乳腺腺样囊性癌18例临床病理分析

Adenoid cystic carcinoma of the breast:a clinicopathological analysis of 18 cases

目的探讨乳腺腺样囊性癌(adenoid cystic carcinoma of the breast,ACC)的临床病理特征、免疫表型及其鉴别诊断。方法复习18例ACC的临床病理资料,观察肿瘤的组织形态学及免疫表型特点。同时对患者进行随访获取预后信息。结果 18例ACC患者均为女性,年龄29～80岁。肿瘤大体上多界限清楚,镜下呈浸润性生长,主要由筛状、管状-梁索状、实体和微囊结构组成。肿瘤成分包括腺上皮、肌上皮、基底样细胞和细胞外基质。肿瘤的腺上皮成分表达CK7、CK5/6和CD117,肌上皮成分表达SMA和p63,基底样细胞不同程度表达CK5/6、p63和CD117。随访期内有2例患者肿瘤局部复发,无患者死亡。结论 ACC是一组具有形态学异质性的肿瘤,其腺上皮、肌上皮和基底样细胞成分的免疫表型各有特点,联合运用CK7、CK5/6、p63、SMA和CD117有助于诊断与鉴别诊断。ACC预后良好,具有基底样特征的实体型ACC可能是侵袭性更强的组织学亚型。

Purpose To study the elinicopathological and immunohistochemical features and differential diagnosis of adenoid cystic carcinoma of the breast. Methods 18 patients with breast adenoid cystic carcinoma were studied by means of 61inical and follow-up data, light microscopy and immunohistochemistry. Results All t8 patients of breast adenoid cystic carcinoma were female, age from 29 - 80. The tumor comprised of cribriform, trabecular-tubular and solid structures. All glandular epithelium expressed CK7, CK5/6 and CD117, myoepithelium expressed SMA and p63, basal-like cell expressed CK, p63 and CD117 at different levels. 2 patients were confirmed local recurrence. All patients were alive during the follow-up. Conclusions Breast adenoid cystic carcinoma is a kind of morphologically heterogeneous neoplasm. The glandular epithelium, myoepithelium and basal-like cell have distinct immunohistochemieal characteristics. The solid variant of mammary adenoid cystic carcinoma with basaloid features is maybe more aggressive.