25例乳腺腺样囊性癌的临床分析

Adenoid cystic carcinoma of the breast： report of 25 cases

目的探讨乳腺腺样囊性癌（ACC）的临床特点、治疗及预后。方法对1990至2012年收治的25例ACC患者的临床病理资料进行回顾性分析，并分析其预后情况。结果25例ACC患者确诊的中位年龄为53岁；男性1例，女性24例（未绝经7例，绝经17例）。所有患者均以乳腺肿物为首发症状，外』二象限和乳晕区肿物共12例（48．0％）。25例ACC患者中，有5例行粗针穿刺，其中3例诊断为腺病，2例诊断为浸润性癌；23例患者行腋窝淋巴结清扫手术，其中腋窝淋巴结转移2例，阳性淋巴结比例分别为3／14和2／20。14例患者行免疫组化检测，其中雌激素受体阳性1例，孕激素受体阳性3例。25例ACC患者的中位随访时间为118个月，有2例患者分别于术后3、10年死于肺转移。结论ACC的组织结构模式复杂，粗针穿刺结论需谨慎对待。ACC的生物学行为相对良好，腋窝淋巴结转移较少见。ACC的激素受体检测多为阴性，辅助治疗的价值有待于进一步评价。

Objective To explore the clinical features, management approach and treatment outcomes for adenoid cystic carcinoma （ ACC ） of the breast. Methods The clinicopathological data of 25 patients with breasts ACC treated in our hospital from years 1990 to 2012 were retrospectively reviewed and their prognosis was analyzed. Results The median age of these 25 patients was 53 years （ ranged from 31 to 81 years）. With the exception of one male case, all patients were female including 17 cases of postmenopausal women. The most frequent presenting symptom is breast lumps, most （48.0%） were in the upper outer quadrant and areola area of the breast. Core needle biopsy was performed in five patients. The specimen finding were adenoids in three and invasive carcinoma in two cases. Axillary lymph node dissection was performed in 23 patients. Only two patients had histologically positive lymph nodes （3 of 14 and 2 of 20 ）. Expression of ER and PR in 14 cases was detected by immunohistochemistry, showing one PR-positive and three ER-positive cases. The median follow-up of the 25 cases was 118 months （ranged from 12 to 244 months）. Two patients died of lung metastases at 3 and 10 years after the surgery, respectively. Conclusions Due to the complexity of the histology of ACC, adequate sampling of specimens is essential for accurate diagnosis. ACC of the breast is a rare disease with a relatively good prognosis. The low incidence of axillary lymph node metastasis suggests that axillary node dissection is not recommended as a routine procedure. Breast ACC are often with negative ER and PR expression, and the value of adjuvant therapy needs to be further investigated.