乳腺实性乳头状癌的临床病理特征  

Clinicopathological features of solid papillary carcinoma of the breast

作　　者：罗华荣[1] 徐铖[1] 郑海红[1] 翁寿向[1] 甘梅富[1] 

机构地区：[1]温州医科大学附属台州医院病理科,浙江台州317000

出　　处：《温州医学院学报》2015年第5期364-368,共5页Journal of Wenzhou Medical College

摘　　要：目的:探讨乳腺实性乳头状癌(SPC)的临床病理特征。方法:收集18例SPC患者资料,总结其临床和病理特征,选用雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(Cerb B-2)、增殖标记(Ki-67)、细胞角蛋白5/6(CK5/6)、细胞角蛋白14(CK14)、肌上皮标记(P63)、突触素(Syn)和嗜铬素A(Cg A)等抗体行免疫组织化学染色,并用荧光原位杂交法行人表皮生长因子受体-2(HER-2)基因检测。结果:肿瘤主要表现为中心性的乳腺肿块或乳头溢血。镜下肿瘤由边界清楚的膨胀性生长的结节构成,结节内可见纤细的纤维血管轴心。55.6%伴有黏液分泌,16.7%伴有浸润性癌。免疫组织化学染色显示瘤细胞ER、PR呈强阳性,Cerb B-2大部分呈阴性,仅4例Cerb B-2(1+)。肿瘤细胞均不表达CK5/6、CK14及P63,9例肿瘤细胞巢周围显示完整的肌上皮围绕,5例显示肌上皮部分缺失,4例完全缺失。Syn阳性率为72.2%,Cg A阳性率为55.6%,Ki-67增殖指数平均为8.5%。3例伴浸润的SPC均无HER-2基因扩增。17例腋窝淋巴结清扫或前哨淋巴结活检中仅1例见癌转移。获得随访的17例(占94.4%)患者均未见肿瘤复发或转移。结论:乳腺SPC是一种少见的乳腺癌,好发于老年女性,具有独特的组织学形态和免疫表型。多项临床病理特征及随访资料显示SPC具有惰性的生物学行为和良好的预后。Objective： To investigate the clinicopathological features of solid papillary carcinoma （SPC） of the breast. Methods： A study was performed to analyse the clinical and pathological manifestations in 18 cases of SPC. Immunohistochemical staining for ER, PR, CerbB-2, Ki-67, CK5/6, CK14, P63, Syn and CgA was per-formed. And the expression of HER-2 gene amplification was detected by fluorescence in situ hybridization. Results： All the tumors presented as a palpable, centrally located mass or as bloody nipple discharge. Histologically, the tumor was comprised of multiple circumscribed expansile nodules with delicate fibrovascular cores. 55.6% of these tumors had extracellular or intracellular mucin and 16.7% was associated with invasive carcinoma. Immunohistochemically, all tumor cells were strongly positive for ER and PR. CerbB-2 was negative in the most cases except for 4 cases with weak expression. All cases were negative for CK5/6, CK14 and P63 in the cellular nod-ules. Peripheral myoepithelium was complete in 9 cases, discontinued in 5 cases and loss in 4 cases. The positive expression rates of Syn and CgA were 72.2% and 55.6%, respectively. The average positive rate of Ki-67 in tumor cells was 8.5%. None of 3 cases with invasion had HER-2 gene amplification. One of 17 cases with axillary lymph node dissection or sentinel lymph node biopsy had axillary lymph node metastasis at operative time. And none of 17 patients （94.4%） followed up had tumor recurrence and metastasis. Conclusion： SPC is a rare breast cancer, predominantly found in elderly females, with distinctive histological morphology and immunophenotype. Clinicopathological features and follow-up data suggest that SPC often carries an indolent clinical behavior and favorable prognosis.

关 键 词：乳腺肿瘤 实性乳头状癌 病理 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]