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| 转移至乳腺的具有乳头状结构及核下空泡的内膜样癌——日常病理诊断过程中的陷阱一例报道 |
| Endometrioid carcinoma with papillary structures and subnuclear vacuoles that metastasize to the breast: a pitfall in the daily pathological diagnosis processLiu Xiaomei, Bu Wenjing, Zhang Hongkai |
| 投稿时间：2024-05-17 修订日期：2024-06-18 |
| DOI： |
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| 中文关键词: 乳腺转移性癌 内膜样癌转移至乳腺 诊断及鉴别诊断 临床病史 |
| 英文关键词:metastatic breast cancer Endometrioid carcinoma metastasizes to the breast Diagnosis and differential diagnosis Clinical History |
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| 中文摘要: |
| 摘要：目的: 乳腺癌转移至远处多见，但其他部位转移至乳腺者极为罕见。子宫内膜样癌转移至乳腺的病例仅有不足5例报告。在临床诊断过程中，当转移瘤的形态与原发肿瘤较为相似、免疫组化结果有重叠、临床病史未被刻意获取时，病理诊断可能出现误诊。方法：在此报告一例乳腺穿刺病例，初时被诊断为乳腺原发癌，后在获得了临床病史后，更正诊断为转移的病例。同时，我们也对转移至乳腺的内膜癌文献进行了复习。结果：显微镜下送检乳腺穿刺组织内肿瘤细胞呈乳头状结构，可见核下空泡，细胞异型程度中等；免疫组化结果符合乳腺癌表型；最初诊断乳腺导管内乳头状癌可能性大；后因临床提示患者有子宫内膜癌病史，加染女性生殖道来源免疫组化标记，最终更正诊断为转移性子宫内膜样癌。文献中诊断内膜样癌乳腺转移的过程也同样充满挑战。结论：病理医生在恶性肿瘤（原发/继发）的诊断过程中处于核心位置。在临床诊断过程中，我们即使面对常见病、多发病时也需时刻提高鉴别诊断意识。其中临床-病理紧密协作且尽可能详尽收集患者的病史资料在正确诊断过程中至关重要。 |
| 英文摘要: |
| Abstract: Objective: Distant metastasis of breast cancer is common, but metastasis from other parts of the body to the breast is extremely rare. There are less than 5 reported cases of endometrial carcinoma metastasis to the breast. In the daily clinical diagnosis, when the morphology of tumor cells is similar to the primary ones, in addition to the overlap in immunohistochemical features, pathological diagnosis may lead to a misdiagnosis. Methods: We report a case of breast biopsy, initially diagnosed as primary breast cancer, but later corrected the diagnosis as a metastatic endometrioid adenocarcinoma after obtaining the patiants’ clinical history and use immunohistochemistry. We also reviewed the related endometrioid carcinoma metastatic to breast in the literature. Results: Microscopically, the tumor cells in the breast were papillary, with visible subnuclear vacuoles and moderate degree of cell dysplasia. The immunohistochemical results were consistent with the phenotype of primary breast cancer. Due to clinician inquiry whether it is possible a metastatic tumor since the patient had endometrioid carcinoma 7 years ago, we realized the possibility of metastasis. Then we used immunohistochemical markers for confirming the origin of the female reproductive tract. With PAX8 positivity, we corrected the diagnosis as metastatic endometrioid carcinoma. Conclusion: Pathologists play a crucial role in the diagnosis of malignant tumors (primary/secondary). In the daily work, even when facing common diseases, we need to constantly alert ourselves that there would be a secondary tumor in those who had a history. The patient’s history, good communication of clinicians and pathologists, is the key to avoid misdiagnosis. |
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