第10回京都乳癌コンセンサス会議 ミニレクチャー「特殊型乳 …

1 Invasive Lobular Carcinoma 10 16 2008 In situ carcinoma15-30% 80%20%Invasive carcinoma70-85% / 79%10%6%2%2%1%< 1%Robbins and Cotran pathologic basis of disease , Professional Edition, 8thEditionLi Cl et al. JAMA 2003; 289: 1421-41987~1999 Li Cl et al. JAMA 2003; 289: 1421-4Li Cl et al.

2 Cancer Epidemiol Biomarkers Prev 2007; 16: 1773-80 ILCIDCAll invasvie cancers SEER 1998 2004 50 / * Women s Health Initiative Trial Results ERT 17% 7%1999 2004 Eheman CR et al. Cancer Epidemiol Biomarkers Prev 2009; 18: 1763-9 5~15% HRT 50 >2cm 50% vs. 39% in IDC mutifocal bilateral 6~47% 70~80% * 43% vs.

3 16% in IDC mSBR grade-II ~76% ER ~93% AR ~88% vs. ~56% in IDC HER2 ~11% E-cadherin * indian file indian file indian file targetoid / onion skin (tubulolobular variant) Solid ILC Alveolar ILC Apocrine ILC Signet-ring cell ILC Histiocytoid ILC Pleomorphic ILC Tubulolobular carcinoma Weigelt B et al.

4 J Pathol 2009;220:45-57 grade molecular subtype Down-regulationUp-regulation E-cadherin DNA TGF- / / vs Classical Lumina ER/PR HER2 mSBR grade I,II Pleomorphic Luminal, HER2, mSBR gradeIII Aggressive Invasive lobular carcinomaWeigelt B et al. J Pathol 2009;220:45-57 HER2 92% vs. 68% CD44 31% vs. 16% VEGFR2 36% vs.

5 47% 5 15% vs. 25% E-cadherin 0% vs. 90% N0 Gonzalez-Angulo AM at al. Clin Breast Cancer 2006; 7: 396-400E-CadE-cadherin 5 E-cadherin 16 Ch LOH E-cadherin E-cadherin ~ LOH E-Cadherin Rakha EA et al. Am J Surg Pathol 2001;34:1472-79 16% (38/239) E-Cadherin tubulolobular, mixed 43% vs 19% , , - p120 p120 E- - mSBR system ?

6 Grade AJCC stage ER, PR, E-cadherin HER2 Bane AL et al. 2005 mSBR system ?OverallGrade-IGrade-IIGrade-III 46765539 Classical 53715538mSBR grade 10 Periera et al. Histopathol 1995; 27219-226 Rakha EA et al. Breast Cancer Res Treat 2008; 111: 121-7 mSBR grade N=517 Rakha EA et al. Breast Cancer Res Treat 2008; 111: 121-7 Fritz P et al. Anticancer Res 2010;30;5137-44 ER/PR HER2 ( vs. ; p= ) ER/PR grade Wasif N et al.

7 Ann Surg Oncol 2010;17;1862-9 SEER 1993-2003 263,408 235,769 27,639 2 cm vs. ; P < vs. ; P < ER vs. ; P < Wasif N et al. Ann Surg Oncol 2010;17;1862-9 5 Overall 90 vs. 88%; P < stage T1N0 (98 vs. 96%; P < ) stage T2N0 (94 vs. 88%; P < ) stage T3N0 (92 vs. 83%, P < ) stage T1N1 (89% vs. 88%; P = NS) stage T2N1 (81 vs. 73%; P < ) stage T3N1 (72 vs. 56%; P < ) Survival benefit 14% , 95% CI pCR 15% ( ) 2% NAC Soucy G et al.

8 J Am Coll Surg 2009; 206: 1116-1121 NAC Soucy G et al. J Am Coll Surg 2009; 206: 1116-1121 NAC NAC 21%18% NST 43%16%ER/PR+ER/PR-20%10%p= leptomeninges peritoneal surface retroperitoneum Case CK19 GCDFP-15 ERTAKE HOME 5~15% HRT 50 >2cm 50% vs. 39% in IDC mutifocal bilateral 6~47% TAKE HOME 70~80% * 43% vs.

9 16% in IDC mSBR grade-II ~76% ER ~93% AR ~88% vs. ~56% in IDC HER2 ~11% E-cadherin * 55