pdf (俄语)
pdf suppl (俄语)

关键词

рак молочной железы
муцинозная карцинома молочной железы
тубулярный рак молочной железы
криброзная карцинома молочной железы
папиллярная карцинома молочной железы
медуллярный рак молочной железы
апокриновый рак молочной железы
секреторный рак молочной железы
аденокистозный рак молочной железы
ацинарноклеточная карцинома молочной железы
особые типы/подтипы рака молочной железы

##submission.howToCite##

Особые гистологические типы рака молочной железы. Благоприятный прогноз. (2025). VOPROSY ONKOLOGII, 71(3), OF-2397. https://doi.org/10.37469/0507-3758-2025-71-3-OF-2397

摘要

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.

pdf (俄语)
pdf suppl (俄语)

参考

Amin M.B., Edge S.B., Greene F.L., et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017; 67(2): 93–99.-DOI: 10.3322/caac.21388.

World Health Organization. WHO classification of tumours of the breast. Lyon: IARC. 2019; 356.-DOI: 10.1007/978-3-319-78121-4.

Weigelt B., Geyer F.C., Reis-Filho J.S. Histological types of breast cancer: how special are they? Mol Oncol. 2010; 4(3): 192–208.-DOI: 10.1016/j.molonc.2010.03.004

Мартынова Г. В., Высоцкая И. В., Летягин В. П., et al. Особенности клинической картины и биологических характеристик редких форм рака молочной железы. Опухоли женской репродуктивной системы. 2008; (3): 14–19.-DOI: 10.17650/1994-4098-2008-0-3-14-19. [Martynova G. V., Vysotskaya I. V., Letyagin V. P., el. al. Clinical features and biological characteristics of rare forms of breast cancer. Tumors of Female Reproductive System. 2008; (3): 14–19.-DOI: 10.17650/1994-4098-2008-0-3-14-19 (In Rus)].

Высоцкая И. В., Мартынова Г. В., Летягин В. П., et al. Клинико-морфологические особенности и прогноз при редких формах рака молочной железы. Опухоли женской репродуктивной системы. 2010; (1): 29–36.-DOI: 10.17650/1994-4098-2010-0-1-29-36. [Vysotskaya I. V., Martynova G. V., Letyagin V. P., et al. Clinical and morphological features and prognosis in rare forms of breast cancer. Tumors of Female Reproductive System. 2010; (1): 29–36.-DOI: 10.17650/1994-4098-2010-0-1-29-36 (In Rus)].

Rakha E.A., Reis-Filho J.S., Baehner F., et al. Tubular carcinoma of the breast: further evidence to support its excellent prognosis. J Clin Oncol. 2010; 28(1): 99–104.-DOI: 10.1200/JCO.2009.21.3977.

Оксанчук Е. А., Меских Е. В., Фролов И. М. Редкие формы рака молочной железы. Онкология. Журнал им. П.А. Герцена. 2015; 4(1): 30–36. [Oksanchuk E. A., Meskikh E. V., Frolov I. M. Rare forms of breast cancer. Journal of Oncology named after P.A. Hertsen = Onkologiya. Zhurnal im. P.A. Gertsena. 2015; 4(1): 30–36 (In Rus)].

Jenkins S., Kachur M.E., Rechache K., et al. Rare breast cancer subtypes. Curr Oncol Rep. 2021; 23(5): 54.-DOI: 10.1007/s11912-021-01048-4.

Nascimento R.C., Otoni K M. Histological and molecular classification of breast cancer: what do we know? Mastology. 2020; 30: 1-8.-DOI: 10.29289/25945394202020200024.

Di Saverio S., Gutierrez J., Avisar E. A retrospective review with long-term follow-up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat. 2008; 111(3): 541–547.-DOI: 10.1007/s10549-007-9809-z.

