乳腺腺样囊性癌的临床病理学特点分析  

Clinicopathologic features of adenoid cystic carcinoma of breast

作　　者：郭双平[1,2] 李擒龙[1,2] 王映梅[1,2] 曾凯旋 刘杨[2] 徐婉妮 张秀敏[2] Guo Shuangping Li Qinlong Wang Yingmei Zeng Kaixuan Liu Yang Xu Wanni Zhang Xiumin(Department of Pathology, Xijing Hospital, College of Basic Medical Science, the Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]第四军医大学西京医院病理科,西安710032 [2]第四军医大学病理学教研室 [3]第四军医大学西京医院病理科,西安710032

出　　处：《中华病理学杂志》2017年第1期25-29,共5页Chinese Journal of Pathology

基　　金：国家自然科学基金（81472597）

摘　　要：目的：探讨乳腺腺样囊性癌的临床病理学特点、组织学分级及意义。方法分析16例乳腺腺样囊性癌的临床病理学特点，采用免疫组织化学法检测肿瘤免疫表型、Ki-67阳性指数和组蛋白甲基转移酶2（ EZH2）的表达情况，分析其与肿瘤分级及预后的关系。结果16例腺样囊性癌分化程度不一，其中11例为Ⅰ级，上皮细胞和肌上皮细胞排列成管状、筛状和假腺样结构，无实性成分。3例为Ⅱ级，由管状、筛状结构和实性成分混合，实性成分＜30％。2例为Ⅲ级，实性成分＞90％，肿瘤细胞为基底样，胞质稀少，细胞核染色深，核分裂象＞5／10 HPF，为具有基底样特点的乳腺实性型腺样囊性癌。免疫表型上，腺上皮细胞表达细胞角蛋白（CK）7、CK8／CK18及CD117，肌上皮细胞表达p63和CK5／6，基底样细胞表达CK5／6和CD117。13例患者得到随访，中位随访时间为42个月，1例Ⅱ级的患者于术后12个月肺转移，34个月后死亡，1例Ⅲ级的患者于术后12个月胸椎转移，另1例Ⅲ级的患者腋窝淋巴结转移，其余病例未转移或复发。结论乳腺腺样囊性癌包括低级别和高级别形态学谱系，不应被笼统地看作低度恶性潜能，有必要进行分级，以制定合理的治疗方案。Objective To investigate the clinicopathologic features and grading of adenoid cystic carcinoma （ACC） of the breast.Methods Sixteen cases of ACC of the breast were analyzed and graded according to the previous report . Immunohistochemical （ IHC ） staining was used to detect the immunophenotype , Ki-67 proliferative index and expression of EZH 2, and the association with tumor grade and outcome was analyzed .Results Of the 16 cases, 11 were grade Ⅰ, with the epithelial and myoepithelial cells being arranged into tubular and cribriform structure with no solid component ; three were grade Ⅱ, which were composed of mixed tubular , cribriform and solid component （〈30%）;and two were grade Ⅲ, which showed mainly solid component （ 〉90%） and the tumor cells showed basaloid features with scanty cytoplasm and hyperchromatic nuclei , and mitotic count was 〉 5/10 HPF.Immunophenotypically , the epithelial cells expressed CK 7, CK8/18 and CD117; the myoepithelial cells expressed p63 and CK5/6; while the basaloid cells were positive for CK 5/6 and CD117.Tubular and cibriform ACC showed low Ki-67 and EZH2 expression, while the two cases of solid variant with basaloid features showed high level of Ki-67 and EZH2 expression .Follow-up data were available in 13 cases with a median follow-up period of 42 months.Lung metastasis occurred after 12 months in one grade Ⅱ case and the patient died of disease after 34 months.Vertebral metastasis occurred after 12 months in one grade Ⅲcase and axillary lymph node metastasis occurred in another grade Ⅲ case.All other patients were free of disease at the end of the follow-up periods .Conclusions ACC shows morphologic spectrum varying from low to high grade , the latter can may give rise to local and distant metastasis.ACC should not be regarded simply as low malignant potential , and should be graded for optimal treatment .

关 键 词：乳腺肿瘤 癌 腺样囊性 免疫组织化学 

分 类 号：R737.9[医药卫生—肿瘤]