乳腺分泌型癌的临床病理及免疫组化观察

Clinicopathological and immunohistochemical study of secretory carcinoma of breast

目的探讨乳腺分泌型癌的临床病理特点、鉴别诊断和预后及组织起源。方法对1例乳腺分泌型癌进行光镜、组织化学和免疫组化观察并结合文献进行讨论。结果分泌型乳腺癌主要表现为乳房内近乳晕区无痛肿块,大体观察肿物大多周界较清、质硬;光镜下肿瘤细胞异型性较小,排列为实性、小囊性和导管性三种结构,癌细胞有颗粒性嗜酸性胞质,癌细胞内外有大量均质嗜伊红耐淀粉酶的PAS阳性分泌物。免疫组化标记:CK(+);CEA(+);α-乳清蛋白(++);S-100(+++);CgA(-);NSE(-);actin(-);ER:(-);PR(+)。腋下淋巴结无转移。结论乳腺分泌型癌是一种罕见且预后较好的肿瘤。临床易误诊为良性肿瘤.确诊必须依赖于组织学、组织化学及免疫组化检查。免疫组化S-100强阳性而其他神经内分泌标记均阴性,是否排除神经内分泌肿瘤而考虑为乳腺肌上皮细胞向粘液上皮分化而形成的肿瘤,有待于进一步探讨.

Objective To study the clinicopathological characteristics, differential diagnosis and prognosis of secretory carcinoma of the breast. Methods Light microscopy, histochemical and immunohistochemical staining were used with the review of the literature. Results Patients presented with a palpable firm mass near the areola Tumors had infiltrating margin as seen on gross examination.Histologically the tumors revealed three patterns,namely,solid,microcystic and ductal, and appeared large amounts of intracelluiar and extracellular eosinophilic PAS-positive secretory material,and the granular eosinophilic cyloplasm of the tumor cell. Immmunhistochemical marks are CK（＋） ; CEA（＋） ;S-100（＋＋＋） ; CgA（-） ; NSE（-） ;actin（-） ; E R：- （-） ; PR：- （＋）. Conclusion Secretory carcinoma of the breast is a rare breast carcinoma and has better prognosis.Patholgic examination and Immmunhistochemical are the only way to the definite diagnosis.