乳腺病变中异型大汗腺化生的形态学特征及意义

Morphological characteristics and significance of apocrine metaplasia with atypia in breast lesions

目的探讨乳腺病变中异型大汗腺化生的形态学改变及其意义。方法回顾性观察分析2011年1月—2012年9月间190例浸润性乳腺癌和48例乳腺良性病变的病理切片,显微镜下观察各种大汗腺化生的形态学特征,并进行巨囊病液化蛋白(GCDFP-15)和雄激素受体(AR)免疫组织化学染色。结果显微镜下观察可将大汗腺化生分为囊型、乳头型和异型三种形态。在浸润性乳腺癌中发现大汗腺化生40例,囊型、乳头型和异型的大汗腺化生分别为28例、4例和8例;乳腺良性病变中大汗腺化生13例,囊型、乳头型和异型的大汗腺化生分别为9例、2例和2例,两组病例大汗腺化生发生率比较差异无统计学意义(P>0.05)。异型大汗腺化生在浸润性乳腺癌组和乳腺良性病变组中均占4.2%(8/190,2/48),在伴有大汗腺化生的浸润性乳腺癌及乳腺良性病变中分别占20.0%(8/40)和15.4%(2/13)。免疫组织化学染色结果显示,汗腺化生GCDFP-15和AR均呈阳性表达。结论大汗腺化生广泛存在于乳腺的良恶性病变中,通过GCDFP-15和AR表达可以证明大汗腺化生。虽然未发现其在浸润性乳腺癌和乳腺良性病变间的差异,但异型大汗腺化生可能具有发展为乳腺癌的危险性,应该引起注意。

Objective To observe the morphological changes and significance of apocrine metaplasia with atypia in breast lesions. Methods The pathological sections of 190 cases of invasive breast cancer and 48 cases of breast benign lesions were retrospectively analysed between January 2011 and September 2012, the morphological characteristics of apocrme metaplasia were observed under microscope, and gross cystic disease fluid protein-15 kDa （GCDFP-15） and androgen receptor （AR） were determined by immunohistochemieal staining. Results Apocrine metaplasia exhibited cystic, papillary and atypical type under microscope. There were 40 cases of apocrine metaplasia in invasive cancer, including 28 cases of cystic type, 4 cases of papillary type and 8 cases of atypical type. There were 13 cases of apocrine metaplasia m breast benign lesions, including 9 cases of cystic type, 2 cases of papillary type and 2 cases of atypical type. There was no significant difference in the incidence of apocrine metaplasia between cases of invasive cancer and those of breast benign lesions （P 〉0. 05）. Apocrine metaplasia of atypical type accounted for 4.2% （8/190） and 4.2% （2/48） in cases of invasive cancer and those of breast benign lesions respectively, and accounted for 20.0% （8/40） and 15.4% （2/13） m cases of invasive cancer with apocrine metaplasia and those of breast benign lesions with apoerine metaplasia respectively. Immunohistochemieal staining revealed that the expression of GCDFP-15 and AR was positive in apocrine metaplasia. Conclusion Apocrine metaplasia extensively exists in the benign and malignant lesions of the breast, and can be identified by expression of GCDFP-15 and AR. Though no significant difference is found between invasive breast cancer and breast benign lesions, apocrine metaplasia of atypical type has the risk to develop into breast cancer, which should be attached great importance.