胸水转移性非特殊类型乳腺浸润性癌8例并文献复习  

Metastatic nonspecific invasive breast carcinoma in pleural effusion:report of eight cases and review of literature

作　　者：兰智华[1] 张小丽[1] 张海 马昕[1] 赵强[1] 贺荣芳[1] 杨芳[2] LAN Zhi-hua;ZHANG Xiao-li;ZHANG Hai;MA Xin;ZHAO Qiang;HE Rong-fang;YANG Fang(Department of Pathology,the First Affiliated Hospital of University of South China,Hengyang 421000,China;Department of Colorectal Surgery,the First Affiliated Hospital of University of South China,Hengyang 421000,China)

机构地区：[1]南华大学附属第一医院病理科,湖南衡阳421000 [2]南华大学附属第一医院肛肠外科,湖南衡阳421000

出　　处：《诊断病理学杂志》2021年第8期657-661,共5页Chinese Journal of Diagnostic Pathology

基　　金：湖南省卫生与计划生育委员会科研计划课题项目(B20180052)。

摘　　要：目的探讨胸水转移性非特殊类型乳腺浸润性癌的临床病理学特征、诊断、鉴别诊断与预后。方法复习2018-2019年8例胸水转移性非特殊类型乳腺浸润性癌液基涂片、细胞块HE切片及原发灶资料与切片。EnVision法检测CK7、Mammaglobin、Gata-3、vimentin、ER、PR及Her-2的表达,FISH检测Her-2呈2+及3+的标本,并复习相关文献。结果 8例患者平均年龄47岁,液基涂片均可见单个散在癌细胞与小团片状癌细胞处于淋巴细胞与间皮细胞的背景中。细胞块免疫表型:8例CK7与Gata-3均(+),癌细胞vimentin(-)。4例Mammagloblin弱(+)。原发灶Luminal A型2例;Luminal B型1例,Her-2/FISH阳性(+);Her-2过表达型4例,Her-2/FISH均(+);基底样型1例。其中6例细胞块ER、PR及Her2与原发灶一致,1例Luminal A型转移灶ER与PR(-),1例Luminal B型原发灶Her2呈1+,细胞块呈2+,FISH(+)。结论胸水转移性非特殊类型乳腺浸润性癌形态学在光镜下容易遗漏或误诊为增生的间皮细胞。病理医师应仔细观察,充分利用免疫组化标记以资鉴别。ER、PR与Her2表达与原发病灶可不一致,应引起重视。Objective To explore the clinicopathological features,diagnosis,differential diagnosis and prognosis of metastatic nonspecific invasive breast carcinoma in pleural effusion.Methods Eight cases of liquid-based cytology and HE sections of cell block from metastatic nonspecifie invasive breast carcinoma in pleural effusion were collected.Immunohischemistry was used to detect the expression of CK7,mammaglobin,Gata-3,vimentin,ER,PR and Her-2 by EnVision methods.HER2/CEP17 ratios of Her2 2+ and 3+ amplified cases were assessed by fluorescence in situ hybridisation(FISH).Relevant literatures were reviewed.Results The average age of 8 cases was 47 years.Liquid-based cytology of 7 cases exhibited scatted cancer cells and small clusters of cancer cells in the background of lymphocytes and mesothelial cell.Immunophenotyping of cell block showed that all the cases were positive for CK7 and Gata-3 and negative for vimentin.Mamaglobin was positive in 4 cases.In the 8 cases of primary foci,2 was luminal A subtype;luminal B subtype with positive Her-2/Fish result and basal-like subtype occurred in one case respectively;4 cases were belonged to Her-2 overexpressed subtype.The expression of ER,PR and Her2 in 6 cases of cell block was in accordance with primary lesion.One of Luminal A type was positive for ER and PR,which were negative in the cell block.The Her2 IHC of the luminal B subtype was classified as 1+,while the cell block was 2+and demonstrated positive result by FISH.Conclusion'The morphology of metastatic nonspecifie invasive breast carcinoma in effusion could be easily missed or misdiagnosed as proliferative mesothelial cells.Pathologists should examine the cytology carefully and make full use of immunohistochemistry for differential diagnosis.It is noted that the expression of ER,PR and Her2 could not be in accordance with the primary lesion.

关 键 词：胸水 非特殊类型乳腺浸润性癌 细胞块 免疫组化 

分 类 号：R734.2[医药卫生—肿瘤]