乳腺浸润性微乳头状癌临床病理学特征分析

Clinical and pathological features of IMPC

目的:探讨乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)的临床病理学特点和免疫组织化学染色表达,并结合文献讨论其预后情况。方法:选取2011年2月至2015年9月本院确诊的23例IMPC(IMPC组)并抽取同期的71例浸润性导管癌(invasive ducal carcinoma,IDC)(IDC组)作为对照,分析比较两组间的临床病理特点。结果:IMPC镜下表现为肿瘤细胞团排列形成微小乳头状或假腺管状,细胞团与周边间质之间具有不等的腔隙。两组在年龄、肿瘤最大径、WHO分级、核级方面的比较,差异无统计学意义(P>0.05)。IMPC组与IDC组淋巴结转移率分别为91.3%和62%,前者明显高于后者(P<0.05)。各项免疫组化指标阳性率:IMPC组vs IDC组,ER(91.3%vs 66.2%)、PR(69.6%vs 60.6%)、HER-2(17.4%vs 23.9%)、Ki67(69.6%VS 74.6%)、P53(52.2%vs 64.8%),IMPC组中ER的阳性率明显更高,差异有统计学意义(P<0.05),余免疫组化指标的比较,差异无统计学意义(P>0.05)。结论:乳腺IMPC是一种比较少见的特殊类型的浸润性癌,较IDC更容易出现淋巴结的转移,单独的ER高表达并不代表其预后较好,应该注意联合检测的重要性。

Objective： This article describes the pathological features of IMPC using immunohistochemical staining of a panel of proteins, as well as the discussion of the prognosis of IMPC in combination with the literature review. Methods： Twenty three IMPC cases （IMPC group） confirmed during Feb. 2011 to Sep. 2015 from our hospital and 71 invasive ductal carcinoma （IDC） cases （IDC group） were compared to analyze the pathological features between the two groups. Results： Microscopically, IMPC shows clusters of tumor cells in a micro-papillary or pseudoglandular form. Varying lacuna can be found between the tumor cell clusters and the surrounding mesenchyme. The comparison in terms of the age, maximum diameter of tumor, WHO grading and nuclear grade between the two groups present no statistical difference （P 〉 0.05）. Rate of lymph node metastasis is significantly higher in IMPC （91.3%） than in IDC （62%）（P 〈 0.05）. Positive rates of various proteins for IMPC group and IDC group are： 91.3% VS 66.2% for ER, 69.6% VS 60.6% for PR, 17.4% VS 23.9% for HER-2, 69.6% VS 74.6% for Ki67, and 52.2% VS 64.8% for P53. Of all positive proteins, the positive rate of ER in IMPC group was obviously higher than that in IDC group （P 〈 0.05）, whereas no statistical significance was observed in other proteins studied above （P 〉 0.05）. Conclusion：As a rare special type of invasive cancer, IMPC patients are easier to get lymph nodes metastasis as compared with IDC patients. A combined evaluation is warranted since high expression of ER alone doesn＇t necessarily mean good prognosis.