乳腺上皮-肌上皮癌合并非特殊型浸润性癌的临床病理分析

Epithelial-myoepithelial carcinoma with invasive carcinoma of no specific type of breast: report and literature review

目的探讨乳腺上皮-肌上皮癌合并非特殊型浸润性癌临床病理学特征、诊断及鉴别诊断。方法对1例恶性成分由上皮-肌上皮癌和非特殊型浸润性癌共同构成的乳腺肿瘤进行形态学观察及免疫组化标记,并结合相关文献对其进行综合分析。结果肿瘤95%区域由异型增生的内层腺上皮细胞及外层肌上皮细胞共同组成,可见核分裂象和坏死。免疫组化腺上皮细胞表达CK7、EMA,肌上皮细胞表达p63、CK34βE12、S-100和CK5/6;5%区域仅由异型增生的腺上皮细胞构成,呈条索状、小梁状排列,表达CK7、EMA、ER、PR和HER-2。结论乳腺上皮-肌上皮癌在乳腺肿瘤中罕见,WHO(2012)乳腺肿瘤分类中将其命名为伴癌的腺肌上皮瘤,同时合并非特殊型浸润性癌尚未见报道,应与腺样囊性癌、导管内癌、肌上皮癌等鉴别。

Purpose To investigate the clinical and pathological features, diagnosis and differential diagnosis of epithelial-myoepitheli- al carcinoma （EMC） with invasive carcinoma of no specific type of breast. Methods Morphological observation and immunohistochemistry were applied in one case of breast tumor which consists of EMC with invasive carcinoma of no specific type, and the related literatures were reviewed. Results 95% of the tumor was composed of epithelial and myoepithelial cells. Both of proliferative ceils were presented with cellular atypia and pleomorphism. Mitoses and necrosis could be seen. The immunohistochemical analysis showed biphasic patterns, the glandular epithelial cells of the tumor were positive for CK7, EMA, while the myoepithelial ceils of the tumor were positive for p63, CK3413E12, S-100 and CK5/6. 5% of the tumor was only composed of epithelial cells which arranged in cord and trabecula. These tumor cells were positive for ER, PR and HER-2, but negative for p63, CK3413E12 and S-100. Conclusions EMC is a very rare tumor of breast which it was named as adenomyoepithelioma with carcinoma in the 2012 edition of WHO. EMA with invasive carcinoma of no specific type has not been reported before. EMC should distinguish from adenoid cystic carcinoma, ductal carcinoma in situ and myoepithelial carcinoma.