乳腺实体乳头状癌的临床病理诊断

Clinicopathological featues of breast solid papillary carcinoma

目的 对乳腺实体乳头状癌（SPC）的临床病理特点和预后进行探讨.方法对17例乳腺SPC的临床病理资料作回顾性分析,进行免疫组织化学及特殊组织化学染色,检测抗体包括CK5/6、34βE12、Calponin、SMA、p63、CgA、Syn、CD56、CollagenⅣ、ER、PR、CerbB-2,并进行阿尔辛蓝过碘酸雪夫反应和嗜银染色.结果 17例患者中男1例,女16例,平均年龄68.3岁.主要表现为乳头血性溢液和乳腺肿块,B超或乳管镜检查发现病灶;实体乳头状结构和单一形态的瘤细胞构成其典型的组织学表现,肿瘤均有不同程度的神经内分泌分化,88.2%伴有黏液分泌,41.2%伴有浸润性癌; 肌上皮标记大部分表现为不同程度的不连续,2例完全缺乏和1例完全环绕,CollagenⅣ多数呈连续性表达,3例仅局灶表达;17例患者随访2 ～45个月（平均22.5个月）,均无瘤生存.结论 SPC常见于老年女性,具有独特的组织学形态和免疫表型,其低级别的形态学特征,ER、PR高表达、CerbB-2阴性以及随访结果显示它具有惰性临床过程.

Objective TO investigate the clinicopathological features and prognosis of breast solid papillary carcinoma （SPC）. Methods Clinical and pathological data were retrospectively analyzed for 17 cases of breast solid papillary carcinoma. Histochemistry and immunohistochemistry were performed using Alcian blueperiodic acid-Schiff, Grimelius staining for detection of CK5/6, 3413 E12, Calponin, SMA, P63, CgA, Syn, CD56, Collagen IV, ER, PR and CerbB-2. Results There were 16 females and one male patients with mean age of 68.3y. All patients presented a palpable mass or bloody nipple discharge. Ultrasound or fibroptic ductscopy examination found the mass in all patients. The solid papillary pattern and tumor cells with monotonous appearance were the typical features in morphology and all tumors had neuroendocrine differentiation,88.2% of these tumors had extracellular or intracellular mucin and 41.2% was associated with invasive carcinoma. Myoepithelial cell layer was discontinued in most cases, loss in two cases and complete in one. Collagen IV was continued in most cases and focal positive in three cases. Patients were followed up from 2 to 45 months and within the period they all survived with tumor free. Conclusion SPC was predominantly found in elderly females with distinctive pathological features and immunophenotype. Low grade morphologic features, high expression of estrogen receptor and progesterone receptor, negative for c-erbB-2 and indolent clinical behavior are the clinicopathological features of this disease.