乳腺导管原位癌伴微小浸润10例临床病理分析

Breast ductal carcimona in situ with microinvasion: clinicopathological analyses of 10 cases

目的总结和分析乳腺导管原位癌伴微小浸润(DCIS-MI)的临床病理学特点、诊断与鉴别诊断及预后。方法回顾分析10例乳腺DCIS-MI的临床特征,观察其组织病理学表现并对部分病例补做免疫组化,同时收集随访资料和复习相关文献。结果 10例乳腺DCIS-MI中,最大浸润灶直径均≤0.1 cm;4例为高级别导管原位癌,6例为中级别导管原位癌;10例均为粉刺型,管腔内均可见坏死,细胞核呈中/高级别。免疫组化:c-erb B-2(+)7例,其中3例为中等(+),2例为强(+)。除1例失访外,其余中位随访时间为39个月,内无复发和转移。结论乳腺DCIS-MI是一种比较少见的乳腺癌,WHO(2012)乳腺肿瘤分类规定:以最大浸润灶直径≤0.1 cm为诊断标准。免疫组化c-erb B-2和肌上皮标记物有助于鉴别诊断。本病很少发生复发及转移,其预后很好。

Objective To discuss the clinical, histopathological characteristics, diagnosis and differential diagnosis, and prognosis of breast ductal carcimona in situ （DCIS-MI）. Methods Relative clinical features and histological changes were reviewed in the ten cases of breast ductal carcimona in situ. Immunohistochemical stains were carried out in part cases. Relative literatures and follow-up data were reviewed. Results All of the 10 cases of DCIS-MI showed micro invasive lesions with maximum size of ≤0. 1 cm; 4 cases were high grade ductal carcimona in situ, and 6 cases were intermediate grade ductal carcimona in situ. All cases were comedo type and demonstrated necrosis, and cell nuclei presented intermediate/high dysplasia. C-erbB-2 was positive in 7 cases, in which 3 cases were moderately and 2 cases strongly positive. No patients had local recurrence and distant metastasis after a median follow-up of 39 months （ except for only 1 case that lost follow-up）. Conclusion DCIS-MI is a less common type of breast carcinoma. Classification of the breast carcinoma （2012） defines that the diagnosis standard of micro invasive lesions is within≤0. 1 cm in maximum size. C-erbB-2 and myoepithelial markers contribute to its differential diagnosis. Only few cases have local recurrence and distant metastasis with extremely good prognosis.