6例伴印戒细胞分化的原发性乳腺癌的临床病理分析

Clinicopathological analysis of 6 cases of primary breast carcinoma with signet-ring cell differentiation

目的:探讨6例伴印戒细胞分化的原发性乳腺癌的临床病理特征、免疫表型、诊断和鉴别诊断。方法:对6例伴印戒细胞分化的原发性乳腺癌的临床特点、病理学特征、免疫组化特点等进行分析,并复习相关文献。结果:6例患者均为女性,平均年龄45岁,均因发现乳腺肿块而就诊。镜下肿瘤细胞呈印戒状,胞浆内可见大空泡,核被挤于一侧,呈弥漫性、巢状及条索状分布于乳腺纤维间质中。6例中有3例为单纯型的印戒细胞癌,3例合并其他类型浸润性乳腺癌。免疫组化显示:6例中有5例肿瘤细胞ER为阳性,3例E-Cad her in阳性。6例中Her-2(3+)1例、Her-2(2+)2例、Her-2(1+)3例。6例中5例均有腋窝淋巴结转移。5例行乳腺改良根治切除术,1例行单纯乳腺切除术。2例分别于术后3年及4年发生远处转移。6例至随访结束均存活。结论:伴印戒细胞分化的乳腺癌的病理诊断主要依赖于其特征性组织学表现与免疫组化染色特点。与其他类型乳腺浸润性癌相比,伴印戒细胞分化的乳腺癌更具侵袭性,预后较差。

Objective：To explore the clinicopathological characteristics of 6 cases of primary breast carcinoma with signet-ring cell differentiation. Methods：Six cases of primary breast carcinoma with signet-ring cell differentiation were studied with histopathological and immunohistochemical staining, and its clinical and pathological ifndings were analyzed with review of the literature. Results：All the patients were female, with the average age of 45 years. All the patients presented with a lump in the breast. hTe histological examination of the neoplastic cells showed that the majority of tumor cells showed features of signet-ring cells. hTey were small and round, scattered or funicular distribution, and with large intracytoplasmic mucin compressing the nuclei toward one pole of the cell. hTree of the six cases were pure signet-ring cell carcinoma, and three were mixed with other subtypes of invasive breast carcinoma. Immunohistochemically, the tumor cells in 5 of the 6 cases were focally positive for ER, and 3 of 6 cases were focally positive for E-Cadherin. One of 6 cases have the positive status of Her-2 （3＋）, 2 of them with Her-2 （2＋）, and 3 of them with Her-2 （1＋）. Five of the six cases had lymph node metastases. Five cases were treated with modiifed radical mastectomy, and 1 case with mastectomy alone. Two of the six cases occurred distant metastasis atfer 3 and 4 years respectively. All the cases survived atfer the last follow-Up. Conclusion：hTe diagnosis of primary breast carcinoma with signet-ring cell differentiation is based on distinctive histopathology and immunohistochemical staining. Compared with other subtypes of invasive breast carcinoma, primary breast carcinoma with signet-ring cell differentiation exhibits higher invasiveness and worse prognosis.