乳腺梭形细胞/肉瘤样化生性癌临床病理和免疫表型分析

Spindle cell/sarcomatoid metaplastic carcinoma of breast:a clinicopathologic and immunohistochemical analysis

目的探讨以梭形细胞/肉瘤样成分为主的乳腺化生性癌(metaplastic breast carcinoma with dominant spindle cell/sarcoma-toid component,MBCSC)的临床病理及免疫表型特点。方法复习15例MBCSC的临床病理资料,并对其中12例肿瘤进行免疫组化染色(抗体包括上皮标记、肌上皮标记和肿瘤标记物)。同时就腋淋巴结状态,ER、PR和Her2的表达与浸润性导管癌做简要比较。结果本组MBCSC患者平均年龄41岁,均因发现乳腺包块就诊。多数肿瘤呈界限清楚的结节状。镜下8例肿瘤完全由梭形/肉瘤样细胞构成,6例以梭形/肉瘤样细胞为主伴少量浸润性导管癌(invasive ductal carcinoma IDC)成分,1例伴少量导管原位癌。肿瘤显示中-高级别组织学改变。11/12例(91.7%)MBCSC的梭形细胞/肉瘤样成分至少表达一种上皮标记,全部病例均至少表达一种肌上皮标记。本组MBCSC的腋淋巴结转移率和ER、PR、Her2的表达均低于对照组。结论 MBCSC在独特的组织病理学基础上呈现出肌上皮分化,其生物学特性如腋淋巴结状态和肿瘤标记物的表达与浸润性导管癌有所不同,提示其可以作为独立的病理亚型。系列上皮和肌上皮标记的免疫组化染色有助于MBCSC的病理诊断。

Purpose To study the clinicopathologic and immunohistochemical features of metaplastic breast carcinoma with dominant spindle cell/sarcomatoid component（MBCSC）.Methods Clinicopathologic data of 15 cases of MBCSC were analyzed.Immunohistochemical staining were performed in 12 cases（including epithelial markers,myoepithelial and tumor markers）.Differences in axillary lymph node metastases,and the expression of ER,PR,Her2 were assessed between MBCSC and invasive ductal carcinoma（IDC）.Results The mean age of the patients was 41 year-old.The main complain of all patients was noting a breast lump.Grossly,most tumors were well-circumscribed nodules.8 cases of tumors contained almost pure spindle cell,6 cases of tumors contained mainly spindle cell /sarcomatoid with a small area of IDC and 1 case of tumor with a little DCIS component.The tumors displayed moderate-high grade of histological morphology.11/12 cases（91.7%） of spindle cell/sarcomatoid components were positive for at least one epithelial markers.All cases of spindle cell expressed at least one or more than one myoepithelial markers.The rate of axillary lymph node metastases and the expression of ER,PR,Her2 were lower in case group than that in control group.Conclusions MBCSC exhibits characteristically histopathologic morphology and myoepithelial differentiation,with the biologic features such as the axillary lymph node metastases and the expression of tumor markers were different from IDC,suggesting an independent pathologic subtype.Immunohistochemical staining of series of epithelial and myoepithelial markers could contribute to the pathologic diagnosis.