乳腺癌血管生成拟态的形态学观察及其临床病理意义

Morphological observation of vasculogenic mimicry in breast cancer and its clinicopathological significance

目的研究乳腺癌中的血管生成拟态(VM)观察及其临床病理意义。方法选取我院2008年7月至2014年7月收集的乳腺浸润性导管癌标本107例,对其石蜡标本进行CD34和PAS双重染色,观察是否存在VM,并分析VM与乳腺癌临床病理指标的关系。结果由肿瘤细胞围成的VM呈不规则的管道样结构,管壁内无内皮细胞衬覆,PAS染色可见相互连接成环状的网络通道,为基底膜样结构,这些PAS阳性管道与周边的正常血管联系紧密,且管壁内CD34染色阴性,管腔内偶见红细胞,周围无炎性细胞或坏死组织,如部分管道内皮细胞呈CD34染色阳性,则为内皮细胞性血管(血管生成)。CD34和PAS双重染色结果发现,107例乳腺浸润性导管癌标本中,25例有VM形成,阳性率为23.4%。肿瘤大小>2 cm、Ⅱ~Ⅲ级、淋巴结转移组的VM阳性率高于肿瘤大小≤2 cm、Ⅰ级和无淋巴结转移组(P<0.05),而患者年龄≥50岁组与年龄<50岁组的VM阳性率比较,差异无统计学意义(P>0.05)。结论乳腺癌中存在VM,且VM形成与乳腺癌的肿瘤大小、病理分级和远处转移有关。

Objective To investigate the vasculogenic mimicry（VM） in breast cancer and its clinicopathologic significance. Methods One hundred and seven cases of breast invasive ductal carcinoma specimens in our hospital from July2008 to July 2014 were selected and CD34 and PAS double staining were used to know the existence of VM, the relationship between VM and clinicopathological parameters of breast cancer were analyzed. Results The VM enclosed by tumor cells was irregularly structured, no endothelium lining in the tube, interconnected loop network channel being basement membrane-like structure was found in the PAS staining, these PAS-positive tubules were closely related to the surrounding normal blood vessels, and being CD34 staining negative inside the wall, red blood cells occasionally appeared in the tubes and there were no inflammatory cells or necrotic tissue around, when part of the tubes＇ endothelial cells being CD34 staining positive,which was the endothelial cell blood vessels（angiogenesis）. CD34 and PAS double staining results found that, of the 107 cases of breast cancer specimens, 25 cases with VM formation, the positive rate was 23.4%. The positive rate of VM in the groups of tumor size 2 cm, grade Ⅱ-Ⅲ and lymph node metastasis were higher than tumor size ≤2 cm, grade Ⅰ and non-lymph node metastasis groups（P〈0.05）. But the positive rate of VM in the patients ≥50 years old group and patients50 years old group were not statistically significant（P〉0.05）. Conclusion VM exists in breast cancer, and it is associated with tumor size, pathological grading and lymph node metastasis of breast cancer.