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目的探讨乳腺分泌性癌的临床病理特点、鉴别诊断和预后。方法收集5例乳腺分泌型癌的临床病理资料进行病理学分析,并复习相关文献。结果 5例乳腺分泌型癌发病平均年龄44.8岁,主要表现为乳腺内肿块,多位于外上象限。大体上肿物多边界清,质硬;镜下瘤细胞呈实性、小囊状和导管性排列,胞质丰富,含有嗜酸性颗粒。瘤细胞胞质内外有大量均质的嗜伊红PAS阳性的分泌物。例4腋下淋巴结见转移癌(1/10)。免疫组化:CK、CEA和S-100均呈(+),ER均(-),GCDFP-15和c-erbB-2(-)或仅灶性(+),仅1例PR(+)(阳性细胞为20%),1例部分细胞p53、Ki-67和cyclinD1(+)(阳性细胞25%～30%),另4例仅少数细胞阳性(阳性细胞为5%～8%)。尽管ER、PR(-)或仅局灶(+),但预后影响因素c-erbB-2、p53、cyclinD1和Ki-67增殖指数低,提示该病生长方式相对惰性。结论乳腺分泌型癌是一种罕见且预后较好的肿瘤,确诊需依据病理学形态和免疫组化。
Objective To investigate the clinicopathological features, differential diagnosis and prognosis of breast cancer with secretory carcinoma. Methods The clinicopathological data of 5 cases of secretory carcinoma of the breast were collected for pathological analysis and reviewed the relevant literature. Results The average age of 5 cases of secretory carcinoma of the breast was 44.8 years. The main manifestations were intramammary masses, mostly in the upper quadrant. In general, the mass of the tumor is clear and hard, and the tumor cells in the microscope are solid, small cystic and ductal arrangement, rich in cytoplasm, containing eosinophilic granules. There are a large number of homogeneous eosinophil PAS-positive secretions inside and outside the cytoplasm of tumor cells. Example 4 Axillary lymph node metastases (1/10). Immunohistochemistry showed that the positive rate of CK, CEA and S-100 was (+), ER (-), GCDFP-15 and c-erbB- (Positive cells was 20%), a part of cells p53, Ki-67 and cyclinD1 (+) (positive cells 25% to 30%), the other 4 cases only a few positive cells (positive cells 5% to 8%). Proliferation index of c-erbB-2, p53, cyclinD1 and Ki-67, which are the prognostic factors, are low in spite of ER, PR (-) or focal foci (+), suggesting that the growth pattern of this disease is relatively inert. Conclusions Breast-secreting carcinoma is a rare and well-prognted tumor. The diagnosis should be based on pathological morphology and immunohistochemistry.