乳腺内外Paget病的形态学特征及病理诊断

Pathological diagnosis of Paget's disease

目的探讨乳腺Paget病(m emm ary paget’s d isease,MPD)和乳腺外Paget病(extram amm ary paget’s d isease,EMPD)的临床病理特征及其诊断。方法对61例Paget病(Paget’s d isease,PD)进行形态学观察、AB/PAS组化染色及免疫组化检测。结果①EMPD细胞具有独特的排列方式和细胞形态,MPD细胞形态与伴发的BC细胞类似。②GCDFP-15、Muc-1及CK8在MPD中的阳性表达率分别为2%(1/50)、92%(46/50)及88%(44/50),在EMPD中的阳性表达率分别为18%(2/11)、36%(4/11)及81%(9/11)。结论PD是表皮内的腺癌,可分为原发与继发两类,原发性PD细胞可分为大汗腺样、皮脂腺样、黏液型及混合细胞型,诊断应排除病变周围原发性腺癌的存在;继发性PD大多来自深部相关肿瘤。

Aim To investigate the clinicopathological features of Paget＇s disease and its diagnosis. Methods 61 cases of Paget＇s disease were observed under light microscopy with stains of hematoxylin eosin and were stained with diastase periodic acid-Schiff （PAS） and alcian blue（AB） . Immunohistochemical staining was used to detect the expression of GCDFP-15, Muc-1, CK8 in 61 cases of PD. Results （ 1 ） Morphologically, features of cell of MPD showed similarity to the BC cell while EMPD cell possess special pattern and cell form. （2）The expression of GCDFP-15,Muc-1 and CK8 in MPD were 2% （1/50） ,92% （46/50） and 88% （44/50） respectively, in EMPD were 18%（2/11）,36%（4/11） and 81%（9/11） respectively. Conclusions （1）Paget＇s disease is intraepidermal adenocarcinoma, which can be divided into primary Paget＇s disease and secondary Paget＇s disease. A majority of MPD were secondarily and minority were primarily, but EMPD is primary adenocarcinoma in intraepidermal. （2）Primary EMPD consists chiefly of 4 types , including mucin type, apocrine type, sebaceous gland type and commix type. （3） The qualification of diagnosis of primary EMPD is ： ① The PD cell possess of the character of adenocarcinoma. ② PD cell show the positivity of AB/PAS and CK8, Muc-1, GCDFP-15. ③excluding another adenocareinoma.