基底细胞样乳腺癌的临床病理研究

Clinicopathological Research of Basal-like Breast Carcinoma

目的探讨基底细胞样乳腺癌(basal-like breast carcinoma,BLBC)的病理形态特征和免疫组化特点。方法筛选分析18例女性BLBC患者的临床资料,采用免疫组化等方法分析其病理学特征。结果本组患者发病年龄35～76岁(平均50.8岁),占全部乳腺癌的6%。18例BLBC均为高级别浸润性导管癌(Ⅲ级),病例形态特征显示癌细胞胞浆少,胞核圆形或卵圆形,异型性大,可见较多病理性核分裂像;癌细胞排列呈巢片状或条索状,周边呈推挤性生长,有不同程度的坏死;间质胶原增生较明显,伴有较多淋巴细胞浸润;10例(55.5%)伴有淋巴结转移。免疫组化显示18例CK5/6和P120阳性,14例E-cad和Vim阳性,9例SMA和CK18阳性,6例CD117阳性,2例EGFR阳性,P63均无表达,Ki67阳性细胞数多数超过80%。结论 BLBC作为一种高级别浸润性导管癌的亚型,具有独特的病理形态特征和免疫表型,P120、CK5/6、SMA、Vim和Ki67可用于BLBC的病理诊断和鉴别诊断。

Objective To investigate the histological changes and immunohistochemical characteristics of basal-like breast carcinoma（BLBC）.Methods The clinical materials of 18 BLBC cases were retrospectively reviewed and the pathological feature were analysed by immunohistochemistry.Results All the patients were females and the age were 35-76（mean 50.8） years.The incidence rate of BLBC in all breast carcinoma cases was about 6%.All the BLBC tumors were high-degree invasive ductal carcinoma（grade Ⅲ）.The tumor cells displayed less cytoplasma,round or oval nucleus,great heteromorphism and more pathological nuclear mitotic figures.The tumor cells array showed nest,patchy or cord structure with a pushing growth pattern and lamellar necrosis in different extents.There was obvious interstitial collagen hyperplasia accompanied with more stromal lymphocytic infilitration.Ten cases had lymph node metastasis.The positive immunohistochemical expression of CK5/6 and P120 was observed in all 18 cases,of E-cad and Vim in 14 cases,of SMA and CK18 in 9 cases,of CD117 and EGFR in 6 and 2 cases respectively.P63 was negatively expressed in all the cases.The postive cell population of Ki67 were above 80% in most cases.Conclusion As a subtype of high-grade infitrating ductal carcinoma,BLBC possess distinctive patho-morphological features and immunophenotype.P120,CK5/6,SMA,Vim and Ki67 may contribute to the pathological and differential diagnosis of BLBC.