乳腺神经内分泌癌18例病理形态观察

Pathomorphologic observation of 18 cases with neuroendocrine carcinoma of breast

目的：分析乳腺神经内分泌癌的病理形态特征，阐明其诊断要点。方法：对确诊为乳腺神经内分泌癌的切除标本１８例进行光镜观察和神经元特异性烯醇化酶（ＮＳＥ）及嗜铬素Ａ（ＣｇＡ）免疫组织化学染色、８例进行电镜观察，并复习其临床资料。结果：本组患者均为女性，年龄３６～７７岁，平均５３岁，肿瘤大小１２～５５ｃｍ，平均２７ｃｍ。１８例乳腺神经内分泌癌中，典型类癌５例，不典型类癌８例，未分化型小细胞癌５例；电镜下８例癌细胞胞浆内均找到神经内分泌颗粒（ＮＥＧ）；５０％以上癌细胞免疫组织化学染色显示ＮＳＥ及ＣｇＡ均为阳性反应。结论：乳腺的神经内分泌癌作为乳腺癌的一种罕见类型，我们认为应按照其分化程度及组织结构分为类癌、不典型类癌及未分化型小细胞癌。

Purpose To analyse the pathomorphology of neuroendocrine carcinoma of the breast and to clarify the main points of diagnosis. Methods The pathologic features of 18 cases were observed, all of them immunochemically stained with NSE, chromogranin A, eight of them observed under electron microscope and reviewed their clinical data in all. Results All of the patients were female, aged 36 to 77 years(mean age 53 years). The tumor diameter varied from 1 2 cm to 5 5 cm (mean 2 7 cm). In 18 cases of neuroendocrine carcinoma of the breast, 5 were carcinoid, 8 atypical carcinoid and 5 undifferentiated small cell carcinoma. The results of Immunohistochemistry indicated that NSE and chromogranin A on more than half of the tumor cells were positive. There were neuroendocrine particles in the carcinoma cell of 8 cases observed under electron microscopy. Conclusion As a rare type of the breast carcinoma, neuroendocrine carcinoma of the breast should be classified into carcinoid, atypical carcinoid and undifferentiated small cell carcinoma according to the differentiated grades and histological features of the tumor.