乳腺实性乳头状癌临床病理研究及治疗  

Clinicopathology research and treatment of breast solid papillary carcinoma

作　　者：丁雨飞 贺同新[1] 魏溪[3] 张虹[2] 陈建华[1,3] Ding Yufei He Tongxin Wei Xi Zhang Hong Chen Jianhua(Department of Pathology, the Fourth Division Hospital of the Xinjiang Production and Construction Corps, Yining , Xinjiang 835000,China（ Ding YF , He TX , Chen JH Department of Oncology , the Fourth Division Hospital of the Xinjiang Production and Construction Corps, Yining,Xinjiang 835000, China （ Zhang H Department of Pathology, the First Affiliated People＇s Hospital of Jiangsu University, Zhenjiang 212002, China （ Wei X, Chen JH)

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

出　　处：《中国基层医药》2016年第21期3235-3240,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：新疆生产建设兵团科技计划项目（kj201426）;江苏省镇江市卫生局科研项目（WS0805）

摘　　要：目的：研究乳腺实性乳头状癌（solid papillary carcinoma，SPC）的临床病理特征和免疫表型特点，并对其诊断、鉴别诊断、预后及治疗进行探讨。方法回顾性分析52例伴或不伴浸润 SPC 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）、肌上皮标记、神经内分泌标记、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52例均为女性，平均年龄（66．76±10．19）岁，占同期乳腺癌的0．99％，肿瘤最常见的临床症状为乳腺中央区无痛性肿块伴／或不伴乳头溢液。均行手术切除，13例手术后化疗，6例放疗，34例行腋窝淋巴结清扫术仅4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，35例伴有黏液分泌。肿瘤细胞均表达 ER、PR、CK8／18，不表达 CK5／6、34βE12；CK5／6、34βE12、p63在乳头轴心肌上皮的阳性率分别为5．78％、9．62％、7．69％，细胞巢及肿瘤周缘肌上皮阳性率分别为21．15％、38．46％、19．23％；CgA、Syn、NSE、CD56阳性率分别为82．69％、88．46％、94．23％、90．38％；HER2大部分阴性，23例 FISH 检测均为阴性；Ki-67平均阳性指数为4．28％。获得随访的患者中47例（90．38％）仅1例死亡，1例复发，其余均未见肿瘤复发或转移，无瘤生存。结论乳腺实性乳头状癌是一罕见独特临床病理类型，好发于老年女性，诊断依赖其独特病理特征及免疫表型和基因特点，与黏液癌和神经内分泌癌密切相关，治疗以手术为主，具有较为惰性的生物学行为。Objective To study the clinicopathologic features,immunophenotype,diagnosis and differential diagnosis,prognosis and treatment of solid papillary carcinoma（SPC）of breast.Methods A retrospective study was performed to analyse the clinicalpathologic features and immunophenotype of 52 case 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 （66.76 ±10.19）years. The incidence of SPC among all the breast cancers in this department was 0.99%.The presenting symptoms was a painless mass with or without nipple discharge in the central of breast.All of them accepted surgical resection,13 cases were administrated with chemotherapy after surgery,6 cases were radiotherapy.Metastasis was observed four in 34 cases who had undergone axillar lymph node dissection.General observation tumor was substantive and nodular lesions,may be accompanied by cyst formation,microscopy tumor for swelling,substantive nodules within only fine fiber vascular axis,and lacked obvious nipples and screen structure.The cells were lack of atypia,adhesive in cells nest,35 patients were accompanied with mucus secretion.Immunohistochemical study show that the tumor cells experssed CK8 /18,ERnbsp;and PR,but not basal cell cytokertin CK5 /6 and 34βE12.Positivity for CK5 /6,34βE12 and P63 were 5.78%, 9.62% and 7.69% in the myoepithelial layers of axis of papillary,and were 21.15%,38.46% and 19.23% in cell nests and tumor peripheral myoepithelial,respectively.Positivity for CgA,Syn,NSE,CD56 were 82.69%,88.46%, 94.23% and 90.38%,respectively.The staining of HER2 oncoprotein was most negative,and 23 cases of FISH detection were all negative.The average positive index of Ki -67 was 4.28%.47 cases received follow -up of patients（90.38%）,only 1 cas

关 键 词：乳腺肿瘤 癌 乳头状 病理学 临床 

分 类 号：R737.9[医药卫生—肿瘤]