乳腺实性乳头状癌临床病理分析

Clinicopathologic analysis of solid papillary carcinoma of breast

目的：探讨乳腺实性乳头状癌（ solid papillary carcinoma, SPC）的临床病理学特点、组织学特征及预后。方法对9例SPC进行组织形态学观察,行AB-PAS染色和免疫组化MaxVision法染色,对其临床资料进行跟踪随访、分析并复习相关文献。结果9例SPC患者年龄32～83岁,平均69．2岁,其中以乳头溢液发病3例；9例核级别为低～中级别,7例细胞内和细胞外伴黏液分泌,2例伴钙化,3例伴粉刺样坏死。9例ER、PR均阳性且阳性率较高（均〉70%）,HER-2均阴性。9例SPC中神经内分泌标志物Syn呈弥漫阳性（8例）、灶阳性（1例）；CgA有4例呈弥漫阳性,1例部分阳性,4例呈阴性；6例有部分区域肌上皮标志物表达缺失,3例肌上皮标志物连续表达；Ki-67增殖指数为3%～20%。9例SPC中有1例伴小灶性浸润性导管癌（ invasive ductal carcinoma, IDC）（最大径2 mm）,其余8例均不伴其它类型乳腺癌,前哨和（或）腋窝/锁骨下淋巴结均未见癌转移。9例中有8例进行乳腺癌保乳根治术,1例为局部肿物切除过程中偶然发现微小病灶,未行根治术；9例中有1例因伴有IDC,行4周期TC方案化疗,化疗耐受可,目前处于化疗后恢复期；其余8例术后口服内分泌药物治疗,临床密切随访观察,随访时间3～61个月（平均19.6个月）,均未发现复发。结论9例SPC均表现为核级别较低、常伴细胞内外黏液分泌、神经内分泌标志物阳性、淋巴结转移率低等特点,随访未发现复发,提示SPC临床预后较好。

Purpose To investigate the clinical pathological features, histologic features, and prognosis of solid papillary carcinoma （ SPC） of breast. Methods Nine cases of SPC of breast were analyzed by morphological observation, AB-PAS staining and immuno-histochemical MaxVision staining. The follow-up and analysis of the clinical datas of these nine cases were performed and relevant literatures were also reviewed. Results The age of 9 cases of SPC of breast ranged from 32 to 83 years old （mean age is 69. 2 years old）. Three cases presented with nipple discharge. Nuclear levels of 9 cases were between low to midlevel. Seven cases were associated with intracellular and extracellular mucus secretion, two cases with calcification, and 3 cases with comedonecrosis. All of these nine cases were ER, PR positive and the positive rates were high （ 〉70%） , HER-2 was all negative. Syn expression in these nine cases were diffused positive except for one case showing focal positive, 4 with CgA diffused positive, 1 with partial positive and 4 were negative of CgA. Six patients had partial loss of the expression of myoepithelial markers, and 3 cases with complete myoepithelial expression. Ki-67 proliferation index was between 3% and 20%. Except for only one case with small area of invasive ductal carcinoma （IDC） （2 mm in great diameter） , all other cases were not associated with other types of breast cancer, sentinel lymph nodes and/or axillary/supraclavicular lymph nodes metastasis. 8 patients accepted breast-conserving surgey, one case did not undergo radical mastectomy for small lesion. All of these cases were accepted further endocrine drugs treatment and only one case accepted chemical therapy simultaneously because of the accompanied IDC. None of them was found to relapse for 3 to 61 months （mean 19. 6 months） of follow-up. Conclusion Nine cases of SPC of breast showed some characteristics such as relatively low nuclear level, often accompanied by intracellular and extracellular mucus secretion, positive for neuroendocrine marker, low lymph node metastasis rate, and no recurrence, which suggest that SPC may have a better clinical prognosis.