乳腺多形性小叶癌7例临床病理及免疫组化分析

Pleomorphic lobular carcinoma of breast: a clinicopathologic study of 7 cases

目的：探讨乳腺多形性小叶癌（ pleomorphic lobular carcinoma, PLC）的临床病理及免疫表型特点。方法回顾性分析34例浸润性小叶癌（ invasive lobular carcinoma, ILC）,从中筛选7例PLC；对其进行病理形态学观察,并行免疫组化EnVision两步法检测。结果 PLC患者平均年龄56.6岁（47-74岁）。肿瘤呈结节样肿块,镜下生长方式表现典型或不典型的单行及列兵样排列特点；癌细胞具有显著的多形性和异型性,胞质丰富,嗜酸性或颗粒样,核深染,核膜不规则,核仁明显,核分裂象活跃,肿瘤内可伴导管原位癌（ ductal carcinoma in situ, DCIS）及多形性小叶原位癌（ pleomorphic lobular carcinoma in situ, PLCIS）；免疫组化及HER-2 FISH检测显示E-cadherin（7/7）失表达及p120（7/7）胞质表达,ER（5/7）、PR（5/7）、HER-2（7/7）失表达,5例表现为三阴性乳腺癌,其中2例具有基底样表型。部分病例有神经侵犯（3/7）及腋窝淋巴结转移（4/7）。结论 PLC是ILC的一种少见亚型,部分病例有神经侵犯及腋窝淋巴结转移。 PLC的诊断主要依据病理形态学及免疫组化标记。

Purpose To investigate the clinical and morphological features as well as immunophenotype of pleomorphic lobular carcino-ma （ PLC） . Methods Seven cases of PLC were retrieved from 34 cases of invasive lobular carcinoma. The clinical data, histologic features, immunohistochemical findings were analyzed. Results The mean age of the patients was 56. 6 years, with a range of 47 to 74 years. PLC might be nodular mass in general macroscopy. Histologically, PLC retained classical or non-classical single cells, but exhibited a greater degree of cellular atypia and pleomorphism and a higher mitotic rate than classic invasive lobular carcinoma （ ILC） . PLC was accompanied by ductal carcinoma in situ （ DCIS） and pleomorphic lobular carcinoma in situ （ PLCIS） . Immunohistochemistry and HER-2 FISH were detected. PLC showed E-cadherin negative （7/7） and p120 cytoplasmic positive （7/7）, ER （5/7）, PR （5/7）, and HER-2 （7/7） mostly negative. 5 cases were characterized by triple negative breast cancer, two of which are basal-like pheno-type. Some cases could be observed nerve invasion （3/7） and axillary lymph node metastasis （4/7）. Conclusion PLC is a very rare subtype of invasive lobular carcinoma. In some cases there are nerve invasion and lymph node metastasis. The diagnosis of PLC de-pends on the pathological morphological and immunohistochemical markers.