Редкие морфологические формы рака молочной железы: особенности хирургической тактики

Высоцкая И.В., Летягин В.П., Колядина И.В., Мартынова Г.В. Редкие морфологические формы рака молочной железы: особенности хирургической тактики. Современная Онкология. 2016; 18 (1): 45–49.

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Vysotskaya I.V., Letyagin V.P., Kolyadina I.V., Martynova G.V. Rare morphological forms of breast cancer: features of surgical approach. Journal of Modern Oncology. 2016; 18 (1): 45–49.

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Аннотация

В соответствии с рекомендациями Вcемирной организации здравоохранения среди эпителиальных опухолей молочных желез принято выделение карцином редких гистологических подтипов. Это многообразная, малоизученная и прогностически неоднородная группа рака молочной железы. Подобная ситуация связана с редкостью встречаемости в популяции заболевших – от нескольких десятков до единичных случаев, что приводит к невозможности получения статистически достоверных выводов. Это касается как клинических и прогностических особенностей, так и лечебной тактики. Оптимальные подходы локального контроля при инфильтративном протоковом и дольковом варианте рака молочной железы хорошо изучены, определены стандартные хирургические вмешательства и показания к ним. Несколько иначе выглядит ситуация в случае редких гистологических типов рака молочной железы, при которых данный вопрос остается предметом исследований.

Ключевые слова: рак молочной железы, редкие гистологические типы рака молочной железы, органосохраняющее лечение, радикальная мастэктомия, биопсия сторожевого лимфоузла.

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In accordance with WHO recommendations among the epithelial tumors of breast carcinomas made selection of rare histological subtypes. It is diverse, poorly studied and prognostically heterogeneous group of breast cancer. This situation is related to the rarity of their occurrence in the breast cancer population – from several tens to individual cases, which leads to the inability to obtain statistically valid conclusions. This concerns both the clinical and prognostic features and treatment strategy. Optimal control of local approaches in infiltrative ductal and lobular form of breast cancer are well understood, defined the standard surgery and indications for it. Somewhat different is the situation in the case of rare histological types of breast cancer, in which this problem is the subject of research.

Key words: breast cancer, rare histological types of breast cancer, breast conserving surgery, radical mastectomy, sentinel lymph node biopsy.

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1. Martynova G.V. Redkie formy raka molochnoi zhelezy. Lechenie i prognoz. Dis. … kand. med. nauk. M., 2009. [in Russian]
2. Vysotskaia I.V., Ermilova V.D., Letiagin V.P. i dr. Klinicheskie i morfologicheskie osobennosti redkikh gistologicheskikh tipov raka molochnoi zhelezy. M.: ABV-press, 2011. [in Russian]
3. Portnoi S.M.. Rak molochnoi zhelezy (faktory prognoza i lechenie). Dis. … d-ra med. nauk. M., 1998. [in Russian]
4. Koliadina I.V. Lokal'nye retsidivy pervichno-operabel'nogo raka molochnoi zhelezy. Dis. … kand. med. nauk. M.: 2009. [in Russian]
5. Vu-Nishino H, Tavassoli FA, Ahrens WA et al. Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT). Int J Radiat Oncol Biol Phys 2005; 62: 1040–7.
6. Cheang MC et al. Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 2008; 14: 1368–76.
7. Cremoux P et al. p53 mutation as a genetic trait of typical medullary breast carcinoma. J Natl Cancer Inst 1999; 91: 641–3.
8. Xu R, Feiner H et al: Differential amplification and overexpression of HER-2/neu, p53, MIB1, and estrogen receptor/progesterone receptor among medullary carcinoma, atypical medullary carcinoma, and high-grade invasive ductal carcinoma of breast. Arch Pathol Lab Med 2003; 127: 1458–64.
9. A-Yong Cao, Min He, Liang Huang. Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China: a comparison with infiltrating ductal carcinoma-not otherwise specified. World J Surgic Oncol 2013; 11: 91
10. Richardson WW. Medullary carcinoma of the breast; a distinctive tumour type with a relatively good prognosis following radical mastectomy. Br J Cancer 1956; 10: 415–23.
11. Terando AM et al. Treatment and prognosis of Rare Breast Cancer. Ann Surg Oncol 2015; 14: 1268–79.
12. Vranic S, Bender R, Palazzo J et al. A review of adenoid cystic carcinoma of the breast with emphasis on its molecular and genetic characteristics. Hum Pathol 2013; 44: 301–9.
13. Vranic S, Tawfik O, Palazzo J et al. EGFR and HER-2/neu expression in invasive apocrine carcinoma of the breast. Mod Pathol 2010; 23: 644–53.
14. Dellapasqua S, Maisonneuve P, Viale G et al. Immunohistochemically defined subtypes and outcome of apocrine breast cancer. Clin Breast Cancer 2013;13: 95–102.
15. Montagna E, Maisonneuve P, Rotmensz N et al. Heterogeneity of triple-negative breast cancer: Histologic subtyping to inform the outcome. Clin Breast Cancer 2013; 13: 31–9.
16. Chen L, Fan Y, Lang RG et al. Heterogeneity of micropapillary breast cancer: prognosis and outcomes. Int J Surg Pathol 2008; 16: 155–63.
17. Jacobs M, Fan F, Tawfik O. Clinicopathologic and biomarker analysis of invasive pleomorphic lobular carcinoma as compared with invasive classic lobular carcinoma: an experience in our institution and review of the literature. Ann Diagn Pathol 2012; 16:185–189
18. Jung HN, Shin JH, Han BK et al. Are the imaging features of the pleomorphic variant of invasive lobular carcinoma different from classic ILC of the breast? Breast 2013; 22: 324–9.
19. Hennessy et al. Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol 2006; 17: 605–13.
20. Qing Hu, Wei-Xian Chen, Shan-Liang Zhong et al. Current Progress in the Treatment of Metaplastic Breast Carcinoma. Asian Pacific J Cancer Prevent 2013; 14: 6221–5.
21. Sebolt-Leopold. Development of anticancer drugs targeting the MAP kinase pathway. Oncogene 2000; 19: 6594–9.
22. Shah DR, Tseng WH, Martinez SR. Treatment Options for Metaplastic Breast Cancer Oncol 2012; 2012: 706162.
23. Pezzi CM et al. Metaplastic Breast Cancer. Breast Cancer Res Treat 2012; 131 (1): 10.1007/s10549-011-1393-6.
24. Chao TC et al. Metaplastic carcinomas of the breast. J Surg Oncol 1999; 71: 220–5.

Авторы

И.В.Высоцкая*1, В.П.Летягин2, И.В.Колядина3, Г.В.Мартынова1

1 ГБОУ ВПО Первый Московский государственный университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
2 ФГБУ Российский онкологический научный центр им. Н.Н.Блохина Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23;
3 ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*vysotskaya.irina@mail.ru

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I.V.Vysotskaya*1, V.P.Letyagin2, I.V.Kolyadina3, G.V.Martynova1

1 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
2 N.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23;
3 Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 125995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*vysotskaya.irina@mail.ru

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