乳腺浸润性筛状癌临床病理分析

Invasive cribriform carcinoma of breast:a clinicopathologic study

目的探讨乳腺浸润性筛状癌(invasivecribriformcarcinoma,ICC)的临床病理和免疫表型特点。方法复习8例乳腺ICC的临床病理资料,并将其组织学特征、免疫表型和预后与浸润性导管癌进行比较。结果乳腺ICC发病平均年龄42.9岁,多表现为无痛性乳房肿块,影像学微钙化常见。组织学特征是不规则癌细胞团巢呈筛状结构浸润性生长,瘤细胞核级低～中等,多数病例核分裂象少见,胞质顶浆分泌和间质成纤维细胞增生易见,常并存筛状型导管原位癌和小管癌。免疫表型显示CK34βE12高表达而CK5/6阴性,肌上皮标记阴性。8例中经典型6例、混合型2例,其发病年龄、组织学分级、腋淋巴结转移率、cerbB2和Ki67阳性率均低于浸润性导管癌,近期随访结果显示预后优于浸润性导管癌。结论乳腺ICC作为WHO新确定的浸润性癌类型,预后较好,需要与筛状型导管原位癌和腺样囊性癌等鉴别,免疫组化染色有助于确诊。

Purpose To study the clinicopathological and immunohistochemical characteristics of invasive cribriform carcinoma （ICC） of the breast. Methods A retrospective analysis of 8 cases of ICC was performed by comparing histopathologieal, immunohistoehemieal changes and prognosis with invasive duetal carcinoma. Results The mean age of ICC patients was 42.9. The tumor usually presented as a painless mass frequently containing mieroealeifieations at mammography. Histologically, ICC contained predominantly irregular eribriform arrangement, showing a low to moderate degree of nuclear pleomorphism. Mitoses were rare. Apical snouts and prominent fibroblastie stroma were present in many cases. Cribriform type duetal carcinoma in situ and tubular carcinoma were also frequently coexisted. Immunohistochemically, ICC was CK34βE12 positive and CK5/6 negative, no myoepithelial marker immunostaining was present. There were 6 classical and 2 mixed types of ICC in this study. The mean age, histological grade, percentage of axillary node metastases and the positive percentage of e-erbB-2 and Ki-67 of ICC were lower than those of invasive duetal carcinoma （ IDC NOS）. ICC had a better prognosis than IDC within similar follow-up time. Conclusions ICC has an excellent prognosis as a newly established type of the tumor in the WHO classification, which shoud be distinguished from eribriform type duetal carcinoma in situ and adenoid cystic carcinoma of the breast. Immunohistoehemistry is useful in the diagnosis.