乳腺腺样囊性癌3例临床病理观察  

Adenoid cystic carcinoma of the breast:report of 3 cases and review of the literature

作　　者：陈海霞[1] 王翠翠[1] 姬文莉[1] 王维娜[1] 张焕[1] 陈定宝[2] 

机构地区：[1]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830011 [2]北京大学人民医院病理科,北京100044

出　　处：《诊断病理学杂志》2016年第2期93-96,99,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨乳腺腺样囊性癌（ACC）的临床病理特征、免疫表型和鉴别诊断。方法对3例乳腺ACC的临床病理资料进行回顾性分析,并复习相关文献。结果 3例乳腺ACC年龄分别为41、61和77岁,平均60岁。肿瘤最大径为2.5 cm、1.5 cm和3.5 cm。镜下：肿瘤由腺上皮细胞和肌上皮细胞组成,可见3种结构模式：筛状、管状-小梁状和实性结构。例1,2肿瘤呈筛状和管状-小梁状分布,未见实性结构,其中例1伴有导管内钙化;例2局灶筛状结构区域核分裂象2个/10HPF,肿瘤细胞侵犯神经;例3肿瘤大部分呈实性片状和巢状分布,伴有少量筛状和管状结构,细胞轻~中度异型,可见多灶坏死,核分裂象〉10个/10HPF,周围间质透明变性。免疫组化：腺上皮细胞CK5/6、CK14、EGFR和CD117均（＋）,肌上皮细胞p63和SMA（＋）,而ER、PR和Her-2均（-）,Ki-67阳性指数分别为5%、10%和25%。结论乳腺ACC少见,具有独特的病理学特点,诊断与鉴别诊断依靠病理形态学和免疫组化,预后较好。Objective To investigate the clinical pathological characteristics inununohistochemical features and differential diagnosis of adenoid cystic carcinoma of the breast. Method Clinical and pathological data of three cases of adenoid cystic carcinoma of the breast were analyzed retrospectively , and the related literatures were reviewed. Result The patients age were 41,61 and 77 years old respectively（ average 60 years）. The maximum diameter of the tumor were 2.5 cm, 1.5 cm and 3.5 cm respectively. Microscopically, the tumors were composed of adenoepithelial and myoepithelial ceils , and there were 3 architectural patterns： cribriform, tubular-rabecular and solid. The tumor were distributed tubular and trabecular in Case 1 and 2 , without solid structure , case 1 with intraductal calcification , and mitotic figures （2/ 10HPF） were observed in focal cribriform structure of case 2, and the peripheral nerve was invaded by the tumor cells. Most of the tumor exhibited solid and some cribriform, tubular structure in case 3, tumor cells showed mild to moderate atypia, muhifocal necrosis, mitotic figures were more than 10/10HPF, hyaline degeneration can be seen in the surrounding stroma. Immunohistochemically , the adenoepithelial cells were positive for CK5/6, CK14, EGFR and CD117, the myoepithelial cells were positive for p63and SMA, but the tumor cells were negative for ER ,PR and HER -2. The positive index of Ki-67 were 5%, 10% and 25% respectively. Conclusion ACC of the breast is rare ,with distinctive histology. It＇ s diagnosis and differential diagnosis rely on histology and immunohistochemistry, with a favorable prognosis.

关 键 词：乳腺肿瘤 腺样囊性癌 免疫组化 

分 类 号：R737.9[医药卫生—肿瘤]