乳腺导管内乳头状癌22例临床病理分析

Clinicopathological Analysis of 22 Cases with Intraductal Papillary Carcinoma of Breast

目的探讨乳腺导管内乳头状癌的临床病理学特征。方法复习22例乳腺导管内乳头状癌手术切除标本的病理切片并做相应的免疫组织化学染色,结合临床资料和组织学特点进行分析。结果眼观:包块边缘呈推挤状,直径1.5～4.2cm,切面灰粉色、实性、质脆。其中,6例标本切面上可见一囊内明显的乳头状成分,质脆易碎,边界不清。镜检:表现为乳头状结构,乳头被覆单一的腺上皮,≥90%的乳头完全缺乏肌上皮层,腺上皮单层或多层,与纤维轴心垂直,瘤细胞有不同程度的异型性。免疫组织化学:Actin、SMMHC、Calponin、p63、CD10、CK5/6显示≥90%的乳头缺乏肌上皮层;乳腺导管上皮细胞AE1/AE3、CK7全部病例阳性、CEA18例病例阳性。结论乳腺导管内乳头状癌是一种罕见的乳腺低度恶性肿瘤,预后较好;诊断必须与乳腺导管内乳头状瘤鉴别,免疫组织化学在鉴别诊断中起关键作用。彻底切除肿瘤及其周围部分乳腺组织已属充分治疗。

Objective To discuss the clinicopathological features of intraductal papillary carcinoma of breast. Methods The clinical, histological and immunohistochemical data of 22 cases with intraduetal papillary carcinoma of breast were collected and analyzed; related literatures were reviewed. Results Macroscopical study showed that masses were pushing their edges to the surrounding tissues and the diameters of the tumors were from 1.5 em to 4.2 cm ; in the tumor sections, the masses were grey pink in solid and crisp texture; the papillary elements were obviously observed in 6 specimens and they were in crisp texture with unclear border; microscopical study showed that papillary structure was found in all the 22 cases with papillary cover of simple glandular epithelium; ≥ 90% of the papillary was in complete lack of myoepithelial cell layer, The papillary was covered with monolayer or muhilayer glandular epithelium which was perpendicular to the axis of papillary and showed variable heteromorphism ; immunohistochemical study indicated that Actin, SMMHC, Calponin, 1363, CD10, CK5/6 showed that =〉 90% of the papillary myoepithelium were absent or discontinuous while AE1/AE3 and CK7 in 22 cases and CEA in 18 cases were all positive. Conclusions Intraductal papillary carcinoma of breast is a rare low - grade malignant tumor, its prognosis is generally good ; attention should be paid to the differential diagnosis from intraductal papilloma of breast and immunohistochemistry plays a key role in the differential diagnosis ; the complete treatment includes the total remove of the tumor and surrounding breast tissues.