伴有微腺体腺病的乳腺浸润性癌五例临床病理观察

Clinicopathologic features of mammary microglandular adenosis with carcinoma： a study of 5 cases

目的 探讨伴有微腺体腺病的乳腺浸润性癌（microglandular adenosis with carcinoma, MGACA）的临床病理特点、免疫表型、鉴别诊断及预后.方法 收集2010至2016年5例MGACA患者的临床病理资料,对其临床表现、组织形态进行观察、采用免疫组织化学EnVision法检测S-100蛋白、细胞角蛋白（CK）、p63、Calponin、平滑肌肌球蛋白重链（SMMHC）、孕激素受体（PR）、雌激素受体（ER）和HER2,结合文献复习并对预后情况进行分析.结果 5例组织形态上均可观察到从微腺体腺病到不典型微腺体腺病再到浸润性癌的不同阶段的形态特征.1例浸润性癌成分大部分为产生基质的化生癌,见软骨及黏液样化生;其余4例均为浸润性导管癌.免疫组织化学表型：5例不同病变区域的上皮细胞均呈现S-100蛋白和CK阳性;p63、Calponin、SMMHC均显示所有病变区腺体无肌上皮包绕;仅1例PR小灶阳性,其余各例均ER、PR、HER2三阴性;Ki-67阳性指数为20%~40%;层黏连蛋白和Ⅳ型胶原蛋白染色显示微腺体腺病及不典型微腺体腺病区域腺体周围有基底膜围绕,而浸润性癌区域上皮周围基底膜消失.4例行改良根治术患者均未见淋巴结转移.随访7个月至6年,均存活,无复发.结论 MGACA少见,有特征性的组织学特点及免疫组织化学表型,其预后相较其他类型三阴乳腺癌可能较好.

Objective To study the clinicopathologic, immunohistochemical features, differential diagnoses and prognosis of mammary microglandular adenosis with carcinoma （MGACA） with micropapillary pattern.Methods Five cases of MGACA were collected from 2010 to 2016 and reviewed for their clinical, histologic features and outcome.EnVision method were done for S-100 protein, cytokeratin （CK）, p63, Calponin, smooth muscle myosin heavy chain （SMMHC）, PR, ER and HER2.Results Histologically, microglandular adenosis（MGA）, atypical MGA （AMGA） and invasive carcinoma were seen in all five cases of MGACA.The invasive component was metaplastic carcinoma in one case and ductal in four cases.All epithelial cells were S-100 and CK positive in MGA, AMGA and invasive carcinoma.p63, Calponin and SMMHC negativity confirmed the lack of a myoepithelial cell layer in MGA, AMGA and MGACA.PR was weakly focally positive in one case, but ER and HER2 were negative in all cases （four cases were triple negative）.Ki-67 index was 20% to 40%.Laminin and collagen Ⅳ staining showed the presence of basement membrane in MGA and AMGA, except MGACA.The follow-up time ranged from 3 months to 6 years, and all patients were alive without recurrence or distant metastasis.Conclusions MGACA is a rare tumor with distinct morphological and IHC features.Compared to most triple-negative breast cancers, MGACA seems to have a relatively favorable outcome.