Демяшкин Г. А., Пастухова Д. А., Сердюк И. А., Сидорин А. В. Муцинозная карцинома молочной железы: иммунофенотипическая характеристика. Крымский журнал экспериментальной и клинической медицины. 2017; 7(2): 40–45. [Demyashkin G. A., Pastukhova D. A., Serdyuk I. A., Sidorin A. V. Mucinous breast carcinoma: immunophenotypic characteristics. Crimean Journal of Experimental and Clinical Medicine = Krymskiy zhurnal eksperimentalnoy i klinicheskoy meditsiny. 2017; 7(2): 40–45 (In Rus)].

Ranade A., Batra R., Sandhu G., et al. Clinicopathological evaluation of 100 cases of mucinous carcinoma of breast with emphasis on axillary staging and special reference to a micropapillary pattern. J Clin Pathol. 2010; 63(12): 1043-7.-DOI: 10.1136/jcp.2010.082495.

Memis A., Ozdemir N., Parildar M., et al. Mucinous (colloid) breast cancer: mammographic and US features with histologic correlation. European Journal of Radiology. 2000; 35(1): 39-43.-DOI: 10.1016/s0720-048x(99)00124-2.

Kim H.S., Lee J.U., Yoo T.K., et al. Omission of chemotherapy for hormone receptor-positive, small, node-negative mucinous breast carcinoma. J Breast Cancer. 2019; 22(4): 599–612.-DOI: 10.4048/jbc.2019.22.e46.

Limaiem F., Mlika M. Tubular Breast Carcinoma. 2023. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025.

Brandt S., Young G., Hoda S. The "Rosen Triad": Tubular carcinoma, lobular carcinoma in situ, and columnar cell lesions. Advances in Anatomic Pathology. 2008; 15: 140-146.

Sullivan T., Raad R.A., Goldberg S., et al. Tubular carcinoma of the breast: a retrospective analysis and review of the literature. Breast Cancer Research and Treatment. 2005; 93(3): 199-205.-DOI: 10.1007/s10549-005-5089-7.

Lagios M.D., Rose M.R., Margolin F.R. Tubular carcinoma of the breast: association with multicentricity, bilaterality, and family history of mammary carcinoma. American Journal of Clinical Pathology. 1980; 73(1): 25-30.-DOI: 10.1093/ajcp/73.1.25.

Rakha E.A., Reis-Filho J.S., Baehner F., et al. Tubular carcinoma of the breast: further evidence to support its excellent prognosis. J Clin Oncol. 2010; 28(1): 99–104.-DOI: 10.1200/JCO.2009.21.3977.

Wells C.A., Ferguson D.J. Ultrastructural and immunocytochemical study of a case of invasive cribriform breast carcinoma. Journal of Clinical Pathology. 1988; 41(1): 17-20.-DOI: 10.1136/jcp.41.1.17.

Munzone E., Giobbie-Hurder A., Gusterson B.A., et al. Outcomes of special histotypes of breast cancer treated in the BIG 1-98 trial. Ann Oncol. 2015; 26(12): 2442–2449.-DOI: 10.1093/annonc/mdv391.

Colleoni M., Russo L., Dellapasqua S. Adjuvant therapies for special types of breast cancer. Breast. 2011; 20 Suppl 3: 153-7.-DOI: 10.1016/S0960-9776(11)70315-0.

McDivitt R.W., et al. Tumors of the breast, by Robert W. McDivitt, Fred W. Stewart, and John W. Berg. Washington: Armed Forces Institute of Pathology. 1968.

Huang K., Appiah L., Mishra A., et al. Clinicopathologic characteristics and prognosis of invasive papillary carcinoma of the breast. Journal of Surgical Research. 2021; 261: 105-112.-DOI: 10.1016/j.jss.2020.12.026.

Geschickter C.F., Copeland M.M. Diseases of the breast: diagnosis, pathology, and treatment. Philadelphia: Lippincott. 1945.

Foote F.W., Stewart F.W. A histologic classification of carcinoma of the breast. Surgery. 1946; 19(1).

Moore O.S., Foote F.W. The relatively favorable prognosis of medullary carcinoma of the breast. Cancer. 1949; 2(4).

Park I., Kim J., Kim M., et al. Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma. J Breast Cancer. 2013; 16(4): 417-25.-DOI: 10.4048/jbc.2013.16.4.417.

