乳腺管状小叶癌八例临床病理观察及免疫组织化学分析  

Tubulolobular carcinoma of breast： a clinicopathologic study of 8 cases

作　　者：师杰[1] 梁智勇[1] 孟芝兰[1] 罗玉凤[1] 曹金伶[1] 杨春明[1] 刘彤华[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院病理科,100730

出　　处：《中华病理学杂志》2012年第10期681-685,共5页Chinese Journal of Pathology

摘　　要：目的研究乳腺管状小叶癌（TLC）的临床病理特征及免疫表型特点。方法收集北京协和医院2005年1月至2010年3月间病理诊断包含乳腺浸润性小叶癌的病例97例，从中筛选出8例TLC。对8例TLC的临床病理资料进行回顾性分析，并采用免疫组织化学方法检测雌激素受体（ER）、孕激素受体（PR）、HER2、p53、E—cadherin、CK3415E12及CK8在TLC中的表达。结果TLC的发生率占同期乳腺癌患者的1．0％（8／880）。患者平均年龄59岁（45—79岁），多无临床症状而于体检时发现。乳腺B超常表现为形态不规则的低回声结节，边缘多有毛刺；镜下由均匀一致的小细胞交织排列成小管状、单排索条状或单个散在细胞，浸润纤维性间质或小叶间及小叶内间质，并围绕导管呈环靶状排列。近周边可伴有细胞形态相似的低一中级别上皮内肿瘤：包括小叶原位癌、导管内癌及导管内乳头状癌等。免疫组织化学多表达ER（7／8）、PR（8／8），均不表达HER2和p53。不论管状结构还是条索状结构，多一致地表达E—cadherin（7／8）、CK3415E12（5／8）及CK8（8／8）。8例中有2例出现腋窝淋巴结转移。所有患者均行乳腺癌改良根治术，其中7例术后随访28～75个月，患者身体状况均良好，除1例术后60个月发现对侧乳腺新生肿物，但至今未予治疗外，其余病例均未见进展性病变。结论TLC是一种极少见的兼具小管癌及小叶癌病理形态特征的特殊类型的浸润性乳腺癌，免疫组织化学常一致地表达ER、PR、E—cadherin、CK3413E12及CK8等。充分认识TLC有助于及时准确地做出病理诊断。Objective To study the clinical and morphological features as well as immunophenotype of tubulolobular carcinoma of the breast （TLC）. Methods Eight cases of TLC were retrieved from 97 cases of invasive lobular carcinoma between January 2005 and March 2010 in the Peking Union Medical College Hospital. The clinical features and pathologic findings were studied and immunohistochemistry was performed for the expression of ER, PR, HER2, p53, E-cadherin, CK3413E12 and CK8. Results Among the breast cancer patients, the incidence of TLC was about 1.0% （8/880）. The mean age of the patients was 59 years, with a range of 45 to 79 years. All patients were asymptomatic, with incidental finding of a mass in the breast on health examination. Common findings on sonography included a hypoechoic nodule with irregular shape and spiculated margin. Histologically, the small uniform tumor cells were arranged in a mixed pattern showing single cells, single-cell files or cords, small round to angulated tubules, and infiltrating lobular or targetoid patterns around ducts that were specific for classical invasive lobular carcinoma. Low or intermediate grade intraepithelial neoplasms which had similar cellular morphology with the invasive tumor often appeared in the periphery, including ductal carcinoma in situ, lobular carcinoma in situ and intraductal papillary carcinoma. Immunohistochemistry of the tumor cells showed intense reactivity to ER （7/8） and PR （8/8）, but no reactivity to HER2 or p53. Both the tubules and single-cell file or cords expressed E-cadherin （7/8）, CK3413E12 （5/8）, and CK8 （ 8/8 ） with a uniform staining pattern. All patients underwent modified radical mastectomy and 2/8 patients had metastatic carcinoma in the axillarylymph nodes. Seven patients were followed up for 28 to 75 months and remained well, including one patient that had a new breast mass 60 months after surgery, but had no treatment up to now. Conclusions TLC is a rare variant of invasive breast cancer and reveals mixed histolo

关 键 词：乳腺肿瘤 癌 小叶状 癌 导管 乳腺 病理学 临床 免疫表型分型 

分 类 号：R737.9[医药卫生—肿瘤]