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目的探讨乳腺实体型乳头状癌(SPC)的临床病理特征和免疫表型特点。方法收集伴或不伴有浸润癌的 SPC 共21例,总结其临床资料、大体和组织病理特征,并进行免疫组织化学LSAB 法染色和阿辛蓝黏液染色。选用抗体包括细胞角蛋白(CK)、肌上皮标记、神经内分泌标记、增殖标记 Ki-67和雌激素受体(ER)、孕激素受体(PR)等。结果本组患者均为女性,发病平均年龄66.1岁。肿瘤的临床特征与经典型乳头状肿瘤相似。行腋窝淋巴结清扫术的8例中无1例检出癌转移。镜检所有标本均见到实体乳头状病变,19例存在黏液分泌。肿瘤细胞呈卵圆形、多角形、梭形或呈印戒样。细胞为轻度或中度异型性,15例核分裂象<5/10HPF。7例伴发细胞学与导管内癌一致的浸润癌。肿瘤均表达 CK8,但基底型 CK 呈阴性。平滑肌肌动蛋白(SMA)α、Calponin 和 p63在乳头轴心肌上皮的阳性率分别为94.0%、64.7%和58.8%,在导管周缘肌上皮的阳性率分别为94.0%、76.5%和70.6%。CgA 和突触素阳性率分别为88.2%和82.4%。Ki-67平均阳性指数为8.1%。17例行 ER、PR 和 pS2染色的肿瘤均呈阳性,c-erbB-2均阴性。获得随访的患者中16例(94%)均未见肿瘤复发或转移。结论乳腺 SPC 好发于老年女性,具有较独特的病理组织学改变和免疫表型,部分 SPC 与乳腺黏液癌和神经内分泌癌相关。多项临床病理特征和随访显示 SPC 具有较为惰性的生物学行为和良好的预后。
Objective To investigate the clinicopathological characteristics and immunophenotypic features of breast solid papillary carcinoma (SPC). Methods Twenty-one cases of SPC with or without invasive carcinoma were collected, and their clinical data, gross and histopathological features were summarized. Immunohistochemical LSAB staining and Alcian blue mucus staining were performed. Selected antibodies include cytokeratin (CK), myoepithelial markers, neuroendocrine markers, proliferation markers Ki-67 and estrogen receptor (ER), progesterone receptor (PR) and so on. Results The patients were female, the average age of onset was 66.1 years. The clinical features of tumors are similar to those of classic papillary tumors. No axillary lymph node dissection in 8 cases, 1 case detected cancer metastasis. Microscopic examination of all specimens have seen solid papillary lesions, 19 cases of mucus secretion. Tumor cells were oval, polygonal, fusiform or signet ring-like. Cells were mild or moderately atypical and 15 had mitosin <5/10 HPF. Seven patients with invasive cytology and ductal carcinoma consistent with invasive carcinoma. CK8 tumors were expressed, but basal CK was negative. The positive rates of smooth muscle actin (α), Calponin and p63 in the papillary myenteric epithelium were 94.0%, 64.7% and 58.8%, respectively. The positive rates of the catheters in the peripheral myenteric epithelium were 94.0%, 76.5% and 70.6% . The positive rates of CgA and synaptophysin were 88.2% and 82.4% respectively. Ki-67 average positive index was 8.1%. 17 cases of ER, PR and pS2 stained tumors were positive, c-erbB-2 were negative. Tumor recurrence or metastasis was not observed in 16 of the patients (94%) who were followed up. Conclusions Breast SPC is more common in older women and has more unique histopathological changes and immunophenotype. Some SPC are associated with breast mucinous carcinoma and neuroendocrine carcinoma. A variety of clinicopathological features and follow-up showed that SPC has a more inert biological behavior and a good prognosis.