Mills M.N., Yang G.Q., Oliver D.E., et al. Histologic heterogeneity of triple negative breast cancer: a National Cancer Centre Database analysis. Eur J Cancer. 2018; 98: 48–58.-DOI: 10.1016/j.ejca.2018.04.011.

Vincent-Salomon A., Gruel N., Lucchesi C., et al. Identification of typical medullary breast carcinoma as a genomic sub-group of basal-like carcinomas, a heterogeneous new molecular entity. Breast Cancer Res. 2007; 9(2): R24.-DOI: 10.1186/bcr1666.

Surabhi D.M., Wilson J.C., Singh M., Green L. Recognizing invasive breast carcinoma of no special type with medullary pattern. Radiol Case Rep. 2023; 18(5): 1788-1792.-DOI: 10.1016/j.radcr.2023.01.052.

Huober J., Gelber S., Goldhirsch A., et al. Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials. Annals of Oncology. 2012; 23(11): 2843-2851.-DOI: 10.1093/annonc/mds105.

Meyer J.E., Amin E., Lindfors K.K., et al. Medullary carcinoma of the breast: mammographic and US appearance. Radiology. 1989; 170(1 Pt 1): 79-82.-DOI: 10.1148/radiology.170.1.2642350.

Stratton M.R. Pathology of familial breast cancer: differences between breast cancers in carriers of BRCA1 or BRCA2 mutations and sporadic cases. Lancet. 1997; 349(9064): 1505–1510.

Eichhorn J.H. Medullary carcinoma, provocative now as then. Semin Diagn Pathol. 2004; 21(1): 65–73.-DOI: 10.1053/j.semdp.2003.10.005.

Tremblay G. Histochemical studies of oxidative enzymes in apocrine-like cells of the breast and in axillary apocrine glands. Journal of Investigative Dermatology. 1968; 50(3).

Cao L., Niu Y. Triple negative breast cancer: special histological types and emerging therapeutic methods. Cancer Biol Med. 2020; 17(2): 293-306.-DOI: 10.20892/j.issn.2095-3941.2019.0465.

Shirian F., Kheradmand P., Ranjbari N., et al. Immunoexpression of the GCDFP-15 Marker in Different Grades of Breast Carcinoma. Iran J Pathol. 2023; 18(1): 75-81.-DOI: 10.30699/ijp.2023.558196.2945.

Gonzalez-Angulo A.M., Morales-Vasquez F., Hortobagyi G.N. Overview of resistance to systemic therapy in patients with breast cancer. Adv Exp Med Biol. 2007; 608: 1-22.-DOI: 10.1007/978-0-387-74039-3_1.

Banneau G., Guedj M., MacGrogan G., et al. Molecular apocrine differentiation is a common feature of breast cancer in patients with germline PTEN mutations. Breast Cancer Res. 2010; 12(4): R63.-DOI: 10.1186/bcr2626.

Sun X., Zuo K., Yao Q., et al. Invasive apocrine carcinoma of the breast: clinicopathologic features and comprehensive genomic profiling of 18 pure triple-negative apocrine carcinomas. Mod Pathol. 2020; 33(12): 2473–2482.-DOI: 10.1038/s41379-020-0589-x.

Hu T., Liu Y., Wu J., et al. Triple-negative apocrine breast carcinoma has better prognosis despite poor response to neoadjuvant chemotherapy. Journal of Clinical Medicine. 2022; 11(6): 1607.-DOI: 10.3390/jcm11061607.

Romanucci G., Mercogliano S., Carucci E., et al. Low-grade adenosquamous carcinoma of the breast: a review with focus on imaging and management. Acta Radiol Open. 2021; 10(4): 20584601211013501.-DOI: 10.1177/20584601211013501.

González-Martínez S., Pérez-Mies B., Carretero-Barrio I., et al. Molecular features of metaplastic breast carcinoma: an infrequent subtype of triple negative breast carcinoma. Cancers (Basel). 2020; 12(7): 1832.-DOI: 10.3390/cancers12071832.

