乳腺包裹性乳头状癌临床病理分析

Clinicopathologic analysis of breast encapsulated papillary carcinoma

目的:探讨14例乳腺包裹性乳头状癌(encapsulated papillary carcinoma,EPC)的临床病理学特点。方法:对14例乳腺EPC患者进行回顾性分析,观察其组织病理学形态、免疫表型、诊断及预后,并复习相关文献。结果:14例患者中,年龄39~87岁,平均年龄65岁,女性13例,男性1例。肿瘤大体呈囊实性,肿瘤最大直径为2.0~7.5cm。镜检显示肿瘤由纤维囊壁包裹,与周围乳腺组织分界清楚,囊内肿瘤细胞呈乳头状结构。免疫组化染色显示囊内乳头状成分肌上皮完全缺失,11例肿瘤周围肌上皮完全缺失,3例肿瘤周围肌上皮呈不连续表达,ER和PR弥漫强阳性,Her-2阴性,Ki-67增殖指数为1%~20%。13例经肿瘤完全切除确诊,1例经粗针穿刺(core needle biopsy,CNB)确诊,所有病例术后无复发。结论:乳腺EPC是一种预后良好的惰性浸润性癌,主要发生于老年妇女,病理诊断依赖于肿瘤大体切除标本,处理方式与乳腺导管原位癌(ductal carcinoma in situ,DCIS)相同。

Objective：To investigate the clinicopathological features of 14 cases breast encapsulated papillary carcinoma （EPC）.Methods：14 patients with breast EPC were retrospectively analyzed.The pathological morphology,immune phenotype,diagnosis and prognosis were discussed and literatures were reviewed.Results：14 patients were aged from 39 to 87 years,with an average age of 65 years,13 female and 1 male.EPC presented with solid or cystic masses,maximum diameter ranged from 2.0 to 7.5 cm.Microscopically,EPC were capsuled by fibrous walls,with a clear demarcation with the surrounding breast tissue,and tumors presented with papillary structure in the cysts.The immunohistochemistry showed that all of cases were lack of myoepithelial cells in the cysts.11 cases were lack of myoepithelial cells and other 3 cases were expressed myoepithelial cells discontinuously surrounding the tumor nests.ER and PR were diffuse strong positive,and Her-2 was negative.Ki-67 proliferation index ranged from 1% to 20%.13 cases were diagnosed as EPC by the complete resection specimens of tumors,1 case by core needle biopsy （CNB）,all of cases without postoperative relapse.Conclusion：The breast EPC is one of indolent invasive carcinomas,mainly occurs in elder women.Pathological diagnosis depends on the complete resection specimens of tumors,and the treatment of EPC is similar to breast ductal carcinoma in situ （DCIS）.