浸润性微乳头状癌与浸润性导管癌免疫组化及临床病理特征的比较

Clinicopathologic and immunohistochemical feature comparison of breast invasive micropapillary compared with invasive ductal carcinoma

目的:研究乳腺浸润性微乳头状癌(IMPC)的临床病理特点及与ER、PR、c-erbB-2和E-cadherin的表达关系。方法:回顾性分析608例乳腺癌患者临床资料,筛选IMPC,观察其临床病理特点,SP法检测ER、PR、c-erbB-2及E-cadherin的表达,并与浸润性导管癌(IDC)比较。结果:IMPC在乳腺癌中的发生率为4.9%(30/608),组织形态表现为缺乏纤维血管轴心的微乳头或管泡状细胞簇被纤细的胶原纤维间质分隔,两者之间有一个透明、扩张的腔隙,淋巴结转移灶癌组织保留着微乳头状的生长方式。IMPC淋巴结转移90.0%显著高于IDC的53.3%,肿瘤最大径>2cm者83.3%较IDC的53.3%明显多。IMPC与IDC的ER、PR、c-erbB-2表达率分别为46.7%和56.7%,53.3%和43.3%,40.0%和60.0%,两者差异无统计学意义。IMPC的E-cadherin表达为90.0%,明显高于IDC组的63.3%,且主要表达于肿瘤细胞间连接面及管腔内的细胞膜,而微乳头朝向间质面的细胞膜则表达减弱或消失。结论:IMPC是乳腺癌中的少见类型,与IDC相比,具有较高的淋巴结转移率,其高转移潜能可能与微乳头状的生长方式及E-cadherin高表达及特定的表达方式有关,而与ER、PR、c-erbB-2表达无关。

OBJECTIVE：To investigate the clinicopathologic information,histopathology and expressions of ER,PR,c-erbB-2,and E-cadherin in invasive micropapillary carcinoma,and approach the relationship among them and high metastatic potential.METHODS：Thirty cases of invasive breast carcinoma with an IMPC component were reviewed.The clinicopathologic information,histopathology and immunophenotype of the 30 case were studied.RESULTS：Thirty cases of IMPC （4.9%,30/608） were diagnosed during the period of study,being micropapillary carcinoma of the breast characterized by delicate pseudopapillary structures lacking a fibrovascular core and by tubuloalveolar structures freely floating in clear,and empty spaces.In the metastasis of lymph node,the micropapillary growth pattern was retained.Compared with invasive ductal carcinoma,IMPC was larger sized （rates of T2 cm,83.3% vs 53.3%）,and had a higher lymph node metastasis rate （90.0% vs 53.3%）.ER,PR and c-erbB-2 had no significant differences between IMPC and IDC （46.7% vs 56.7%,53.3% vs 43.3%,40.0% vs 60.0%）.The expression of E-cadherin was higher in IMPC （90.0%） than in IDC （63.3%）,and it was expressed in the intercellular contact surface and intraluminal cytoplasmic membrane.In contrast,it was weakly positive or not expressed on the basal surface of the cells.CONCLUSIONS：IMPC is a rare subtype of breast carcinoma.Compared with IDC,IMPC has a higher lymph node metastasis rate.The high metastatic potential may connect with the micropapillary growth pattern,higher positivity and abnormal location of E-cadherin,and have no connect with the expression of ER,PR and c-erbB-2.