伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌

Mammary carcinoma with osteoclastic giant cells or responsive granuloma

目的探讨伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌的临床病理特点。方法复习11例伴破骨细胞样巨细胞的乳腺癌(carcinoma with osteoclastic giant cells,COGC)和8例伴反应性肉芽肿的乳腺癌(carcinoma with responsive granuloma,CRG)的临床病理资料,部分病例行免疫组化染色和特殊染色。结果COGC患者平均年龄40.6岁,CRG患者平均年龄53.6岁,均因发现乳腺包块就诊。COGC多呈界限清楚的结节状,切面多为灰红、灰褐色。COGC肿瘤类型包括浸润性导管癌5例、浸润性乳头状癌、浸润性微乳头状癌和浸润性筛状癌各2例。肿瘤内破骨细胞样巨细胞大小形态各有差异,分布弥散或不均匀,与肿瘤细胞关系密切。肿瘤间质内尚见不同程度的新旧出血、血管和纤维组织增生。腋窝淋巴结癌转移灶保留原发灶的形态学特点。CRG形态多不规则,切面多为灰白色。肿瘤类型均为浸润性导管癌,伴随出现的肉芽肿多密切围绕在癌巢周围,由上皮样细胞和朗汉斯型巨细胞构成。抗酸染色和六胺银染色无阳性发现。进行免疫组化染色病例的破骨细胞样巨细胞和肉芽肿均呈CD68(KP1和PGM1)阳性,S-100蛋白和Ⅷ因子呈阴性。CD34染色显示COGC的微血管密度为(21.9±4.2)/HPF,与对照组浸润性导管癌无明显差异(P>0.05)。获得随访资料的6例COGC和2例CRG在随访期内无复发、转移或死亡。结论乳腺COGC和CRG均属少见肿瘤,前者的大体和组织学具有一定的特异性。破骨细胞样巨细胞和肉芽肿出现的预后意义尚需积累更多的病例进行分析。

Purpose To study the clinicopathological features of mammary carcinoma with osteoclastic giant cells or responsive granuloma. Methods Clinicopathological data of 11 cases of carcinoma with osteoclastic giant cells （COGC） and 8 cases of carcinoma with responsive granuloma （CRG） were analyzed. Immunohistochemistry and special staining were performed in some cases. Results The mean age of the COGC patients and CRG patients were 40.6 and 53.6 separately. The first complains of all the patients were noting a breast lump. Grossly, most tumors of the COGC were well circumscribed nodules with grey-red to brown colour. Histologically, COGC group contained 5 cases of invasive duct carcinoma,2 cases of invasive papillary carcinoma,2 cases of invasive micropapillary carcinoma and 2 cases of invasive cribriform carcinoma. Osteoclastic giant cells varied in size and shape, distributed diffusely or heterogeneously, and have an intimate relationship with the tumor cells. Recent or past hemorrhage, vascular proliferation and fibrosis also can be seen in the stroma. Metastatic foci in the axillary nodes maintain the morphology identical to the primary lesions. All CRG eases were invasive duct carcinoma with irregular shape and grey-white colour. Granulomas consisted of epithelioid cells and Langhans giant cells and most of them located around the tumor nests. Acid-fast staining and Hexamine-silver staining were negative. Osteoclastic giant cells and granulomas expressed CD68 （ KP1 and PGM1 ） but not S-100 protein and Foctor Ⅷ in all cases performed immunohistochemical stain. The average microvessel density of the COGC was （21.9 ± 4. 2）/HPF by CD34 staining and there was no obvious difference compared with the invasive duct carcinoma （P 〉 0. 05 ）. Follow up of 6 cases of COGC and 2 cases of CRG showed no evidence of recurrence, metastasis or death. Conclusions COGC and CRG are rare tumors, the former has distinctive morphology. More cases should be accumulated to appraise if the presence of osteoclastic giant cells and granulomas can modify the prognosis of primitive carcinoma.