧尽。没有残留的肿瘤细胞。所有解剖的淋巴结均无肿瘤。在为期一年的随访中，患者没有肿瘤复发的迹象。
结论：本报告揭示了化生性乳腺癌的独特表现，强调在诊断这种罕见和侵袭性乳腺癌变异时需要保持警惕。此外,患者对化疗的显著反应凸显了化生性乳腺癌的潜在治疗途径。
