乳腺浸润性导管癌中细胞极向倒转与肿瘤淋巴扩散的关系

Invasive ductal carcinomas of breast showing partial reversed cell polarity are associated with lymphatic tumor spread

目的探讨乳腺非特殊类型浸润性导管癌中部分细胞极向倒转与肿瘤淋巴扩散的关系。方法用免疫组织化学EnVision法检查199例包括伴微乳头分化的乳腺非特殊类型浸润性导管癌中上皮细胞膜抗原（EMA）的表达及其细胞极向倒转情况。结果199例浸润性导管癌中5例伴典型的微乳头分化（即浸润性微乳头状癌），30例伴部分细胞极向倒转，不伴上述两种特征的非特殊类型浸润性导管癌164例。此三类中累及淋巴管者分别为4例（4／5）、13例（43．3％）和30例（18．3％），淋巴结转移分别为4例（4／5）、19例（63．3％）和56例（34．1％）。伴部分细胞极向倒转的浸润性导管癌及浸润性微乳头状癌的淋巴管侵犯及淋巴结转移和不伴此两种特征的非特殊类型浸润性导管癌相比，差异均有统计学意义（均P=0．00）。伴部分细胞极向倒转的浸润性导管癌的淋巴管侵犯及淋巴结转移与浸润性微乳头状癌相比，差异无统计学意义（P=0．18，P=0．64）。结论伴部分细胞极向倒转的乳腺癌像浸润性微乳头状癌一样更容易发生淋巴管侵犯及淋巴结转移；完全性或部分性细胞极向倒转在肿瘤的淋巴扩散过程中可能扮演了重要角色。

Objective To investigate the relationship between partial reversed cell polarity （PRCP） and lymphatic tumor spread in invasive ductal carcinoma （IDC） , not othervise specified （NOS）. Methods hnmunohistochemistry （EnVision method ） was used to examine the expression of epithelial membrane antigen （EMA） and the reversed cell polarity in 199 cases of IDC. Results Of the 199 cases, including five cases with micropapillary differentiation, 30 cases with PRCP and 164 cases of IDC-NOS （without micropapillary differentiation and/or PRCP）, lymphovascular invasion was seen in four （4/5）, 13（43.3% ） and 30 cases （18.3%） respectively; nodal metastasis was seen in four （4/5）, 19 （63.3%） and 56 cases （34. 1% ） respectively. The rates of lymphovascular invasion and nodal metastasis were significantly higher in IDC with PRCP or IMPC than IDC-NOS （P =0. 00） ; there was however no significant difference between IDC with PRCP and IMPC for lymphovascular invasion and nodal metastasis （P = 0. 18, P = 0. 64 ）. Conclusions IDC with PRCP, similar to IMPC, is more likely to show lymphovascular invasion and nodal metastasis. Complete or partial reversal of cell polarity may play a significant role in lymphatic tumor spread.