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目的探讨乳腺分泌性癌的临床病理特征、免疫组织化学表达和特殊染色特点及其生物学意义。方法分析3例乳腺分泌性癌的临床表现和病理特征;用黏液卡红(MC)和PAS/AB(Alcian blue)及淀粉酶消化后PAS/AB染色观察分泌物的性质,同时采用免疫组织化学ABC法检测ER、PR、Ki-67、p53、p63、c-erbB-2、S-100蛋白、CK7、SMA、CK1/3、EMA、CEA和CK34βE12在肿瘤细胞中的表达。结果乳腺分泌性癌仅占同期全部活检乳腺癌的0.36%,平均年龄48.7岁。病理形态学的主要特点为癌细胞异型性较小,出现微囊性结构,癌细胞能产生大量分泌物等,对PAS/AB及黏液卡红染色呈现阳性反应。某些病例可以出现印戒样细胞,柱状上皮被覆的腺样结构,及间质广泛透明变性,癌细胞萎缩消失后形成的胶原硬化瘢痕,提示其高分泌活性和相对惰性的生长方式。尽管ER、PR阴性或仅局灶性表达,但预后相关基因p53和c-erbB-2全阴性或仅偶见弱表达,另外,Ki-67反映的增殖指数仅为6.3%,可能同其相对良好的组织形态和较好的预后有关。淋巴结均未见转移。结论乳腺分泌性癌为一种少见的肿瘤,可发生于中老年女性,侵袭性和转移能力弱,预后良好。根据组织学表现,结合特染及免疫组化表达特点,可作出明确的病理诊断。
Objective To investigate the clinicopathological characteristics, immunohistochemical expression, special staining and biological significance of secretory carcinoma of the breast. Methods The clinical manifestations and pathological features of 3 cases of secretory carcinoma of the breast were analyzed. The secretions were observed by PAS / AB staining after being stained with mucinous card (MC), PAS / AB (Alcian blue) and amylase. Meanwhile, immunohistochemistry ABC method was used to detect the expression of ER, PR, Ki-67, p53, p63, c-erbB-2, S-100 protein, CK7, SMA, CK1 / 3, EMA, CEA and CK34βE12 in tumor cells. Results Breast cancer only accounted for 0.36% of all breast biopsies in the same period, with an average age of 48.7 years. The main features of the pathological morphology of the atypia of cancer cells is small, there microcapsulus structure, cancer cells can produce large amounts of secretions, PAS / AB and mucus card red staining showed a positive reaction. Some cases may appear signet-ring-like cells, columnar epithelial-like adenoid structure, and the extensive interstitial degeneration, disappearance of cancer cells formed collagen sclerosis scars, suggesting its high secretion of activity and relatively inert growth. Prognostic-related genes p53 and c-erbB-2 were all-negative or occasionally weakly expressed despite ER, PR-negative or focal-only expression. In addition, Ki-67 reflected a proliferation index of only 6.3% Good tissue morphology and better prognosis. No lymph node metastasis. Conclusions Breast secretory carcinoma is a rare tumor that can occur in middle-aged and elderly women with weak invasive and metastatic potential and good prognosis. According to histological findings, combined with special staining and immunohistochemical expression characteristics, can make a clear pathological diagnosis.