乳腺上皮/间叶混合型化生性癌(癌肉瘤)2例报道及文献复习

Mixed epithelial/mesenchymal metaplastic carcinoma(carcinosarcoma)of breast:two cases report and literature review

目的:探讨乳腺上皮/间叶混合型化生性癌(癌肉瘤)的临床病理学特征、鉴别诊断、预后。方法:对我院2例乳腺上皮/间叶混合型化生性癌(癌肉瘤)进行组织病理学和免疫表型观察并复习文献加以讨论。结果:镜检显示病变边界清楚,1例由分化较差的浸润性导管癌成分及软骨肉瘤组成;另一例主要为恶性纤维组织细胞瘤,其边缘局灶见导管原位癌成分。免疫表型:例1间叶成分vimentin,S-100阳性,CK阴性;浸润性导管癌CK阳性,ER,PR,C-erbB-2均阴性;例2间叶成分vimentin,CD68,AACT阳性,上皮性标记,包括CK-pan,P63,CK-low,CK7,CK19,CK5/6,CK34βE12均阴性,导管原位癌CK阳性,ER,PR,C-erbB-2均阴性。结论:原发于乳腺的上皮/间叶混合型化生性癌(癌肉瘤)较罕见,诊断需与乳腺原发性肉瘤、恶性叶状肿瘤、肉瘤化癌、促纤维增生性乳腺癌相鉴别。

Objective：To investigate the clinical and pathological features,diagnosis and prognosis of breast mixed epithelial/mesenchymal metaplastic carcinoma（carcinosarcoma）.Methods：The histopathology and immune phenotype of two cases of breast carcinosarcoma in our hospital were observed,studied and discussed,and related literatures were reviewed.Results：Microscopic examination showed that pathological changes were well-demarcated.One case was poorly differentiated invasive ductal carcinoma and chondrosarcoma component;the major component of the other case was malignant fibrous histocytoma,and a few ductal carcinoma in situ were observed on the edge of the lesion.Immunohistochemically,the chondrosarcoma cells of the first case were positive for Vimentin and S-100,negative for CK,the carcinoma cells were positive for CK,negative for ER,PR and C-erbB-2,the sarcoma cells of the second case were positive for Vimentin,CD68 and AACT,negative for CK-pan,P63,CK-low,CK7,CK19,CK5/6 and CK34βE12,the carcinoma cells in situ were positive for CK-pan,negative for ER,PR and C-erbB-2.Conclusion：The primary mixed epithelial/mesenchymal metaplastic carcinoma（carcinosarcoma）in the breast gland was rare,whose diagnosis should be differentiated with the primary sarcoma,malignant phyllodes tumor,carcinoma sarcomatodes,promoting fiber hyperplastic cancer in the breast.