乳腺实性乳头状癌31例临床病理分析  

A clinicopathologic analysis of 31 patients with solid papillary carcinoma of breast

作　　者：陈建华[1,2] 贺同新[2] 丁雨飞 魏溪[1] 张虹[3] 

机构地区：[1]江苏大学附属人民医院病理科,镇江212002 [2]新疆生产建设兵团第四师医院病理科,伊宁835000 [3]新疆生产建设兵团第四师医院肿瘤内科,伊宁835000

出　　处：《肿瘤研究与临床》2016年第4期239-243,247,共6页Cancer Research and Clinic

基　　金：新疆生产建设兵团科技局项目，镇江市卫生局科研项目(WS0805)Project of Bureau of Science and Technology of the Xinjiang Production and Construction Corps，Research Project of Health Bureau of Zhenjiang City

摘　　要：目的研究乳腺实性乳头状癌（SPC）的临床病理特征和免疫表型特点，并对其诊断、鉴别诊断及预后进行探讨。方法回顾性分析31例伴或不伴浸润SPC患者的临床病理特征及免疫表型特点。采用免疫组织化学EnVision法进行检测，角蛋白（CK）、肌上皮标志、神经内分泌标志、增殖标志Ki-67和雌激素受体（ER）、孕激素受体（PR）、HER2等。采用荧光原位杂交（FISH）检测HER2基因并随诊患者。结果31例均为女性，平均年龄（67．0±12．5）岁，最常见的临床症状为无痛性肿块伴或不伴乳头溢液。19例行腋窝淋巴结清扫术，仅1例检出癌转移。大体观察肿瘤呈实体性及结节性病变，可伴有囊肿形成；镜检肿瘤为膨胀性、实体性结节，结节内仅见纤细纤维血管轴，缺乏明显的乳头和筛状结构，细胞巢内细胞缺乏显著异型性，具有黏附性。20例伴有黏液分泌。肿瘤细胞均表达ER、PR、CK8／18，不表达CK5／6、34B12。CK5／6、341312、p63在乳头轴心肌上皮的阳性率分别为3．23％（1／31）、9．68％（3／31）、6．45％（2／31），细胞巢及肿瘤周缘肌上皮阳性率分别为19．35％（6／31）、38．71％（12／31）、16．13％（5／31）；CgA、Syn、NSE、Cd56阳性率分另0为83．87％（26／31）、87．10％（27／31）、93．55％（29／31）、90．32％（28／31）；HER2大部分阴性，15例FISH检测均为阴性；Ki-67平均阳性指数为4．12％。获得随访的28例（90．23％）患者中仅1例死亡，其余均未见肿瘤复发或转移，无瘤生存至今。结论乳腺SPC是一罕见的独特临床病理类型，好发于老年女性，诊断依赖其独特的病理特征、免疫表型和基因特点，与黏液癌和神经内分泌癌密切相关，具有较为惰性的生物学行为。Objective To study the clinicopathologic features, immunophenotype, diagnosis and differential diagnosis of solid papillary carcinoma （SPC） of breast. Methods A retrospective study was performed to analyse the clinicopathologic features and immunophenotype of 31 cases of SPC with or without invasion. The cytokeratins （CK）, myoepithelial markers, neuroendocrine markers, proliferation marker Ki-67, estrogen receptor （ER）, progesterone receptor （PR）, HER2, ect were detected by immunohistochemical staining, and HER2 was detected by FISH. All patients were followed up. Results All the patients were females with a mean age of （67.0±12.5） years. The presenting symptom was a painless mass with or without nipple discharge. In 19 cases who had undergone axillar lymph node dissection, only one metastasis was observed. General observation showed that tumors had substantive and nodular lesions, accompanied by cyst formation. Microscopy examination showed that tumors had swell and substantive nodules with only fine fiber vascular axis, and lacked obvious nipples and screen structure. The cells were lack of atypia,adhesive in cells nest. 20 patients were accompanied by mucus secretion. Immunohistochemical study showed that the tumor ceils expressed CK8/18, ER, PR, but didn＇t express basal cell CK5/6, 34β12. The positive rates of CK5/6, 34β2, p63 were 3.23 % （1/31）, 9.68 % （3/31）, 6.45 % （2/31） in the myoepithelial layers of axis of papillary,and were 19.25 % （6/31）, 38.71% （12/31）, 16.13 % （5/31） in peripheral cell nests and tumors, respectively. The positive rates of CgA, Syn, NSE, Cd56 were 83.87 % （26/31）, 87.10 % （27/31）, 93.55 % （29/31）, 90.32 % （28/31）, respectively. The staining of HER2 oncoprotein was negative mostly, and the FISH detection outcome of 15 cases were all negative. The average positive index of Ki-67 was 4.12 %. 28 cases （90.23 %） received follow-up, only 1 patient died, and the rest patients were without tumor recurrence or metastasis. C

关 键 词：乳腺实性乳头状癌 临床病理 免疫表型 原位杂交 荧光 预后 

分 类 号：R737.9[医药卫生—肿瘤]