30例乳腺化生性癌的多种影像学对比分析

doi:10.3969/j.issn.1674-8115.2022.01.010

摘要/Abstract

摘要：

目的·分析、对比乳腺化生性癌（metaplastic carcinoma of the breast，MBC）的影像学表现，并归纳其免疫学特征。方法·回顾性分析上海交通大学医学院附属仁济医院2008年1月—2021年1月收治的30例MBC患者的病例资料，分析、对比肿块的影像学表现和免疫组织化学结果。结果·30例MBC病例共有31个病灶，其中鳞状细胞癌18个，混合型化生性癌3个，伴间叶分化的化生性癌7个，肌上皮癌1个，梭形细胞癌2个。患者均为女性，年龄33~89岁，平均年龄（61.8±14.2）岁。肿块的最大径101.0 mm，最小径6.6 mm，中位数25.5 mm，平均（33.1±18.5）mm。术前共有29例患者行超声检查，累计共检出30个病灶；其中，23个病灶形态不规则（76.7%），19个呈低回声（63.3%），11个呈混合回声（36.7%），14个边界不清楚（46.7%），7个病灶内伴细小钙化（23.3%）；有5例腋下淋巴结肿大，其中3例经病理证实为淋巴结转移（10.3%）。8例患者行计算机X线摄影（computed radiography，CR）检查，病灶呈分叶状、团块状或不对称外形，边界欠清或不清，部分内可见粗大不均质或细沙样钙化。6例患者行磁共振成像（magnetic resonance imaging，MRI）平扫，均呈T1加权像（T1 weighted imaging，T1WI）、T2WI低信号；强化后呈不均匀信号，边缘欠光整，呈分叶或毛刺样。3例患者MRI平扫提示分别存在周围组织侵犯及腋下淋巴结转移可能，但超声均未提示；除1例胸大肌侵犯经病理证实，另外2例均为假阳性。4例患者同时行CR、MRI和超声检查，MRI对2例微小钙化未显示，超声对1例淋巴结肿大未显示。16个病灶为三阴性，三阴性率为51.6%；雌激素受体（estrogen receptor，ER）/孕激素受体（progesterone receptor，PR）表达率达32.2%，人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）过表达率为25.8%。结论·超声、CR与MRI联合检查可以相辅相成，提高对MBC恶性程度判断的准确性。

关键词: 乳腺化生性癌, 超声检查, 磁共振成像, 计算机X线摄影, 三阴性乳腺癌

Abstract:

Objective·To comparatively analyze features of metaplastic carcinoma of the breast (MBC) images and immunological characteristics.

Methods·The data of 30 patients with MBC treated in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to January 2021 were analyzed retrospectively, and the imaging findings and immunohistochemical results of tumors were analyzed and compared.

Results·A total of 31 lesions were found in 30 cases of MBC, including 18 squamous cell carcinomas, 3 mixed metaplastic carcinomas, 7 mesenchymal differentiated carcinomas, 1 myoepithelial carcinoma, and 2 spindle cell carcinomas. All patients were female, aged from 33 to 89 years old, with an average age of (61.8±14.2) years. The maximum size of the tumors was 101.0 mm while the minimal was 6.6 mm, with the medium size 25.5 mm and the average size (33.1±18.5) mm. A total of 29 patients underwent ultrasound examination before operation, with a total of 30 lesions. Among them, 23 lesions were irregular-shaped (76.7%), 19 lesions were hypoechoic (63.3%), 11 lesions were mixed echogenicity (36.7%), 14 lesions were found with unclear boundary (46.7%), and 7 lesions were accompanied by small internal calcifications (23.3%). Five cases of axillary lymph nodes were found, in which 3 cases were confirmed by pathology as lymph node metastasis (10.3%). Eight patients were examined by computed radiography (CR), showing lobulated, lumpy or asymmetrical shape, with unclear boundary, and some of them were found with coarse, heterogeneous or fine sand-like calcification. Magnetic resonance imaging (MRI) showed low signal intensity on T1 weighted imaging (T1WI) and T2WI in 6 patients. After enhancement, uneven signal, obscure border, and lobulated shape were shown. The MRI images of 3 patients showed that there was the possibility of surrounding tissue invasion and axillary lymph node metastasis respectively, but ultrasound examination did not show that. Except the invasion of pectoralis major, which was confirmed by pathology, the other 2 cases were all false positive. Four cases accepted CR, MRI and ultrasound, 2 cases of small calcification were missed by MRI and 1 case of axillary lymph node was missed by ultrasound. Sixteen lesions were triple-negative (51.6%), estrogen receptor (ER)/progesterone receptor (PR) expression rate was 32.2% and the over-expression rate of human epidermal growth factor receptor 2 (HER2) was 25.8%.

