乳腺包被性乳头状癌的临床病理特征及预后分析

Analysis of clinical-pathological features and prognosis of patients with encapsulated papillary carcinoma of the breast

背景与目的：乳腺包被性乳头状癌是一种少见的乳腺恶性肿瘤，术前诊断较困难。本研究旨在探讨乳腺包被性乳头状癌患者的资料，探讨临床病理特征、治疗及预后。方法：回顾性分析2005-2010年在宁波市医疗中心李惠利医院甲乳外科就诊的11例乳腺包被性乳头状癌患者的临床资料。结果：11例乳腺包被性乳头状癌患者的中位年龄为64岁；肿块直径1．5-10cm，多位于乳头乳晕区；BN表现为“囊性肿块伴有囊壁乳头状结节”。11例患者中3例肿瘤周围伴有导管内癌，3例伴有浸润性癌；所有患者ER、PRgH性，HER-2阴性，囊壁的肌上皮细胞标志物Actin、SMA、S-100、p63均为阴性，腋下淋巴结未见转移。在随访时间内，11例患者均存活，未发现肿瘤复发和转移。结论：乳腺包被性乳头状癌是一种好发于老年女性的恶性肿瘤，预后良好，肿瘤周围常伴发导管原位或浸润性癌。单独发生或伴发导管原位癌时，按照导管原位癌的原则治疗；伴发浸润性癌时按照浸润性癌的原则治疗。

Background and purpose： Encapsulated papillary carcinoma （EPC） of the breast is a kind of rare malignant tumor, which is difficult to diagnose before surgery. In this study, we analyzed the clinical-pathological features, treatment and prognosis of 11 EPC cases of breast treated in our hospital. Methods： A total number of 11 cases with EPC treated in our hospital from 2005 to 2010 were retrospectively analyzed. Results： The average age of onset was about 64 years-old, ranging from 40 to77 years-old. The mass was mostly located on ＂nipple-areola complex＂, and ＂complex cyst with mural nodule＂ was the ultrasound imaging. In all 11 EPC patients, there were 3 patients coexisting with ductal carcinoma in situ （DCIS） and 3 patients with invasive ductal carcinoma （IDC）. ER, PR expression of all patients were positive and HER-2 expression was negative, and all myoepithelial cell markers surrounding cyst wall, including Actin, SMA, S-100, and p63 were negative. There was no axillary lymph node metastasis in all patients and during follow-up time, there was no local recurrence and distant metastasis and all patients were still alive. Conclusion： EPC is a good- prognosis breast tumor in old women, and is commonly coexisting with DCIS or invasive ductal carcinoma. The treatment principle is the same to DCIS when pure EPC or accomplished with DCIS, and the same to IDC when coexisting with IDC.