Rakha E.A., Tan P.H., Naik R., et al. Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management. Histopathology. 2016; 68(1): 45–56.-DOI: 10.1111/his.12861.

Bataillon G., Fuhrmann L., Girard E., et al. High rate of PIK3CA mutations but no TP53 mutations in low-grade adenosquamous carcinoma of the breast. Histopathology. 2018; 73(2): 273–283.-DOI: 10.1111/his.13514.

Tamminen A., Boström P. Low-grade adenosquamous carcinoma of the breast: a single-center retrospective study and a systematic literature review. Cancers. 2024; 16(24): 4246.-DOI: 10.3390/cancers16244246.

Hoda R.S., Brogi E., Pareja F., et al. Secretory carcinoma of the breast: clinicopathologic profile of 14 cases emphasising distant metastatic potential. Histopathology. 2019; 75(2): 213–224.-DOI: 10.1111/his.13879.

Horowitz D.P., Sharma C.S., Connolly E., et al. Secretory carcinoma of the breast: results from the survival, epidemiology and end results database. Breast. 2012; 21(3): 350–353.-DOI: 10.1016/j.breast.2012.02.013.

Li D., Xiao X., Yang W., et al. Secretory breast carcinoma: a clinicopathological and immunophenotypic study of 15 cases with a review of the literature. Mod Pathol. 2012; 25(4): 567–575.-DOI: 10.1038/modpathol.2011.190.

Jacob J.D., Hodge C., Franko J., et al. Rare breast cancer: 246 invasive secretory carcinomas from the National Cancer Database. J Surg Oncol. 2016; 113(7): 721–725.-DOI: 10.1002/jso.24241.

Pareja F., Ferrando L., Lee S.S.K., Beca F., et al. The genomic landscape of metastatic histologic special types of invasive breast cancer. NPJ Breast Cancer. 2020; 6: 53.-DOI: 10.1038/s41523-020-00195-4.

Roviello G., D’Angelo A., Sciortino M., et al. TRK fusion positive cancers: from first clinical data of a TRK inhibitor to future directions. Crit Rev Oncol Hematol. 2020; 152: 103011.-DOI: 10.1016/j.critrevonc.2020.103011.

Li L., Wu N., Li F., et al. Clinicopathologic and molecular characteristics of 44 patients with pure secretory breast carcinoma. Cancer Biol Med. 2019; 16(1): 139-146.-DOI: 10.20892/j.issn.2095-3941.2018.0035.

Nassira K., Haloui A., Bekhakh C., et al. Secretory breast carcinoma: a rare breast cancer with an excellent behavior. Cureus. 2024; 16(11): e73312.-DOI: 10.7759/cureus.73312.

Dietrich, M.; Velez, M. Larotrectinib in NTRK3 fusion-positive metastatic secretory carcinoma of the breast: A case study. Curr Prob Cancer Case Rep. 2025; 17: 100334.-DOI: 10.1016/j.cpccr.2024.100334.

Santamaría G., Velasco M., Zanón G., et al. Adenoid cystic carcinoma of the breast: mammographic appearance and pathologic correlation. AJR Am J Roentgenol. 1998; 171(6): 1679–1683.-DOI: 10.2214/ajr.171.6.9843312.

Marchiò C., Weigelt B., Reis-Filho J.S. Adenoid cystic carcinomas of the breast and salivary glands (or 'The strange case of Dr Jekyll and Mr Hyde' of exocrine gland carcinomas). J Clin Pathol. 2010; 63(3): 220–228.-DOI: 10.1136/jcp.2009.073908.

Weigelt B., Horlings H.M., Kreike B., et al. Refinement of breast cancer classification by molecular characterization of histological special types. J Pathol. 2008; 216(2): 141–150.-DOI: 10.1002/path.2407.

Martelotto L.G., De Filippo M.R., Ng C.K., et al. Genomic landscape of adenoid cystic carcinoma of the breast. J Pathol. 2015; 237(2): 179–189.-DOI: 10.1002/path.4573.

