Morphologically In Situ Solid Papillary Carcinoma of the Breast With Lymph Node and Lung Metastasis: A Rare Case Report and Literature Review.

IF 0.9 4区 医学 Q4 PATHOLOGY
Sayed Matar, Seyed Reza Taha, Fouad Boulos
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引用次数: 0

Abstract

Solid papillary carcinoma (SPC) is rare, accounting for less than 1% of all breast cancers. According to the 5th edition of the WHO Classification of Breast Tumors (2019), SPC is divided into invasive (ISPC) and in situ (SPC in situ) subtypes. ISPC is characterized by an irregular or jigsaw pattern lacking myoepithelial cells, while SPC in situ is well-circumscribed, regardless of myoepithelial cell presence. Metastasis is infrequently reported, with most patients involving lymph nodes and arising from ISPC. Metastases from SPC in situ without myoepithelial cells have rarely been reported. We present a 66-year-old woman with a 28 × 13 mm hypoechoic breast mass detected on ultrasound. Microscopic examination revealed well-circumscribed nests of SPC, positive for ER, PR, and synaptophysin, with a Ki-67 proliferation index of 10%. HER2 was negative. Myoepithelial markers, including p63, smooth muscle actin, keratin 5/6, p40, and CD10, were all negative, confirming the absence of a myoepithelial layer. Axillary lymph node dissection revealed metastasis in three of eighteen lymph nodes, with the metastatic foci demonstrating the same well-circumscribed SPC architecture as the primary tumor in the breast. Additionally, a lung biopsy exhibited metastatic SPC with identical histomorphology and immunohistochemical profile to the primary tumor. Although rare, SPC presenting a well-circumscribed morphology, and classified as in situ according to the WHO, should be approached with caution when myoepithelial cells are absent, as the in situ histomorphology does not necessarily exclude the potential for metastasis.

乳腺原位实体乳头状癌伴淋巴结及肺转移一例罕见病例报告及文献复习。
实体乳头状癌(SPC)是罕见的,占不到1%的所有乳腺癌。根据世界卫生组织第五版乳腺肿瘤分类(2019),SPC分为浸润性(ISPC)和原位(SPC in situ)亚型。ISPC的特征是缺乏肌上皮细胞的不规则或拼图图案,而原位SPC的界限很好,无论是否存在肌上皮细胞。转移很少报道,大多数患者累及淋巴结,由ISPC引起。没有肌上皮细胞的SPC原位转移很少有报道。我们报告了一位66岁的女性,超声检测到28 × 13毫米的低回声乳房肿块。显微镜检查显示SPC巢状结构清晰,ER、PR和synaptophysin阳性,Ki-67增殖指数为10%。HER2阴性。肌上皮标志物,包括p63、平滑肌肌动蛋白、角蛋白5/6、p40和CD10均为阴性,证实肌上皮缺失。腋窝淋巴结清扫发现18个淋巴结中有3个有转移,转移灶与乳腺原发肿瘤具有相同的SPC结构。此外,肺活检显示转移性SPC与原发肿瘤具有相同的组织形态学和免疫组织化学特征。虽然罕见,但SPC表现出明确的形态学,并根据WHO分类为原位,当肌上皮细胞缺失时应谨慎处理,因为原位组织形态学并不一定排除转移的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
198
审稿时长
1 months
期刊介绍: International Journal of Surgical Pathology (IJSP) is a peer-reviewed journal published eight times a year, which offers original research and observations covering all major organ systems, timely reviews of new techniques and procedures, discussions of controversies in surgical pathology, case reports, and images in pathology. This journal is a member of the Committee on Publication Ethics (COPE).
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