分泌型乳腺癌临床病理观察

Clinicopathological study of secretory breast carcinoma

目的探讨分泌型乳腺癌（secretory breast carcinoma,SBC）的临床病理参数、免疫表型、诊断与鉴别诊断要点。方法整理3例SBC的临床病理资料及光镜HE染色、免疫组化检测特点,并复习相关文献总结患者临床情况。结果患者均为女性,年龄分别为30岁、56岁和86岁。主要临床表现为乳腺实质内单发的无痛性肿块9个月至15年不等。大体表现为直径1-4 cm不等的实性肿物,与周围组织界限较清楚,切面灰白灰黄色,质地较硬。光镜下肿瘤细胞主要排列成实性巢片状、微囊状和小管状3种形态。肿瘤细胞内外及囊腔内均出现PAS及AB-PAS染色阳性的均质分泌物。免疫组织化学染色显示肿瘤细胞S-100、E-cadherin、CK8/18和EMA阳性,P53、P63、SMA和GCDFP-15阴性,1例表达ER、PR和c-erb B-2,2例不表达ER、PR和c-erb B-2。Ki-67增殖指数2例为3%,1例为4%。3例患者经手术治疗后,在2-12年的随访期内均无复发和转移。结论 SBC是一种少见的乳腺恶性肿瘤,与乳腺其他恶性肿瘤相比预后相对较好,尽管其具有特征性的临床表现、病理形态特点和免疫组织化学表型,但在诊断时仍需要与乳腺其他恶性肿瘤鉴别。

Object To explore the clinicopathological features,immunophenotyping,diagnosis and differential diagnosis characteristic of secretory breast carcinoma（ SBC）. Methods Three cases of SCB were investigated by microscopy and immunohistochemical staining,and related literatures were reviewed. Results All the three patients were female,with the age30 years old,56 years old and 86 years old respectively. The main clinical manifestation of patients was single breast mass without pain,and the time was 9 months to 15 years since the mass found. All the three cases were solid tumor with 1 to 4cm in diameter,clear boundary,yellow- white section,hard character. Solid nest,microcapsule and tube forms were observed microscopically. The tumor cells and cystic spaces were filled with homogeneous secretions,which were positive for PAS and AB- PAS staining. Immunohistochemically,tumor cells were positive for S- 100,E- cadherin,CK8 /18 and EMA,negative for P53,P63,SMA and GCDFP- 15. One case expressed ER,PR and c- erb B- 2,other two ones did not. Proliferation index by Ki- 67 was 3% in two cases,4% in one case. Three patients did not reapear or metastasis during follow- up period of 2 to 12 years. Conclusion SBC is a rare kind of breast malignant tumor,it had better prognosis compared with other kinds. Although SBC has characteristic clinical manifestation,pathological and immunohistochemical features,other breast malignant tumors need to be excluded for it＇s diagnosis.