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目的:探讨乳腺梭形细胞癌的生物学特点和预后。方法:分析15例乳腺梭形细胞癌的临床病理特征及预后。结果:患者为成年女性,年龄40～96岁,中位年龄68岁。肿瘤直径1.5～15cm。所有病例临床为乳腺原发肿瘤,形态上≥80%区域为梭形(肉瘤样)形态,并显示细胞角蛋白阳性和(或)与导管原位癌密切相关。免疫组织化学染色显示40%的病例中,瘤细胞不同程度地呈平滑肌肌动蛋白、细胞角蛋白14和p63阳性,因此表现出肌上皮的分化。13例呈完全的梭形(肉瘤样)形态特征,2例找到高级别浸润性导管癌成分(其含量占全部肿瘤的≤20%)。14例有随访资料(随访时间1～120个月;中位数20个月)。13例行腋窝淋巴结清除的病例中,仅1例见淋巴结转移。3例术后局部复发。42.9%(6/14)见结外转移,最多见为肺转移。35.7%(5/14)术后1～46个月死亡(中位生存期11.5个月)。结论:乳腺梭形细胞癌为高度侵袭性肿瘤,易发生结外转移。纯粹的梭形细胞癌较之普通型乳腺导管癌的淋巴结转移率要低得多。
Objective: To investigate the biological characteristics and prognosis of breast spindle cell carcinoma. Methods: The clinicopathological characteristics and prognosis of 15 cases of breast spindle cell carcinoma were analyzed. Results: The patient was an adult female, aged 40-96 years, with a median age of 68 years. Tumor diameter 1.5 ~ 15cm. All cases were clinically primary breast tumors with a morphology of ≥80% spindle-shaped (sarcomatoid) morphology and showed cytokeratin positive and / or close correlation with ductal carcinoma in situ. Immunohistochemical staining showed that in 40% of the cases, the tumor cells showed smooth muscle actin, cytokeratin 14 and p63 positive to varying degrees, and thus showed myoepithelial differentiation. Thirteen cases showed complete spindle-shaped (sarcomatoid) morphological features. Two cases of high-grade invasive ductal carcinoma were found (their content accounted for ≤20% of all tumors). Fourteen patients had follow-up data (follow-up period of 1 to 120 months; median 20 months). Among 13 cases of axillary lymph node dissection, only 1 case was found to have lymph node metastasis. 3 cases of local recurrence. 42.9% (6/14) see extranodal metastasis, the most common lung metastasis. 35.7% (5/14) died 1 to 46 months after operation (median survival 11.5 months). Conclusion: Fusiform cell carcinoma of the breast is a highly aggressive tumor, which is prone to undergo extranodal metastasis. Pure spindle cell carcinoma than ordinary breast ductal lymph node metastasis rate is much lower.