乳腺导管内二态性乳头状癌的形态及免疫表型特征  

Morphologic and immunohistochemical features of breast intraductal dimorphic papillary carcinoma

作　　者：邵牧民[1] 徐华[1] 余学问[1] 何沁[1] 

机构地区：[1]广州中医药大学深圳附属医院病理科,深圳518033

出　　处：《临床与实验病理学杂志》2010年第3期265-269,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨乳腺导管内二态性乳头状癌的形态及免疫表型特征。方法收集具有二态性形态学特征的乳腺导管原位癌7例,观察其组织形态学特点,并采用EnVision免疫组化法检测CK5/6、CK34βE12、CK8、CD10、p63、SMA、ER、E-cad、Syn、CgA、GCDFP-15和AR的表达。结果二态性导管内乳头状癌4例,具有二态性特征的筛状型导管原位癌3例;其中4例伴有导管内非典型增生。二态性乳头状癌有两种形态不同的肿瘤细胞:一种是普通性肿瘤细胞,多为柱状细胞,胞质不透明,核为低或中间级别。此类细胞分布于乳头或筛状结构的浅层;第二种细胞是二态性肿瘤细胞,多呈多角形或立方形,胞质透明或淡染,核级别及形态与普通性肿瘤细胞相同。此种细胞位于柱状肿瘤细胞内侧,排列呈条带状、筛状、实性巢状或单个细胞播散分布,其胞质及细胞分布位置类似增生的肌上皮细胞。两种肿瘤细胞均显示CK8、ER阳性,基底高分子量角蛋白(CK5/6、CK34βE12)、肌上皮(CD10、p63、SMA)、Syn和CgA阴性;E-cad阳性5例,另2例部分细胞呈胞膜胞质型微弱阳性而大部分细胞不表达;1例GCDFP-15及AR阳性。结论二态性导管内乳头状癌的两种肿瘤细胞均呈腺系上皮分化,两种肿瘤细胞的形态及胞质染色不同,但核的异型性及其形态相同,免疫组化结果也相同。二态性肿瘤细胞在HE切片内与肌上皮细胞很相似,易被误认为肌上皮,从而导致诊断不足或误诊,宜予高度重视。Purpose To investigate the morphologic and immunohistochemical features of breast intraductal dimorphic papillary carcinoma（DPC）.Methods Seven cases of DCIS of breast were evaluated with hematoxylin eosin stain and immunohistochemistry（EnVision mathod） for the expression of cytokeratins（CK5/6,34βE12,CK8）,myoepithelial markers（CD10,SMA,p63）,neuroendocrine markers（CgA,Syn）,GCDFP-15,AR,ER and E-caddherin.Results Cases with dimorphic forms including four cases intraductal papillary carcinoma and three cases cribriform subtyp intraductal carcinoma.Four cases were accompanied by atypical ductal hyperplasia（ADH） among total 7 cases.The tumor cell types in DPC included the following：ordinary tumor cells,and dimorphic tumor cells.Most of the ordinary tumor cells were columner cells with unclear cytoplasm,low or intermediate grade nuclei,and were located the outer layer of papillary or cribriform structure.The dimorphic tumor cells showed polygonal or cuboidal shape with pale or clear cytoplasm,and had close similarity in cells shape and nuclei grade comparing with the ordinary tumor cells.These dimorphic cells were located mainly near the basement membrane,singly,in small clusters or in broad sheets,and the distribution and cell cytoplasm were very similar to myoepithelial cells.Immunohistochemical study showed that both ordinary tumor cells and dimorphic tumor cells were positive for CK8 and ER,but were negative for high molecular weight cytokeratins（CK5/6 and CK34βE12）,myoepithelial markers（CD10,SMA,p63）and neuroendocrine markers（CgA,Syn）.Five cases were positive for E-cad,whereas two cases showed both membrane and cytoplasm weak positive only in partly cells.One case was positive for GCDFP-15 and AR.Conclusions Both of two type tumor cells in DPC showed epithelial cell differentiation with the same immunohistochemiscal staining,and the cells nuclei shape and nuclei atypia were very similar though the cells shape and cytoplasmic staining were different.Dimorphic tumor cells were v

关 键 词：乳腺肿瘤 导管内乳头状癌 二态性 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]