乳腺分泌型癌1例报道并文献复习

Report of 1 cases of breast secretory carcinoma and review of the literature

目的探讨乳腺分泌型癌的临床病理学特征。方法对1例乳腺分泌型癌的临床资料、病理形态学、免疫组织化学及特殊染色进行观察,并通过复习相关文献进行分析。结果乳腺无痛性肿物10余年伴刺痛2周,术中所见肿物质地中等偏硬,边界欠清,活动度差,包膜不完整。显微镜下肿瘤细胞排列成囊泡状、筛孔状,腔内充满嗜酸性分泌物,酷似甲状腺滤泡,部分区呈实性巢团状,小管状及乳头状结构,被覆细胞常空泡状;肿瘤细胞异型性不明显,核分裂像少见,罕见病理性核分裂像。免疫组化:ER、PR、HER-2均(-),Ki-67(5%+),癌细胞表达CKH、CK8/18、S-100、E-cadherin、P120(膜+)、GCDFP-15,不表达肌上皮标记calponin、p63及SMA。特殊染色:肿瘤细胞内外、囊腔及小管腔内见AB-PAS染色阳性的分泌物。结论乳腺分泌型癌是一种罕见且预后较好的肿瘤,该肿瘤组织形态特殊,属于特殊类型乳腺癌,临床病史及影像学检查很容易误诊为乳腺良性肿瘤。

Objective To investigate the clinical and pathological features of secretory carcinoma of the breast. Methods The clinical data of 1 cases of breast cancer type on the secretion of the morphological, chemical and special staining were observed by immunohistochemistry, and related literatures were analyzed. Results Painless breast mass was found more than 10 years with sting for 2 weeks. In the operation, we can see that the medium is hard, the boundary is not clear, the activity is bad, the capsule is not complete. Microscope can see tumor cells were arranged in vesicular and cribriform cavity filled with eosinophilic secretion, resembles thyroid follicular, the district was solid nests, tubular and papillary structures, covering cells often vacuolated. Tumor cell atypia is not obvious, nuclear division like rare, rare pathological mitotic figures. Tumor necrosis can be seen in the small part. Immunohistochemical results showed ER, PR and HER-2 negative, Ki-67 （5 % positive）. Cancer cells can express CKH, CK8/18, S-100, E-cadherin, P120 （film positive） and GCDFP-15 and do not express myoepithelial markers calponin, P63 and SMA. Special staining showed that the positive staining of AB-PAS was found in the inner and outer of the tumor cells. Conclusion Secretory carcinoma of the breast is a rare and good prognosis of the tumor, the tumor tissue with special morphology,is a special type of breast cancer, clinical history and imaging examination are easily misdiagnosed as benign breast tumor.