少见类型乳腺癌的影像、临床、病理及免疫组化分析

Imaging,clinical,pathology and immunohistochemistry appearances of scarce types of breast carcinomas

目的探讨少见类型乳腺癌影像、临床、病理及免疫组化主要特点,提高对其认识。方法回顾性分析经活检和/或手术病理证实的少见类型乳腺癌21例,观察并分析其X线、超声、相关临床、病理及免疫组化资料。结果 21例中乳头状癌4例,浸润性微乳头状癌5例,粘液癌8例,髓样癌4例。21例X线主要表现边缘模糊或浸润型肿块;超声主要表现均为不规则实性不均质低回声团,边缘欠清,病灶内及周围可见血流。总的中位发病年龄为48.7岁;淋巴结情况:乳头状癌(4/4例)及粘液癌(7/8例)未见淋巴结转移;浸润性微乳头状癌(4/5例)及髓样癌(4/4例)可见淋巴结转移。镜下病理:乳头状癌(4/4例)癌细胞形成中心见纤维血管束的乳头状结构;浸润性微乳头状癌(4/5例)癌细胞簇与间质之间形成间隙;粘液癌(8/8例)癌细胞漂浮于细胞外液粘液湖中;髓样癌(4/4例)癌细胞密集,间质纤维少,间质中淋巴细胞弥漫浸润。免疫组化:髓样癌3/4例为三阴性;乳头状癌(3/4例)、浸润性微乳头状癌(4/5例)及粘液癌(7/8例)为非三阴性;浸润性微乳头状癌(4/5例)肿瘤外侧细胞膜EMA染色阳性。结论少见类型乳腺癌各亚型间病理组织学及免疫组化具有一定特征性;浸润性微乳头状癌及髓样癌易发生淋巴结转移;但各型间影像学表现及发病年龄不具有特征性,术前影像确诊困难,主要依靠术后病理确诊。

Objective To explore the imaging, clinical, pathology and immunhistochemistry appearances of scarce types of breast carcinomas in order to know more about them. Methods The main the clinical, pathology, immunhistochemis- try, mammography and ultraphonic characteristics of 21 cases of scare types of breast carcinomas confirmed by the pathol- ogy were retrospectively analyzed. Results Papillary carcinoma were found 4/21 cases, infiltrating micropapillary carcino- ma in 5/21 cases, mucous carcinoma in 8/21cases, medullar carcinoma in 4/21 cases. The main appearance of mammogra- phy in all coses was the indistinct or infiltrated boundary of mass; the main appearance of Ultrasound was irregular asym- metry solid low echo group, indistinct boundary; and blood flow was found around and/or insible the lesions. The mean age of all was 48.7. Lymph node： infiltrating micropapillary carcinoma （4/5） and medullar cancer （4/4） were found me- tastasized; papillary carcinoma （4/4） and mucous cancer （7/8） were none. Pathology：the tumor cells of papillary carcino- ma （4/4） were formed the papillary architecture with fiber vascular bundle; there were gaps between the tumor cells and interstitial of the infiltrating micropapillary carcinoma （4/5）; the tumor cells of the mucous carcinoma （8/8） were floated in the extracellular mucous lake; the tumor cells of the medullar carcinoma （4/4） were intensives and lots of lymphocyte were found in the interstitial. The medullar carcinoma （3/4） was triple negative; papillary carcinoma （3/4）, infiltrating micropapillary carcinoma （4/5） and mucous carcinoma （7/8） were none-triple negative. Conclusion The pathology and immunhistochemistry of our cases are characteristic. Infiltrating micropapillary carcinoma and medullar cancer are vulnera- ble to be found lymph node metastasis. But the main imaging appearance and the mean age of our cases are no characteris- tic. It is difficult to diagnose each subtype preoperative; the postoperative pathologic diagnosis is gold standard.