6例乳腺腺样囊性癌临床病理分析

Clinicopathological analysis of six cases of breast adenoid cystic carcinoma

目的探讨乳腺腺样囊性癌的临床病理特征、免疫表型及鉴别诊断。方法收集6例乳腺腺样囊性癌患者的资料,对患者的临床病理特征及其预后进行回顾性分析。结果 6例乳腺腺样囊性癌患者的年龄为49-86岁;肿块均位于左侧乳房,肿块界清,切面灰白或灰黄色,呈分叶状或囊性;镜下肿瘤组织呈浸润性生长,有筛状和管状-梁状和突体型构型。肿瘤实质由腺上皮细胞、基底样细胞和皮脂腺分化细胞构成。免疫组织化学检测结果显示：肿瘤细胞ER、PR和Cerb B-2均阴性,上皮细胞表达CK7、CK5/6和CD117;基底样细胞具有肌上皮细胞特征,表达CK5/6和P63。4例行乳腺改良根治术,均无同侧腋下淋巴结转移;2例行局部扩大切除。随访3-66个月,无复发及转移情况发生。结论乳腺腺样囊性癌为低度恶性肿瘤,具有其独特的组织病理学特征及免疫表型,预后较好,很少发生淋巴结转移。

Objective To explore the clinicopathological features, immune phenotypes, and differential diagnosis of breast adenoid cystic carcinoma. Methods The clinical data of 6 patients with breast adenoid cystic carcinoma were collected and the clinical and histopathological features and their prognosis were retrospectively analyzed. Results The ages of the 6 patients were between 49 and 86 years old. On gross inspection, these tumors located in left breast with clear boundary, pale or grey yellow colour, and lobulated or cystic shape. Microscopically, these tumors showed inf＇dtrative growth with cribriform, trabecula-tubular and solid patterns. The neoplastic parenchyma was consisted of glandular epithelium, basaloid cells, and sebaceous differentiated cells. Immunohistochemically, ER, PR, and CerbB-2 of turnout cells were all negative. The epithelial cells expressed CK7, CK5/6, and CDll7. Basaloid cells has the features of myoepithelial cells and expressed CK5/6 and P63. Four patients underwent modified radical mastectomy without ipsilateral axillary lymph node metastasis and 2 patients underwent extended recection. There was no relapse or metastasis after being followed up for 3-66 months. Conclusion Breast adenoid cystic carcinoma is a low-grade malignant tumor with unique histopathological characteristics and immune phenotype. The prognosis is satisfactory and the incidence of lymph node metastasis is rare.