乳腺浸润性导管癌新辅助化疗后转化为化生性鳞状细胞癌1例并文献复习  

Transformation of breast invasive ductal carcinoma to metaplasia squamous cell carcinoma after neoadjuvant chemotherapy:A case report and literature review

作　　者：秦亚萍 付悦 肖楚蓉 伍金凤 唐娟 陈灵凤 肖胜军 QIN Yaping;FU Yue;XIAO Churong;WU Jinfeng;TANG Juan;CHEN Lingfeng;XIAO Shengjun(Department of Pathology,the Second Affiliated Hospital,Guilin Medical University,Guangxi Guilin 541199,China)

机构地区：[1]桂林医学院第二附属医院病理科,广西桂林541199

出　　处：《现代肿瘤医学》2024年第9期1638-1642,共5页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81760491,82060500,82260476);广西自然科学基金项目(编号:2020GXNSFAA159040);广西高校中青年教师科研基础能力提升项目(编号:2023KY0507)。

摘　　要：目的:探讨新辅助化疗后病理类型转化为化生性鳞状细胞癌(metaplasia squamous cell carcinoma,MSCC)的乳腺浸润性导管癌临床病理特征。方法:报道1例乳腺浸润性导管癌在新辅助化疗后原发灶病理完全缓解(pathological complete response,pCR)、腋窝淋巴结转移灶转化为MSCC的病例;复习相关文献归纳总结其临床病理特征。结果:本例初诊为乳腺浸润性导管癌、腋窝淋巴结转移灶伴有局灶鳞状化生,在新辅助化疗后原发灶完全缓解,腋窝淋巴结转移灶完全转化为MSCC,影像显示淋巴结呈囊性改变,HE染色显示囊腔被覆鳞状上皮,形态学符合高分化鳞状细胞癌。免疫组化染色显示该病例分子分型为三阴性型:ER、PR、HER2均阴性。7例(本例加文献报道的6例)新辅助化疗前诊断均为浸润性导管癌,患者中位年龄56岁;5例为原发、2例为复发病例,其中4例有淋巴结转移;分子分型多为三阴性乳腺癌(5/7例);新辅助化疗后7例均转化为MSCC,1例(本例)原发灶pCR,5例淋巴结转移灶中,1例pCR、3例转化为MSCC、1例没有转化。结论:新辅助化疗可以诱导乳腺浸润性导管癌转化为MSCC,这类病例具有独特临床病理特征;探讨其转化的潜在分子机制,对临床个体化治疗及预后评估具有指导意义。Objective:To explore the clinicopathological features of invasive breast ductal carcinoma cases,which transformated to metaplasia squamous cell carcinoma(MSCC)after neoadjuvant chemotherapy.Methods:A case of primary breast invasive ductal carcinoma with primary tumor pathological complete response(pCR)and axillary lymph node metastasis lesion transformed to MSCC after neoadjuvant chemotherapy was reported.Related literatures were reviewed to summarize clinicopathological characters.Results:The case reported here idiagnosis as invasive ductal carcinoma of the breast,focal squamous metaplasia observed in axillary lymph node metastases.The primary lesions were pathologically complete responds after neoadjuvant chemotherapy and axillary lymph node metastases were completely converted to MSCC.Imaging diagnosisdocumented cystic changes in the lymph nodes.HE showed that the cyst cavity was lined with stratified squamous epithelium,the morphology of which was consistent with well-differentiated squamous cell carcinoma.Immunohistochemical staining defined this case as a triple negative molecular subtype-ER,PR,HER2 negative.Sevencases(including 6 cases reported in the literature and the case reported here)were rerospective analysised.Before neoadjuvant chemotherapy,all cases diagnosed as invasive ductal carcinoma with the median age of 56 years,5 as primary and 2 as recurrent cases,among them 4 showed lymph node metastasis.The molecular subtype of most cases was triple-negative breast cancer(5/7).All 7 cases were transformed into MSCC after neoadjuvant chemotherapy.Among them,1 case(our reported case)showed that the primary lesion undergo pCR.Among 5 cases with lymph node metastases,1 case was pCR,3 cases were converted to MSCC,and 1 case was not transformed.Conclusion:Neoadjuvant chemotherapy could induce the transformation of invasive ductal carcinoma into MSCC.These cases have the unique clinicopathological features.Exploring the underlying molecular mechanisms of this transformationis significant for clinical individua

关 键 词：乳腺肿瘤 浸润性导管癌 乳腺化生性癌 化生性鳞状细胞癌 新辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]