乳腺粘液癌的增殖活性及异质性分化

Mucinous carcinoma of the breast with special refernce to the proliferative activity and heterogeneous differentiation: A pathological study of 24 cases

本文研究２４例乳腺粘液癌。患者平均年龄５９岁。组织学按Ｃａｐｅｌａ标准分为纯型２０例及混合型４例。ＰＣＮＡ检测示Ⅰ级（０～２５％）５例；Ⅱ级（２６～５０％）１３例；Ⅲ级（５１～７５％）５例及Ⅳ级（＞７６％）１例。核分裂相少见，０～５／１０ＨＰＦ。组织化学染色，全部病例ＰＡＳ、ＡＢ（ＰＨ２．５）和甲苯胺兰染色均为阳性，表明其粘液性质为唾液酸和中性粘多糖混合。嗜银染色９例阳性。４例进行了电镜观察，均见分泌活跃的上皮细胞，表面有多量微绒毛，间质见大量粘液湖。２例癌细胞浆内见散在具致密核心的神经分泌颗粒。观察结果表明，部分乳腺粘液癌具神经内分泌分化而表现其异质性。

Our experience with 24 patients diagnosed as mucinous carcinoma of the breast between 1975 and 1995 was reviewed. All patients were females of 27 to 69 years old with an average of 59 6. Histologic types were divided into pure (20 cases) and mixed form (4 cases) according to the criteria of capella. Immunohistochemistry determine proliferating cell nuclear antigen (PCNA) was used. The PCNA scores were varied with the histologic grade of the tumor:Grade Ⅰ (5 casses): 0-25%; Grade Ⅱ(13 cases): 26-50%; Grade Ⅲ(5 cases):51-75%; and Grade Ⅳ(1 cases);>76%,Mitotic figures were rare (0-5/10HPF). Based on the intensive PAS, AB (ph2 5) and toluidine blue positivity, the mucin was interpreted as sialic acid mixed with neutral mucopolyasccharide. By the Grimlius stain, 9 cases were argyrophilic. Ultrastructural examination of 4 cases showed acitve secreting epithelial cells with abundant surface microvelli. There were pools of extracellular mucin in the stroma. Distinct neurosecretory granules were identified in two cases. This research supports that not all but some of the mucinors carcinomas show neuroendocrine differentiation and therefore mucinous carcinomas of the breast are a heterogeneous guoup of tumosrs.