Gonda T.J., Ramsay R.G. Adenoid cystic carcinoma can be driven by MYB or MYBL1 rearrangements: new insights into MYB and tumor biology. Cancer Discov. 2016; 6(2): 125–127.-DOI: 10.1158/2159-8290.CD-15-1470.

Tavassoli F.A., Eusebi V. Tumors of the mammary gland. Washington, D.C: American Registry of Pathology in collaboration with the Armed Forces Institute of Pathology. 2009; XV: 418(ill).

Fausto-Sterling M., et al. (ed.) WHO classification of tumours of the breast, 4th ed. Lyon: IARC Press. 2012.

Roncaroli F., Lamovec J., Zidar A., et al. Acinic cell-like carcinoma of the breast. Virchows Arch. 1996; 429(1): 69–74.-DOI: 10.1007/BF00196823.

Sakuma T., Mimura A., Tanigawa N., et al. Fine needle aspiration cytology of acinic cell carcinoma of the breast. Cytopathology. 2013; 24(6): 403–405.-DOI: 10.1111/j.1365-2303.2012.00996.x.

Conlon N., Sadri N., Corben A.D., et al. Acinic cell carcinoma of breast: morphologic and immunohistochemical review of a rare breast cancer subtype. Hum Pathol. 2016; 51: 16–24.-DOI: 10.1016/j.humpath.2015.12.014.

Damiani S., Pasquinelli G., Lamovec J., et al. Acinic cell carcinoma of the breast: an immunohistochemical and ultrastructural study. Virchows Arch. 2000; 437(1): 74–81.-DOI: 10.1007/s00428-000-0206.

Chang E.D., Lee E.J., Lee A.W., et al. Primary acinic cell carcinoma of the breast: a case report with an immunohistochemical and ultrastructural study. J Breast Cancer. 2011; 14(2): 160–164.-DOI: 10.4048/jbc.2011.14.2.160.

Guerini-Rocco E., Hodi Z., Piscuoglio S., et al. The repertoire of somatic genetic alterations of acinic cell carcinomas of the breast: an exploratory, hypothesis-generating study. J Pathol. 2015; 237(2): 166–178.-DOI: 10.1002/path.456670.

Khalifeh I.M., Albarracin C., Diaz L.K., et al. Clinical, histopathologic, and immunohistochemical features of microglandular adenosis and transition into in situ and invasive carcinoma. Am J Surg Pathol. 2008; 32(4): 544–552.-DOI: 10.1097/PAS.0b013e31815a87e2.

Koenig C., Dadmanesh F., Bratthauer G.L., et al. Carcinoma arising in microglandular adenosis: an immunohistochemical analysis of 20 intraepithelial and invasive neoplasms. Int J Surg Pathol. 2000; 8(4): 303–315.-DOI: 10.1177/106689690000800409.

Geyer F.C., Kushner Y.B., Lambros M.B., et al. Microglandular adenosis or microglandular adenoma? A molecular genetic analysis of a case associated with atypia and invasive carcinoma. Histopathology. 2009; 55(6): 732–743.-DOI: 10.1111/j.1365-2559.2009.03432.x.

Guerini-Rocco E., Piscuoglio S., Ng C.K.Y., et al. Microglandular adenosis associated with triple-negative breast cancer is a neoplastic lesion of triple-negative phenotype harbouring TP53 somatic mutations. J Pathol. 2016; 238(5): 677–688.-DOI: 10.1002/path.4691.

Peintinger F., Leibl S., Reitsamer R., et al. Primary acinic cell carcinoma of the breast: a case report with long-term follow-up and review of the literature. Histopathology. 2004; 45(6): 645–648.-DOI: 10.1111/j.1365-2559.2004.01957.x/.

Ajkunic A., Skenderi F., Shaker N., et al. Acinic cell carcinoma of the breast: A comprehensive review. Breast. 2022; 66: 208-216.-DOI: 10.1016/j.breast.2022.10.012.

##submission.license.cc.by-nc-nd4.footer##

##submission.copyrightStatement##