产生基质的化生性乳腺癌六例临床病理分析

Matrix-producing metaplastic carcinoma of the breast:6 cases reports and literature review

目的产生基质的化生性乳腺癌(matrix-producing metaplastic carcinoma of the breast,MPMC)较罕见,病理形态非常特殊,容易导致误诊。本研究探讨MPMC临床病理学特征、诊断要点及鉴别诊断。方法收集2010-01-01-2016-01-01北京大学人民医院MPMC患者6例。患者均为女性,年龄42~73岁,中位年龄49岁。分析6例MPMC的临床特点,观察其组织病理学表现并进行免疫组化染色,同时复习相关文献资料。结果肿瘤呈结节状生长,部分区域呈浸润性生长方式。结节周围为大片上皮样巢团,中央为黏液软骨样基质,可见坏死。6例上皮样细胞团均为乳腺浸润性导管癌,4例组织学分级呈Ⅲ级改变,2例为Ⅱ级。免疫组化6例患者中有4例ER、PR和C-erbB-2阴性,1例ER阳性,1例C-erbB-2为+,6例CK5/6、S100、CK和Vimentin、EGFR阳性。另做组织化学染色AB-PAS,6例均为阳性。结论MPMC一种非常罕见的恶性肿瘤,诊断时需与叶状肿瘤等鉴别,免疫组化有助于鉴别诊断。

OBJECTIVE To investigate the clinicopathological features,differential diagnosis,histogenesis,therapy and prognosis of matrix-producing metaplastic carcinoma of the breast MPMC.METHODS MPMC is relatively rare,pathological morphology is very special,especially prone to misdiagnosis.6cases of breast MPMC were analyzed with respect to clinical information and pathological features.The related literature and immunohistorical stains were rewiewed.RESULTS The 6cases of patients were female and average age were 49 years old.Histological examination revealed nodules of tumor growth,less of cases shows invasive pattern.Vast epithelioid nest surrounding for nodules the central mucinous chondroid matrix,necrosis were noted within myxoid or myxohyalinous stroma.Epithelial-like cells were invasive ductal carcinomas,4cases wereⅢ grade,2cases wereⅡ grade.The immunohistochemical stains 6cases：in 4cases of ER,PR and C-erbB-2negative,1case of ER positive,1case of C-erbB-2was 1＋,cancer cells were positive for CK5/6,S100,CK,Vimentin and EGFR in all cases.Another histochemical stain has been implemented for AB-PAS,all cases were positive.CONCLUSIONS MPMC of the breast is a rare malignant tumor,belongs to the metasplastic carcinoma.Differential diagnosis such as malignant phyllodes tumor should be considered.Immunohistochemical stains were useful for their differential diagnosis.