Basal-like karcinom prsu - aktuální přehled problematiky a klinicko-patologické korelace

Basal-like Carcinoma of the Breast – the Actual Review and Clinico-Pathological Corelations

Objective:
Comprehensive review of current topic called basal-like carcinoma of the breast, focused on morphology, molecular biology and clinico-pathological aspects concerning biology, prognosis and rational therapy.

Design:
Review article.

Setting:
Biopsy Lab s.r.o. and Šikl’s Department of Pathology, Charles University and Faculty Hospital, Pilsen.

Methods:
Summarized are recent data, diagnostic principals and clinico-pathological recommendations of basal-like carcinoma and outlined is comprehensive guide for daily diagnostic and therapeutic practice.

Results:
Basal-like carcinoma of the breast is a subset of tripple negative lesions (ER-/PR-/Her2-) and accounts for approximately 5-7% all ductal carcinomas. This is a highly aggressive tumor characterized by rapid systemic dissemination, especially to the lung and brain. By definition, there is expression of high molecular weight cytokeratins and in up to 50% of cases alteration of EGFR gene is found, which creates potential for targeted therapy with tyrosin kinase inhibitors. Basic morphology derives from medullary carcinoma with sharp margin from adjacent parenchyma and presents archetype of BRCA1 mutated familial cancer. Existence of the rare noninvasive in situ phase of the basal-like carcinoma having similar phenotype enables both early and reliable diagnosis even from small core biopsy specimens. Correct diagnosis of this relentless tumor not only brings the chance for effective monitoring specific organs apt to potential metastasis but also challenges for implementation of alternative therapeutic approach, because standard protocols usually fail.

Key words:
breast, basal-like carcinoma, triple negative tumors, EGFR, target therapy