Primary osteogenic sarcoma of the breast - A clinicopathologic analysis of 50 cases
Primary osteogenic sarcoma of the breast - A clinicopathologic analysis of 50 cases
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DOI：
10.1097/00000478-199808000-00002
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发表时间：
1998-08-01
影响因子：
5.6
通讯作者：
Tavassoli, FA
中科院分区：
文献类型：
--
作者：
Silver, SA;Tavassoli, FA
外伤性骨肉瘤是罕见的。很少有原发性乳腺骨肉瘤的报告，其中许多已被描述与双相肿瘤。在排除了双相起源的乳腺骨肉瘤后，我们回顾了1957年至1995年间诊断的50例乳腺骨肉瘤。在32例病例中，使用一组免疫组化标记物和另外4例病例中使用超微结构评价证实了上皮分化的缺失。肿瘤发生在49名女性和1名男性;年龄范围为27至89岁（中位数，64.5岁）。1例患者在就诊前9年因同侧乳腺癌接受放疗。患者接受了切除活检（n = 13），切除术（n = 5）或乳房切除术（n = 32）。20例腋窝淋巴结均无肿瘤。1例患者在诊断时出现乳房外扩散。肿瘤直径1.4 ~ 13.0 cm（平均4.6 cm），60%肿瘤边界清楚。肿瘤被分类为成纤维细胞（n = 28）、成骨细胞（n = 14）或成骨细胞（n = 8）。在有可用随访信息的39例患者中，23例（59%）在诊断后平均10.5个月和14.5个月发生局部复发（n = 11）和转移（n = 15）疾病。8例（73%）局部复发的患者接受切除活检或切除术治疗，其中7例切缘阳性。16例（41%）患者在平均17.1个月内死于疾病，在转移发生后20个月内，最常见的是肺转移。乳腺骨肉瘤是一种侵袭性肿瘤，倾向于通过血液而不是淋巴扩散。建议全切除而不作腋窝淋巴结清扫。
Extraskeletal osteosarcomas are rare. Few primary mammary osteosarcomas have been reported; many of these have been described in association with a biphasic tumor. Fifty pure osteosarcomas of the breast, diagnosed between 1957 and 1995, were reviewed after excluding those of biphasic origin. The absence of epithelial differentiation was confirmed using a panel of immunohistochemical markers in 32 cases and using ultrastructural evaluation in an additional four cases. Tumors occurred in 49 women and one man; age ranged from 27 to 89 years (median, 64.5 years). One patient received radiotherapy for ipsilateral breast carcinoma 9 years before presentation. Patients were treated by excisional biopsy (n = 13), tylectomy (n = 5) or mastectomy (n = 32). All axillary nodes, dissected in 20 patients, were free of tumor. One patient had extramammary spread at diagnosis. The neoplasms were 1.4 cm to 13.0 cm (mean, 4.6 cm), and 60% were grossly circumscribed. Tumors were classified as fibroblastic (n = 28), osteoclastic (n = 14), or osteoblastic (n = 8). Of 39 patients with available follow-up information, locally recurrent(n = 11)and metastatic (n = 15) disease developed in 23 (59%) at a mean of 10.5 and 14.5 months from diagnosis. Eight (73%) patients in whom local recurrence developed were treated with excisional biopsy or tylectomy; of these, seven had a positive margin. Sixteen (41%) patients died of disease at a mean of 17.1 months, within 20 months of onset of metastases, most commonly to the lung. Mammary osteosarcomas are aggressive tumors with a propensity for blood-borne rather than lymphatic spread. Total excision without axillary dissection is advised.