原发性乳腺淋巴上皮瘤样癌临床病理观察

The clinicopathological study of the lymphoepithelioma-like carcinoma of the breast

目的观察乳腺原发性淋巴上皮瘤样癌(lymphoepithelioma-like carcinoma,LELC)的临床病理变化和免疫组化特征,以提高人们对该肿瘤的认识。方法对2例原发于乳腺的LELC的临床病理学和组织病理学特征进行观察,结合免疫表型并复习文献。结果 2例均为中年女性,临床均表现为无痛性肿块,肿瘤呈多结节状或弥漫状生长,肿瘤细胞呈卵圆形或多边形,核空泡状,核仁明显,核膜厚,间质有大量小淋巴细胞浸润。免疫表型:肿瘤细胞表达CK7、CK8/18和E-cadherin,缺乏表达ER、PR和c-erbB-2,原位分子杂交检查示EBV阴性,肿瘤细胞Ki-67增殖指数约30%。结论发生于乳腺的LELC极其少见,临床病理学特征和免疫表型与普通乳腺浸润性癌类似,病理诊断时需与乳腺发生的髓样癌和经典型霍奇金淋巴瘤进行鉴别。患者预后较好。

Purpose To study the characteristics of lymphoepithelioma-like carcinoma（LELC） of the breast, and to enhance the rec- ognition and diagnostic level of the disease. Methods Two cases of LELC occurring in rare sites were studied using routine histopa- thology （HE staining） and immunohistochemistry （EnVision）. The clinicopathological characteristics were then described. Results Two cases of LELC were middle-aged women and presented with painless mass. Microscopically, Tumor ceils were oval or polygon which arranged in irregular nodular or diffuse. These tumor cells have a vescular nucleus with prominent nucleolus and thick nuclear membranes. Abundant of small lymphocytes could seen in the stroma of the LELC. Immunohistochemically, two cases of the tumor were positive for CK7, CK8/18, and E-cadherin, and negative for ER,PR, and e-erbB-2. EBV was negative by in situ hybridization and Ki-67 index was 30%. Conclusions Lymphoepithelioma-like carcinoma of the breast is a rare malignant tumor, its clinieopatho- logic feature and immunohistoehemistry are similar to invasive carcinomas of breast. It is necessary that the diagnosis should be differ- ent from medullary Carcinoma and classical Hodgkin lymphom of the breast. The prognosis of the LELC is more better.