乳腺浸润性小叶癌的组织形态学及其分型

Astudy of histopathology and classification on infiltrating lobular carcino ma of the breast

目的 对乳腺浸润性小叶癌（ Ｉ Ｌ Ｃ） 的组织形态特点、组织分型及一般生物学特性进行观察，就其诊断标准及分型提出参考指标。方法 收集同期乳腺癌１６１５ 例，从中查出５６ 例 Ｉ Ｌ Ｃ 病例供研究，分析病历，观察 Ｈ Ｅ组织切片，全部病例有随访材料。结果 发生率占全部乳癌的３ ．５ ％ （５６／１６１５） 。组织学类型分三大类：经典型３５ 例（６２５ ％ ） ，小叶原位癌为主型６ 例和其它型（ 包括印戒细胞型１ 例，组织细胞型４ 例，腺泡型３ 例，小管型４ 例，梁状型２ 例，实性型１ 例） 。本研究提出８ 项特殊形态做为 Ｉ Ｌ Ｃ 病理诊断依据，各项出现率均在５０ ％ 左右。另有两种形态很值得注意，一为纤维化倾向，一为炎症变化。本文收集的有关发生年龄、淋巴结转移情况， Ｔ Ｎ Ｍ 分期， Ｅ Ｒ、 Ｐ Ｒ 检测等与一般性乳腺癌比较， Ｉ Ｌ Ｃ 更倾向于有利预后因素，但差别不显著。 Ｉ Ｌ Ｃ 的预后较好，５ 年存活率为８５ ．２ ％ 。结论 浸润性小叶癌具有自己固有形态诊断标准。观察证明，其生物学特性和生存率均与一般乳腺癌差别不明显，有时形态鉴别也有困难，加之腺泡导管间可以互相演化，故认为除经典型外，其它类型诊断宜慎重，其概念范围不宜无限制的扩大。

Objective To investigate the characteristics of microscopic morphology and classification ofinfiltrating lobular car cinoma ( I L C) ofthe breast. Methods 1615 cases with all types of breast cancer were studied . Ofthem the incidence of I L Cwas 3 .5 % (56/1615) . The 56 cases with I L Cwere analyzed clinically and their H Ehistologicalsections were investigated . Re sults I L Cwas divided into 3 subtypes :classical type in 35 cases (62 .5 % ) ,in situ predominanttype 6 cases ,and others in cluding signet ring type 1 case ,histocytoid type 4 ,alveolartype 3 ,tubular 4 ,trabecular 1 and solid carcinoma 1 . We evaluatedthe diagnostic criteriafor I L Cfrom 8 aspects ;besides ,special attention was paidto thetendency offibrotic sclerosis and inflam ma tory reaction compared with othertypes of breastcancer ,the average age ofinitial- treated patients was younger,the rate oflymphnode involvement was lower (42 .9 % ) ,the stage of T N M was lower (stage 1 ,11 :89 .3 % ) ; estrogen ( E R) and progesterone( P R) positive rates were higher ( E R:71 .7 and P R:56 .7 % ) ,the rate of bilaterality was greater (5 .8 % ) and average survivalrate was higher (85 .4 % ) . These results ,however, did not have significant differences statistically . Conclusion For the rea sons thatthe classicaltype of I L Chas already been familiarto all of us microscopically and conceptually ,there were no significantdifferences statistically between I L Cand other types of breast cancer both in biological behavior and prognosis ,and that I L C maytransform into or coexist with the invasive ductal carcinoma , we consider that it is not necessary to sub - classify further for theroutine pathological diagnosis .