Conclusion·Ultrasound, MRI and CR can complement each other and improve the accuracy of diagnosing the malignant degree of MBC.

Key words: metaplastic carcinoma of the breast (MBC), ultrasonography, magnetic resonance imaging (MRI), computed radiography (CR), triple negative breast cancer

中图分类号:

R730.41

陈翠, 金叶, 王琳, 李红丽, 万财凤, 姜立新. 30例乳腺化生性癌的多种影像学对比分析[J]. 上海交通大学学报(医学版), 2022, 42(1): 70-76.

Cui CHEN, Ye JIN, Lin WANG, Hongli LI, Caifeng WAN, Lixin JIANG. Comparative analysis of 30 cases of metaplastic carcinoma of the breast[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 70-76.

图/表 4

参考文献 21

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Item	Squamous cell carcinoma （n=18）	Carcinoma with mesenchymal differentiation （n=6）	Spindle cell carcinoma （n=2）	Myoepithelial carcinoma （n=1）	Mixed metaplastic carcinoma （n=3）	Total/n（%）
Shape
Regular	2	3	0	1	1	7 （23.3）
Irregular	16	3	2	0	2	23 （76.7）
Margin
Clear	7	5	1	1	2	16 （53.3）
Not clear	11	1	1	0	1	14 （46.7）
Echo
Hypoechoic	14	3	1	0	1	19 （63.3）
Hybrid echo	4	3	1	1	2	11 （36.7）
Calcification
Tiny	5	2	0	0	0	7 （23.3）
Coarse	0	0	0	0	0	0 （0）
None	13	4	2	1	3	23 （76.7）
Axillary lymph node
Swollen	5	0	0	0	0	5 （16.7）
Normal	13	6	2	1	3	25 （83.3）

Item	Squamous cell carcinoma （n=18）	Carcinoma with mesenchymal differentiation （n=6）	Spindle cell carcinoma （n=2）	Myoepithelial carcinoma （n=1）	Mixed metaplastic carcinoma （n=3）	Total/n（%）
Shape
Regular	2	3	0	1	1	7 （23.3）
Irregular	16	3	2	0	2	23 （76.7）
Margin
Clear	7	5	1	1	2	16 （53.3）
Not clear	11	1	1	0	1	14 （46.7）
Echo
Hypoechoic	14	3	1	0	1	19 （63.3）
Hybrid echo	4	3	1	1	2	11 （36.7）
Calcification
Tiny	5	2	0	0	0	7 （23.3）
Coarse	0	0	0	0	0	0 （0）
None	13	4	2	1	3	23 （76.7）
Axillary lymph node
Swollen	5	0	0	0	0	5 （16.7）
Normal	13	6	2	1	3	25 （83.3）

Subtype	Shape， signal and echo			Margin			Calcification			BI-RADS category			Swollen axillary lymph node
Subtype	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound
Squamous cell carcinoma	Irregularly high density	Cyst-like mass with thick wall， low T1WI and T2WI signals； multiregional non-mass-like enhancement	Irregular shape， hybrid echoic	Not clear	Not clear	Not clear	Multiple and tiny	None	Multiple and tiny	5	5	5	Both sides	Both sides	Right side
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	4c	5	5	None	None	None
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； early enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	0	5	5	None	None	None
Spindle cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	Tiny	None	Multiple and tiny	4c	5	4a	None	None	None

Subtype	Shape， signal and echo			Margin			Calcification			BI-RADS category			Swollen axillary lymph node
Subtype	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound	CR	MRI	Ultrasound
Squamous cell carcinoma	Irregularly high density	Cyst-like mass with thick wall， low T1WI and T2WI signals； multiregional non-mass-like enhancement	Irregular shape， hybrid echoic	Not clear	Not clear	Not clear	Multiple and tiny	None	Multiple and tiny	5	5	5	Both sides	Both sides	Right side
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	4c	5	5	None	None	None
Squamous cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； early enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	None	None	None	0	5	5	None	None	None
Spindle cell carcinoma	Irregularly high density	Module-like， low T1WI and T2WI signals； unevenly enhancement	Irregular shape， hypoechoic	Not clear	Not clear	Not clear	Tiny	None	Multiple and tiny	4c	5	4a	None	None	None

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