Аннотация
Рак молочной железы (РМЖ) по своим клиническим, морфологическим и биологическим характеристикам является гетерогенным заболеванием. Данные особенности влияют на клиническое течение, прогноз и ответ на системное лечение. В подавляющем числе случаев специалисты сталкиваются с инвазивным неспецифическим РМЖ и только в 5–15 % случаев — с инвазивным дольковым раком. Еще реже выявляются особые морфологические подтипы РМЖ.
Если для неспецифического РМЖ существуют четкие стандарты лечения, то для большинства особых форм их пока нет. Это отчасти связано с несоответствием их биологических характеристик клиническому течению. В частности, некоторые особые варианты РМЖ с неблагоприятным иммуногистохимическим профилем могут характеризоваться хорошим прогнозом. Кроме того, в пределах одного морфологического варианта встречаются гистологические подтипы как с благоприятным, так и с агрессивным течением. Оценить истинную эффективность классических методов лечения РМЖ достаточно сложно ввиду отсутствия клинических рандомизированных исследований, включающих больных с особыми формами заболевания. Основная доля научных публикаций по данной тематике ограничена небольшими ретроспективными исследованиями или описанием отдельных клинических случаев. В результате алгоритм лечения особых форм РМЖ иногда может не соответствовать биологическим характеристикам опухоли, а иногда и в корне отличаться от рекомендуемых стандартов лечения РМЖ. В настоящей публикации отражен анализ литературы и собственные данные, касающиеся особых форм РМЖ с благоприятным прогнозом. К таким формам относятся муцинозная карцинома, тубулярный рак, криброзная карцинома, папиллярная карцинома, медуллярный рак, апокриновый рак, аденосквамозный рак, секреторный рак, аденокистозный рак и ацинарноклеточная карцинома молочной железы. Во второй части будут рассмотрены неблагоприятные формы и формы с неопределенным прогнозом.
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