乳腺伴极性翻转高细胞癌4例临床病理分析  

Tall cell carcinoma with reversed polarity of breast:a clinicopathological analysis of four cases

作　　者：张梦兰 唐婕晞 邹艳[1] 郎志强[3] 可雪璇 于佳秀 魏兵[1] ZHANG Meng-lan;TANG Jie-xi;ZOU Yan;LANG Zhi-qiang;KE Xue-xuan;YU Jia-xiu;WEI Bing(Department of Pathology,West China Hospital,Sichuan University,Chengdu 610041,China;West China School of Medicine,Sichuan University,Chengdu 610041,China;Department of Pathology,Yuhuangding Hospital of Yantai,Yantai 264000,China)

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川大学华西临床医学院,成都610041 [3]烟台毓璜顶医院病理科,山东烟台264000

出　　处：《诊断病理学杂志》2020年第6期369-375,共7页Chinese Journal of Diagnostic Pathology

基　　金：四川省科技计划重点研发项目(2018SZ0138)。

摘　　要：目的探讨乳腺伴极性翻转高细胞癌(TCCRP)的临床病理特征、基因突变特点和鉴别诊断。方法回顾性分析4例乳腺TCCRP的临床病理资料、免疫组化结果和基因突变检测。随访患者获取预后信息并进行系统的文献复习。结果患者均为女性,年龄55~71岁(平均61岁),多以乳房肿块就诊。肿瘤最大径1.5~2 cm,灰白色实性结节状。镜下肿瘤细胞多形成圆形或卵圆形团巢,膨胀性浸润生长。肿瘤团巢主要呈现3种结构模式:实性乳头状结构、乳头状瘤样结构和乳头-筛状结构。肿瘤细胞柱状或多角形,中等核级为主,可见核沟和核内假包涵体,核分裂象少见;部分区域见细胞核极性翻转。免疫组化:肿瘤为三阴性型,Ki-67增殖指数<10%。不同程度GATA-3、GCDFP-15、CK7和Calretinin(+),高表达CK5/6;TG和TTF-1(-)。p63和calponin染色显示肿瘤团巢周围肌上皮缺失。4例肿瘤均存在IDH2 R172突变。3例患者随访期内均无瘤生存。结论TCCRP具有独特的临床病理特点,属于少见的浸润性乳腺癌亚型。Objective To study the clinicopathological features,gene mutation and differential diagnosis of tall cell carcinoma with reversed polarity(TCCRP)of the breast.Methods The clinicopathological data,immunohistochemistry and gene mutation were retrospectively analyzed in 4 cases of TCCRP.Follow-up and the literature review were conducted.Results All the patients are women,aging 55 to 71 years with a mean age of 61 years.Most of them presented with a breast mass,which ranged from 1.5 to 2.0 cm in size and were described as gray and solid.Microscopically,the round or oval tumor nests showed stromal invasion with an expansile growth pattern.Three main architectural patterns were identified in these nests:solid papillary structures,papilloma-like structures,and papillary-cribriform structures.The tumor cells were columnar or polygonal with intermediate nuclear grade.Nuclear grooves and pseudoinclusions were seen.Mitotic figures were rare.Reverse nuclear polarity was observed in some areas.These tumors showed a triple-negative immunophenotype and a low proliferative index(<10%).Variable immunoreactivity for GATA-3,GCDFP-15,CK7 and calretinin,and strong immunostaining for CK5/6 were observed.TG and TTF-1 were consistently negative.All cases showed loss of myoepithelial cells,as demonstrated by p63 and calponin,and harbored IDH2 R172 mutation.3 patients with available follow-up showed no evidence of disease.Conclusions TCCRP is a rare subtype of invasive breast cancer with unique clinicopathological features.

关 键 词：乳腺肿瘤 极性翻转高细胞癌 临床病理特征 基因突变 

分 类 号：R737.9[医药卫生—肿瘤]