乳腺实性乳头状癌22例临床及病理分析  

Clinical and pathological analysis of 22 cases of solid papillary carcinoma of the breast

作　　者：于秋萍[1] 齐亚飞[2] YU Qiuping;QI Yafei(Department of Pathology,Shenyang 245 Hospital,Shenyang110042,China;Department of Pathology,Shengjing Hospital of China Medical University,Shenyang110004,China)

机构地区：[1]沈阳二四五医院病理科,辽宁沈阳110042 [2]中国医科大学附属盛京医院病理科,辽宁沈阳110004

出　　处：《中国现代医生》2021年第10期130-133,137,共5页China Modern Doctor

摘　　要：目的探讨乳腺实性乳头状癌(SPC)的临床病理特征、免疫表型及鉴别诊断。方法回顾性分析沈阳二四五医院、中国医科大学附属盛京医院病理科2013年1月至2019年1月的手术病例中22例SPC的临床病理特征、免疫组化标记结果,进行病理分析并复习相关文献。结果22例患者均为女性,年龄58~70岁,平均62.4岁,肿物直径2~3.5 cm,平均2.6 cm。组织学特征为瘤细胞圆形、卵圆形,细胞异型性较轻,围绕纤维血管轴心呈放射状、栅栏状分布,排列成实性巢团状。免疫组化结果为22例雌激素受体(ER)、孕激素受体(PR)均强阳性,人类表皮生长因子受体(HER-2)阴性,细胞核增殖指数(Ki67)约2%~10%,平均6.5%,一组肌上皮标记高分子量角蛋白(CK5/6)、P63、钙调节蛋白(Calponin),在巢内瘤细胞22例均阴性,巢外周肌上皮有20例阳性,有2例锯齿状,该处阴性。22例Syn、CgA阳性率为32%~88%,平均65.2%,CgA阳性率为34%~85%,平均60.3%。结论SPC是一种特殊类型导管原位癌,较少见,易误诊为非典型增生或普通型低级别导管原位癌,依据巢团外周有无肌上皮,分为原位型及浸润型,常表达神经内分泌标记,临床治疗方案不同,必须诊断明确。Objective To investigate the clinicopathological characteristics,immunophenotype and differential diagnosis of solid papillary carcinoma of the breast.Methods The clinicopathological characteristics and immunohistochemical marker results of 22 cases of SPC from the Department of Pathology,Shenyang 245 Hospital and Shengjing Hospital of China Medical University from January 2013 to January 2019 were retrospectively analyzed.We performed the pathological analysis and reviewed the relevant literature.Results Among the 22 patients,all were female,aged 58-70 years old,with an average of 62.4 years old,and the diameter of the tumor was 2-3.5 cm,with an average of 2.6cm.The histological characteristics were round and oval tumor cells,mild cell atypia.They were distributed radially and fence-like around the axis of the fibrous vessels,arranged in solid nests.The results of immunohistochemistry showed that 22 cases were strongly positive for estrogen receptor(ER)and progesterone receptor(PR),negative for human epidermal growth factor receptor(HER-2).The nuclear proliferation index(Ki67)was about 2%-10%,with an average of 6.5%.Twenty-two cases of intraneural tumor cells were all negative for a group of myoepithelial markers high molecular weight Cytokeratin 5(CK5/6),P63,and Calponin.However,twenty cases of peripheral myoepithelium of the nest were positive.Two cases were jagged,and the place was negative.The positive rate of Syn and CgA in 22 cases was 32%-88%,with an average of 65.2%,and the positive rate of CgA was 34%-85%,with an average of 60.3%.Conclusion SPC is a special type of ductal carcinoma in situ,which is rare and easy to be misdiagnosed as atypical hyperplasia or ordinary low-grade ductal carcinoma in situ.According to the presence or absence of myoepithelial surrounding the nest,it can be divided into in situ type and invasive type.Neuroendocrine markers are often expressed,and the clinical treatment plan is different,and the diagnosis must be precise.

关 键 词：乳腺实性乳头状癌 乳头状病变 临床病理学 免疫表型 

分 类 号：R737.9[医药卫生—肿瘤]