Contralateral breast cancer: molecular differentiation between metastasis and second primary cancer
Contralateral breast cancer: molecular differentiation between metastasis and second primary cancer
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DOI：
10.1023/a:1010661514306
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发表时间：
2001-05-01
影响因子：
3.8
通讯作者：
Jakesz, R
中科院分区：
文献类型：
--
作者：
Janschek, E;Kandioler-Eckersberger, D;Jakesz, R
一侧乳房的既往癌症是对侧乳房癌症的一个强已知风险因素。肿瘤组织学和核分级的差异被应用于区分转移性扩散和第二原发性癌症，尽管乳腺癌通常具有相同的组织学特征。配对肿瘤中遗传改变的比较可能为辨别克隆关系提供最可靠的方法，从而揭示多原发癌的存在或不存在。我们比较了33例双侧乳腺癌患者的肿瘤中p53基因的突变。通过这种分子方法，我们能够确定13例患者的配对肿瘤之间的关系。两名患者的配对肿瘤具有相同的突变，其中一名患者的第二个病变是首次手术后29个月出现的对侧异时淋巴结转移，另一名患者的第二个病变是扩散到对侧乳房。在11例患者中，突变要么不一致，要么只存在于一个病灶中，证实了双侧乳腺癌的诊断。组织学评价未能提供坚定的诊断在9个11例的一致性，在病理参数，如组织学类型和grading.In我们的研究中，我们可以表明，双侧乳腺恶性肿瘤最常见的代表两个原发性乳腺癌。我们也可以证明对侧乳腺癌扩散确实发生。标准的病理学评估允许一个坚定的诊断，只有在不同的组织学类型的存在。
Previous cancer in one breast is a strong known risk factor for cancer in the contralateral breast. Differences in tumor histology and nuclear grading are applied to distinguish between a metastatic spread and a second primary cancer, although cancers of the breast often share the same histological features. Comparison of genetic alterations in paired tumors may provide the most reliable approach for discerning clonal relationships, hence uncovering the presence or absence of multiple primary cancers. We compared tumors from 33 patients with cancer in both breasts for mutations in the p53 gene. With this molecular approach, we were able to define the relationship within paired tumors in 13 patients. The paired tumors of two patients shared the same mutation, revealing the second lesion in one case as a contralateral metachronous lymph node metastasis appearing 29 months after first surgery, and in the other as a spread to the opposite breast. In 11 patients, mutations were either discordant or solely present in one of the lesions, confirming the diagnosis of bilateral breast cancer. Histopathological evaluation had failed to provide firm diagnosis in nine out of 11 instances on account of concordances in pathological parameters such as histological type and grading.In our study, we could show that bilateral breast malignancies most frequently represent two primary breast cancers. We could also demonstrate that contralateral breast cancer spread does occur. Standard pathological assessment allowed a firm diagnosis only in the presence of different histological types.