乳腺大汗腺癌的形态学与免疫表型特征

Morphologic and immunophenotypic characteristics of apocrine carcinoma of the breast

目的 观察乳腺大汗腺癌(apocrinecarcinoma,AC)的形态学和免疫表型特征,并探讨其诊断标准。方法 对HE染 色片中显示有大汗腺细胞学特点的30例乳腺癌标本进行组织学观察和免疫组化S P法检测,并选取5例大汗腺化生(apo crinemetaplasia,AM)及2例大汗腺腺病(apocrineadenosis,AA)和AA伴导管原位癌(DCIS)1例标本作对照组。使用的一抗包 括GCDFP 15、Mucin 1、AR、ER、c erbB 2、Ki 67。结果 ①8例被确定为AC,均为高核级,其中大汗腺导管原位癌(ADCIS)1 例、ADCIS伴浸润性大汗腺癌(IAC)5例,IAC伴导管原位癌(DCIS)2例。镜下AC细胞的共同特征为:细胞大,胞界清,胞质丰 富,深嗜伊红染,颗粒状;核大、圆,核仁常大而突出。依据胞质形态可分为:A型,胞质深伊红染,有数量不等的清晰颗粒;B 型,胞质内大量细空虚的小泡,可聚呈泡沫状,类似组织细胞或皮脂腺细胞;C型,胞质浅染、均质,如细磨砂玻璃样;②8例AC 与5例AM及2例AA均共同表达GCDFP 15、AR、Mucin 1及Ki 67;除1例外,ER均不表达;③AC的GCDFP 15的表达与大 汗腺化生不同:前者呈胞质内弥漫颗粒或空泡状,表达有异质性;后者阳性颗粒聚成小球状团簇,位于细胞质的核上区。④ AR平均阳性细胞数在AC及AM分别为33.4%及93.8%;Ki 67平均阳性细胞数在AC及AM分别为52.4%及40%。

Purpose To investigate the morphologic and immunophenotypic characteristics of apocrine carcinoma(AC) of the breast and explore the diagnosis criteria. Methods Thirty cases with apocrine cell features of mammary carcinoma were observed under light microscopy with stains of hematoxylin eosin and studied by S-P immunohistochemical method. 5 cases with apocrine metaplasia(AM),2 apocrine adenosis(AA) and 1 DCIS case with AA were compared with AC. Results ① Among the thirty cases,8 cases of AC with high nuclear grade were confirmed,including 1 ADCIS,5 ADCIS with IAC and 2 IAC with DCIS . The common characteristics of AC cell were presented as follows: large size of the neoplastic cells with well-defined outlines and abundant eosinophilic cytoplasm containing distinctly granules,its nuclei were large and round with prominent nucleoli. Three types can be divided according to the morphologic of cytoplasm: A type,neoplastic cells with copious,variably granular eosinophilic cytoplasm. B type,cytoplasm with a great number of small vacuolate displayed foamy shape that similar to histiocyte cell or sebaceous gland cell. C type,carcinoma cells with finely granular pale cytoplasm,like frosting glass. ② 8 AC,5 AM and 2 AA expressed GCDFP-15,AR,Mucin-1,Ki-67,all but 1 case was negative for ER.③ GCDFP-15 gived difference expression to AC and AM: AC cells showed a diffuse granular and small vacuolated pattern with heterogeneity expressed,but the positive granular of AM cytoplasm aggregated like glomus and demonstrated supranuclear localization of the cells.④ Average cells which are positive for AR in AC and AM were 33.4% and 93.8% respectively; Positive for Ki-67 were 52.4% and 40% respectively. Conclusions Diagnosis of AC may be provided with 3 criteria : ① Morphologicly,90% cells possess of AC fuatures.② The positive cells for GCDFP-15 should hold 50% at least among the whole tumor cells. ③ The number of positive cells for AR should excess 20%.