具有基底细胞样特征的乳腺实体型腺样囊性癌的临床病理学观察  

Solid variant of mammary adenoid cystic carcinoma with basaloid features： a clinicopathologic and immunohistochemical study

作　　者：周若骥[1] 胡春燕[1] 喻林[1] 毕蕊[1] 杨文涛[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科复旦大学上海医学院肿瘤学系,200032

出　　处：《中华病理学杂志》2012年第12期803-807,共5页Chinese Journal of Pathology

摘　　要：目的探讨具有基底细胞样特征的乳腺实体型腺样囊性癌的临床病理特点、免疫表型及鉴别诊断。方法收集4例具有基底细胞样特征的乳腺实体型腺样囊性癌患者的临床病理资料，进行光镜观察和免疫组织化学EnVision法染色，并复习相关文献。结果4例患者均为女性，发病年龄46—65岁（平均56岁）。肿瘤最大径为1．5～2．5cm。镜下观察：肿瘤由大小不一的实性细胞巢组成，肿瘤间质呈纤维黏液样或玻璃样变；肿瘤细胞中到重度异型性，部分区域核分裂象≥5／10HPF，具有基底细胞样特征，细胞核呈圆形或卵圆形，可见小核仁，细胞质少。实性细胞巢中可见灶性的导管腺上皮分化，伴小腔隙形成，即所谓的真性腺腔，腔隙衬覆细胞胞质更丰富，呈嗜酸性；偶尔可见呈筛孔状或大小不一的腔隙，即假性腺腔，内含均一的基底膜样嗜酸性物质；肿瘤细胞巢中可见灶性坏死。4例肿瘤细胞均不表达雌激素受体、孕激素受体和HER2，CK5／6、CK7和CK14在实性巢中伴有导管腺上皮分化处呈阳性；CD10染色阳性，波形蛋白和CD117呈不同程度阳性。其中3例Ki-67阳性指数为10％-50％。结论具有基底细胞样特征的乳腺实体型腺样囊性癌是乳腺腺样囊性癌的一种罕见的组织学类型，熟悉其病理学特征有利于诊断及鉴别诊断，对该肿瘤的预后评价尚需积累更多的病例。Objective To investigate the clinicopathologic and immunohistochemical features as well as the differential diagnoses of the solid variant of mammary adenoid cystic carcinoma with basaloid features. Methods Clinical and pathological data were collected in four cases of the solid variant of mammary adenoid cystic carcinoma with basaloid features, and microscopic pathological examination and immunohistochemistry EnVision method were performed. The relevant literature was also reviewed. Results The four patients were female, with age ranged from 46-65 years old （ average 56 years） and the maximum tumor diameter ranged from 1.5 to 2. 5 cm. Microscopically, the tumors exhibited a predominantly solid architecture with a myxoid or hyalinized stroma. The tumor cells showed moderate to marked nuclear atypia, and a basaloid appearance with scanty cytoplasm and inconspicuous nucleoli, and ≥ 5 mitotic figures per 10 high power fields. Glandular space embedded within tumor islands could be noticed. These spaces were genuine glandular structures and the cells lining these true glandular lumens had more abundant and eosinophilic cytoplasm. Pseudoglandular spaces of cribriform pattern or variable shape were also occasionally seen, and these cysts contained homogenous eosinophilic material. Focal necrosis was found. All cases were negative for ER, PR and HER2. Immunohistochemical staining for CK5/6, CK7 and CK14 was positive in the genuine glandular structures. All cases were positive for CD10, but also positive with varying intensity from weak to strong for vimentin and CDl17. Staining for Ki-67 in three patients showed 10%-50% positive. Conclusions The solid variant of mammary adenoid cystic carcinoma with basaloid features is a histologically distinctive and also a rare subset of the mammary adenoid cystic carcinoma. Awareness of its pathological features can help with the diagnosis as well as differential diagnosis. More cases are still neededfor accurately assessing the prognosis of this particular tumor.

关 键 词：乳腺肿瘤 癌 腺样囊性 病理学 临床 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]