乳腺恶性血液病的病理类型、临床特点及生存分析

目的:探讨乳腺恶性血液病的病理分型、患者的临床特征及预后。方法:回顾性分析2014年1月至2019年1月空军军医大学西京医院收治的33例乳腺恶性血液病患者的病理分型、临床特征及预后。结果:33例患者中,32例为女性,1例为男性,平均年龄为45.5岁(12-78岁)。经病理确诊29例(29/33,87.9%)为非霍奇金淋巴瘤,其中弥漫大B细胞淋巴瘤(18/29,62.1%)最为常见,其次是NK/T细胞淋巴瘤(3/29,10.3%),B淋巴母细胞白血病/淋巴瘤(2/29,6.8%),而伯基特淋巴瘤、滤泡淋巴瘤、原发皮肤间变大细胞淋巴瘤各1例(1/29,3.4%),其余3例未进一步分型。此外,1例(1/33,3.0%)霍奇金淋巴瘤,3例(3/33,9.1%)急性白血病复发累及乳腺。原发性乳腺恶性血液病为19例(57.6%),继发性为14例(42.4%),病变主要累及右侧乳腺(18例,54.5%),其次为左侧(10例,30.3%),双侧均累及的为少数(5例,15.2%)。19例原发性乳腺恶性血液病均为淋巴瘤,与14例继发性乳腺恶性血液病相比,其血小板计数明显升高(P=0.004),β2-MG显著降低(P=0.049),B症状少(P=0.017),Ann Arbor分期主要为Ⅰ-Ⅱ期(P<0.01),骨髓受累少(P<0.01)等特点。生存分析提示原发性乳腺恶性血液病患者比继发性患者生存期更长(HR=9.846,P=0.002)。恶性血液病累及骨髓可导致生存期显著缩短(HR=6.434,P<0.01)。结论:乳腺恶性血液病患者以中年女性为主,原发性乳腺恶性血液病比继发性发病率高(分别为57.5%和42.5%),最常见的病理类型为弥漫大B细胞淋巴瘤,病变主要累及右侧乳腺。与继发性乳腺恶性血液病相比,原发性乳腺恶性血液病患者具有血小板计数相对更高,β2-MG水平更低,往往不伴B症状,Ann Arbor分期主要为Ⅰ-Ⅱ期,骨髓不受累,且生存期显著延长等特点。此外,恶性血液病累及骨髓提示预后不良。

Hematologic Malignancies of the Breast: A Investigating Pathological Subtypes, Clinical Characteristics and Prognosis

Objectives: To investigate pathological subtypes, clinical characteristics and prognosis of patients with breast hematological malignancies. Methods: We conducted a retrospective review of Xijing Hospital of Air Force Medical University for hematological malignancies diagnosed in breast tissue form Jan.2014 to Jan 2019. Pathological subtypes, clinical characteristics, and patient outcomes were analyzed. Results: We identified 33 cases, 32 of them were female, with a mean age of 45.5 years(12-78 years). By pathological diagnosis of 30 cases were lymphomas which included 29(29/33, 87.9%) Non-Hodgkin lymphoma(NHL) and 1(1/33, 3.0%) Hodgkin lymphoma and 3(3/33, 9.1%) were recurrence of acute leukemias. The 29 NHL cases included 18(18/29, 62.1%) diffuse large B-cell lymphomas(DLBCLs), 3(3/29, 10.3%) NK/T cell lymphomas, 2(2/29, 6.8%) B lymphoblastic leukemia/lymphomas(B-ALL/LBLs), 1(1/29, 3.4%) each of follicular lymphoma(FL), Burkitt lymphoma, primary cutaneous anaplastic large cell lymphoma(C-ALCL) and 3(3/29, 10.3%) lymphomas-not otherwise specified. In total, 9(57.6%) cases were primary, which were all lymphomas, and 14(42.4%)cases were secondary to the breast. Our study showed the lesions were mainly involved in the right breast(18/33, 54.5%), followed by the left breast(10/33, 30.3%), and were rarely involved in both sides(5/33, 15.2%). 19 primary cases had higher platelet count(P=0.004), significantly lower β2-MG(P=0.049), less B symptoms(P=0.017)and bone marrow involvement(P<0.01), more were Ann Arbor stage I-II(P<0.01) than secondary ones. Significant statistical difference in OS is shown between primary cases and secondary ones(HR=9.846,P=0.002). Patients with marrow involvement had worse overall survival(OS) than those without marrow involvement(HR=6.434, P<0.01). Conclusions: The majority of breast hematological malignancies patients are middle-aged females. Primary hematological malignancies of the breast are more common than secondary ones: 57.5 % versus 42.5%. Our study showed that the most common hematological malignancy was DLBCL, with the right breast mass as the main clinical manifestation. Primary cases had significant higher platelet count, lower β2-MG, less B symptoms and bone marrow involvement, more were Ann Arbor stage I-II than secondary ones.Moreover, primary cases had better OS than secondary ones. Patients with marrow involvement was associated with an inferior outcome.