基底细胞样型乳腺癌的临床病理观察  

Clinicopathologic characteristics of breast cancer with basal-like immunophenotype

作　　者：邬万新[1] 韩文兰[2] 张燕萍[1] 喻其霞[2] 温晓伟[1] 陆宁[1] 唐正英[1] 袁琳娜[1] 张怡[1] 王振[1] 王伟[1] 杨宏杰[1] 陈彩萍[2] 郭文利[2] 

机构地区：[1]浙江嘉兴学院附属第一医院病理科,314000 [2]浙江嘉兴学院附属第一医院乳腺病科,314000

出　　处：《中华病理学杂志》2008年第11期743-748,共6页Chinese Journal of Pathology

基　　金：浙江省嘉兴市科学技术局重点基金资助项目（2006AZ2005）

摘　　要：目的观察基底细胞样型乳腺癌（BLBC）的临床病理特征。方法采用ER、PR、HER2、Ki-67、CK5／6、CK14和表皮生长因子受体（EGFR）进行免疫组织化学EnVision法检测458例女性浸润性乳腺癌以筛选BLBC，比较BLBC与其他免疫表型乳腺癌的临床病理特征。对其中228例浸润性乳腺癌患者进行了随访。结果458例浸润性乳腺癌中发现BLBC46例（10．0％）。癌灶直径平均3．3cm。58．7％（27／46）出现推挤性生长方式，52．2％（24／46）出现地图状坏死，30．4％（14／46）癌灶中心出现无细胞纤维化区域以及63．0％（29／46）癌灶周边和间质内有不同程度淋巴细胞浸润。癌细胞异型性明显，核分裂象多见，主要排列成不规则、紧密实性结构。Ki-67高表达（〉25％）在BLBC中占43．5％（20／46）。CK5／6、CK14和EGFR阳性分别见于58．7％（27／46）、43．5％（20／46）和65．2％（30／46）的BLBC病例。BLBC的3年累积生存率为66．9％，低于管腔A型乳腺癌，与HER2高表达型乳腺癌差异无统计学意义。结论BLBC在女性浸润性乳腺癌中所占比例为10％，其组织结构和细胞形态具有一定特征性，但诊断BLBC仍必需结合其免疫表型。BLBC是预后比较差的乳腺癌亚型之一。Objective To study the clinicopathologic characteristics of basal-like immunophenotype breast cancer （BLBC）. Methods 458 cases of female infiltrative breast cancer were studied using immunohistochemical staining with an antibody panel of ER, PR, HER2, Ki-67, CK5/6, CK14 and epidermal growth factor receptor （EGFR） and were classified basing on the immunophenotypes. The clinicopathologic characteristics were compared with other immunophenotypes of breast cancer. 228 of 458 cases of breast cancer were followed up. Results 46 cases of BLBC were screened out among the 458 breast cancers. And histological features of BLBC were analysed including the larger diameter of cancer foci （ average 3.3 cm ）, appearance of squeezing phenomenon of neighboring cell borders （ 58. 7% , 27/46 ）, geography-like distribution of necrosis （ 52. 2%, 24/46 ）, central zone fibrosis （ 30. 4%, 14/46 ） and lymphoplasmacytic infiltration at the margin and stroma （63.0% ,29/46）. There were nuclear pleomorphism with numerous mitoses. The cancer cells were closely arranged, forming irregular solid architectures . There was a high expression （ 〉 25% ） of Ki-67 （43.5% ,20/46）. CK5/6, CK14 and EGFR were positive in 58.7% （27/46）, 43.5% （20/46） and 65.2% （30/46） respectively. 3-year survival rate of BLBC was 66. 9%, lower than the luminal A breast cancer and similar to HER2 over-expression breast cancer. Conclusions The proportion of BLBC in the group of breast cancers is 10%. BLBC has its distinct histological and cytological features. Currently, it is still necessary to depend on immunophenotyping in making a BLBC diagnosis. BLBC is the one of breast cancer subtypes with the poorest prognosis.

关 键 词：乳腺肿瘤 癌 基底细胞 免疫表型分型 诊断 预后 

分 类 号：R686[医药卫生—骨科学]