Breast carcinoma in pregnant women - Assessment of clinicopathologic and immunohistochemical features
Breast carcinoma in pregnant women - Assessment of clinicopathologic and immunohistochemical features
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DOI：
10.1002/cncr.11614
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发表时间：
2003-09-01
期刊：
影响因子：
6.2
通讯作者：
Sahin, A
中科院分区：
文献类型：
--
作者：
Middleton, LP;Amin, M;Sahin, A
背景乳腺癌是妊娠妇女最常见的恶性肿瘤之一。由于生育延迟和筛查增加的趋势，乳腺癌的发病率在未来可能会增加。然而，很少有当代研究试图确定这些患者乳腺癌的组织病理学和免疫组化特征。作者对39例妊娠期乳腺癌进行了分析。这包括一个关键的组织学审查和免疫组化评估，以确定状态的预后和预测指标，包括雌激素受体（ER），孕激素受体（PR），HER-2/neu，Ki-67，和p53。就诊时的平均年龄为33岁（范围：24-44岁）。在16例有可用影像学信息的患者中，14例在乳房X线片上观察到密度和/或肿块。原发肿瘤最大径平均4.5 cm（范围0.1-13.5 cm）。39例患者中有2例患者在就诊时患有临床（美国癌症联合委员会）I期疾病，19例患者患有11期疾病，16例患者患有III期疾病，2例患者患有IV期疾病。组织学上，高级别浸润性导管癌被发现在32 38例。1例患者的原发性肿瘤无法进行审查。在9例患者中观察到主要为实体生长模式。在61%的病例中发现了血管侵犯。导管原位癌在72%的肿瘤中被确定，并且在所有病例中均为高级别。在25例受试患者中，ER阳性7例，PR阳性6例，HER-2/neu阳性7例，p53阳性12例。Ki-67染色显示60%的病例增殖率较高。35例患者的随访信息可用，平均随访期为43个月（范围，2-163个月）。远处转移7例。至疾病复发的平均时间为20.4个月（范围，10-33个月）。在35例患者中，4例死亡，22例存活但无疾病证据，9例在末次随访时仍存活。其余4例患者死亡原因不明。患有乳腺癌的孕妇通常表现为晚期疾病，并且肿瘤具有不良的组织学和预后特征。随访结果表明，这些肿瘤并不像早期报告中所提出的那样具有非常侵袭性的临床过程。发生在怀孕期间的乳腺癌与发生在其他年轻女性的乳腺癌有许多组织学和预后相似之处。(C)2003年美国癌症协会。
BACKGROUND. Breast carcinoma is one of the most common carcinomas in pregnant women. The incidence of breast carcinoma may increase in the future because of the trend toward delayed childbearing and increased screening. However, very few contemporary studies have attempted to identify the combined histopathologic and immunohistochemical features of breast carcinoma in these patients.METHODS. The authors evaluated 39 patients with breast carcinoma occurring coincident with pregnancy. This was comprised of a critical histologic review and immunohistochemical evaluation to determine the status of prognostic and predictive markers including estrogen receptor (ER), progesterone receptor (PR), HER-2/neu, Ki-67, and p53.RESULTS. The mean age at presentation was 33 years (range, 24-44 years). Densities and/or masses were noted on mammograms in 14 of 16 patients with available radiographic information. The primary tumors were a mean of 4.5 cm in greatest dimension (range, 0.1-13.5 cm). Two of the 39 patients had clinical (American joint Committee on Cancer) Stage I disease, 19 patients had Stage 11 disease, 16 had Stage III disease, and 2 patients had Stage IV disease at the time of presentation. Histologically, high-grade invasive ductal carcinomas were found in 32 of 38 patients. The primary tumor was not available for review in one patient. A predominantly solid pattern of growth was observed in nine patients. Lymphovascular invasion was identified in 61% of cases. Ductal carcinoma in situ was identified in 72% of tumors and was high grade in all cases. Of the 25 patients tested, ER positivity was found in 7 patients, PR positivity was found in 6 patients, HER-2/neu positivity was found in 7 patients, and p53 positivity was found in 12 patients. The proliferation rate as shown by Ki-67 staining was high in 60% of the cases. Follow-up information was available for 35 patients and the mean follow-up period was 43 months (range, 2-163 months). Distant metastasis occurred in seven patients. The mean time to disease recurrence was 20.4 months (range, 10-33 months). Of 35 patients, 4 have died, 22 were alive with no evidence of disease, and 9 were alive with disease at the last follow-up. The remaining four patients died of unknown causes.CONCLUSIONS. Pregnant women with breast carcinomas generally present with advanced-stage disease and the tumors have poor histologic and prognostic features. The findings from the follow-up indicated that these tumors do not follow a very aggressive clinical course as was proposed in earlier reports. Breast carcinomas occurring during pregnancy share many histologic and prognostic similarities with breast carcinoma occurring in other young women. (C) 2003 American Cancer Society.