含有鳞状细胞癌成分的乳腺化生性癌临床病理特征  

Metaplastic carcinoma with squamous cell component

作　　者：李新军[1] 魏兵[1] 步宏[1] 张红英[1] 陈卉娇[1] 陈海玲[1] 

机构地区：[1]四川大学华西医院病理科,成都610041

出　　处：《临床与实验病理学杂志》2006年第5期531-536,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨含有鳞状细胞癌成分的乳腺化生性癌(metaplastic carcinoma with squamous cell component,MCSC)的临床病理特征和免疫表型特点。方法复习20例MCSC的临床病理资料,总结其巨检、组织学、免疫表型和预后特点。结果本组肿瘤中纯鳞状细胞癌(squamous cell carcinoma,SCC)6例、腺鳞癌(adenosquamous carcinoma,ASC)13例、癌肉瘤1例。全组平均发病年龄52·4岁,多表现为无痛性乳腺肿块。SCC和ASC腋淋巴结转移率分别为60%和66·7%。巨检45%病例呈囊性。镜下角化型SCC2例、棘层松解型1例、角化与棘层松解混合型2例、角化与梭形细胞混合型1例。ASC中的SCC成分均为角化型,腺癌成分则为浸润性导管癌,仅1例混有少量黏液癌。1例癌肉瘤含有鳞癌、腺癌和软骨肉瘤成分。进行免疫组化染色病例的SCC成分均呈CK34βE12、CK5/6、CK14和p63阳性,ER、PR阴性。5例腺癌成分呈CK34βE12灶性阳性,各有1例腺癌成分灶性表达CK14和CK5/6。CK8阳性见于所有腺癌成分,仅1例SCC成分呈灶性阳性。SMA在本组肿瘤的腺鳞两种成分均呈阴性。结论MCSC以ASC最为常见,眼观呈囊性是其特点之一。SCC成分的组织学类型和分化程度存在不同程度变异。CK14、p63和CK8作为一种组合可能有助于SCC的鉴别诊断。规范诊断标准的大样本研究将会提供更有价值的临床病理资料。Purpose To study the clinicopathological and immunohistochemical characteristics of metaplastic carcinoma with squamous cell component （MCSC） of the breast. Methods Clinical information and pathological changes of 20 cases were reviewed and summarized. Results This series consisted of squamous cell carcinoma（SCC） in 6 patients, adenosquamous carcinoma（ASC） in 13 and carcinosarcoma in 1, The mean age of all patients was 52.4 years old and the tumors usually presented as painless mass. Metastasis was observed in 60% of the SCC cases and 66. 7% of the ASC cases with axillary lymph node dissection. Grossly 45% of the cases showed cystic change. Microscopically, phenotypes of SCC included keratinizing, acantholytic, mixed keratinizing and acantholytic, mixed keratinizing and spindle cell types. The squamous elements of ASC were exclusively keratinizing type, The adenocarcinoma in ASC presented as invasive ductal carcinoma and mucinous carcinoma coexisted only in one case. The carcinosarcoma case contained SCC, adenocarcinoma and chondrosarcoma. All SCCs performed immunohistochemical stain demonstrated staining for CK34βE12, CK5/6, CK14, p63 but negative for ER and PR. Adenocarcinoma showed focal positive for CK34βE12 ,CK14 and CK5/6 in 5, 1 and 1 cases respectively. CK8 positive was observed in all adenocarcinoma, only one SCC presented focal positive. SMA was negative in both adenocarcinoma and SCC of all cases. Conclusions ASC is the most common subtype of MCSC and cystic change is one of the pathologic features, while the phenotypes and differentiation of SCC varied. A panel of CK14, p63 and CK8 may be useful in the diagnosis of SCC. Studies with consistent criterions and sufficient cases should give more useful clinicopathological information.

关 键 词：乳腺肿瘤/病理学 化生性癌 癌 鳞状细胞 

分 类 号：R737.9[医药卫生—肿瘤]