乳腺恶性导管内乳头状病变28例临床病理分析  

Malignant intraductal papillary lesions of the breast:clinicopathological analyses of 28 cases

作　　者：傅思莹[1] 匡忠生[1] 任明能[1] 肖珊珊[1] 谢宇晖[1] 

机构地区：[1]广州中医药大学第一附属医院,广州510405

出　　处：《临床与实验病理学杂志》2017年第1期55-58,共4页Chinese Journal of Clinical and Experimental Pathology

基　　金：广东省中医药局建设中医药强省科研项目(20141075)

摘　　要：目的探讨乳腺恶性导管内乳头状病变的临床病理学特征、诊断、鉴别诊断及预后。方法回顾性分析28例乳腺恶性导管内乳头状病变的临床表现,观察其组织病理学及免疫表型特征,收集随访资料并复习相关文献。结果 28例患者均为女性,平均年龄55.7岁,主要表现为乳头溢液和乳腺肿块。组织学类型:导管内乳头状癌22例、包膜内乳头状癌2例及实性乳头状癌4例。镜检:肿瘤呈乳头状或实体状,可见纤细的纤维血管轴心。肿瘤细胞形态多一致,细胞核级别低。免疫组化标记示大部分患者肿瘤细胞ER和PR均呈强阳性,HER-2、CK5/6均呈阴性;结节内CK5/6、p63、SMA均呈阴性。实性型者部分可表达CD56、Syn、CgA。Ki-67增殖指数平均为5.3%。27例获得随访资料,随访10~79个月,患者均存活。结论乳腺恶性导管内乳头状病变好发于老年女性,组织学形态多样,诊断需结合临床、组织学形态及免疫表型,应与导管内乳头状瘤鉴别。该肿瘤具有较为惰性的生物学行为,预后较好。Purpose To discuss the clinical, histopatho- logical characteristics, diagnosis, differential diagnosis and prognosis of malignant intraductal papillary lesions of the breast. Methods 28 cases of malignant intraductal papillary lesions of the breast were analyzed by histology and immunohistochemistry. Clinical and follow-up information was obtained. The published relevant literatures were reviewed. Results All the patients were females with a mean age of 55.7 years. The clinical fea- tures were a palpable mass or nipple discharge. 28 cases were diagnosed including 22 cases of intraductal papaillary carcino- ma, 2 cases of encapsulated papillary carcinoma and 4 cases of solid papillary carcinoma. Microscopically, the tumor showed solid and papillary area inside the capsule wall with fine delicate fibrovaseular septa. The tumor ceils usually displayed low-grade nuclear features. Immunohistoehemistry,the tumor cells revealeddiffusely strong positive ER and PR in almost ,all cases and HER-2, CK5/6 were negative positive. All cases were negatiive for CK5/6, p63 and SMA in the celluar nodules. CD56, Syn and CgA were found positively in some solid papillary carcinoma cases. The average positive rate of Ki-67 in tumor cells was 5.3%. 27 patients were available for follow-up examination from l0 to 79 months and all the patients were alive. Conclusion Malignant intraductal papillary lesions of the breast most occurs in postmenopausal women. The diagnosis should be based on the clinical information, histopathological features and immunohis- toehemistry stain due to its diverse histology. The main differen- tial diagnosis is intraductal papilloma. This kind of lesion is a low grade malignant tumor with favorable prognosis.

关 键 词：乳腺肿瘤 导管内乳头状癌 临床病理特征 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]