乳腺化生性癌1例及相关文献复习

Breast metaplastic carcinoma:a case report and review of literature

目的探讨乳腺化生性癌(metaplastic breast carcinoma,MBC)的病理学特征及诊断、鉴别诊断方法。方法通过观察临床表现,以及彩超、组织病理学和免疫组化检查确诊1例乳腺化生性癌,收集该病临床资料并复习相关文献进行讨论。结果临床表现为双侧乳腺肿物进行性增大。彩超示左乳探及一大小5cm×3cm×2.5cm的肿物,边界不清;右乳探及一大小2cm×1cm×0.5cm的肿物。HE染色光镜下见左乳腺正常结构被破坏,见肉瘤样成分,瘤细胞梭形,呈束状、交错及波浪状排列,胞质丰富,核圆形,卵圆形,核仁明显,部分肿瘤细胞由化生性鳞状细胞构成。免疫组化显示肿瘤细胞ER、PR、cerB-2均阴性表达,上皮细胞CK5/6阳性表达,间叶细胞Vimentin阳性表达,Ki67增殖数>90%。结合彩超、组织病理学及免疫组化结果证实为乳腺化生性癌。结论乳腺化生性癌是一种罕见的乳腺恶性肿瘤,诊断需依赖免疫组化及电镜,治疗上手术宜选择乳房切除术。

Objective To investigate the pathological features and methods for diagnosis and differential diagnosis of metaplastic breast carcinoma（MBC）. Methods One case of metaplastic breast carcinoma was proved by observing clinical manifestation,color doppler ultrasonography,histopathology and immunohistochemistry test.The clinical data of this case was collected and the related literatures were reviewed for discussing. Results The clinical manifestation was the progressive enlargement of bilateral breast tumor.Color Doppler ultrasonography showed a mass（size 5 cm×3 cm×2.5 cm）in the left breast and the border was unclear,and a mass（size 2 cm×1 cm×0.5 cm）in the right breast was found.HE staining by microscope showed that the normal structure of the left breast was destroyed,and sarcomatoid components were seen,tumor cells were spindle shaped and arranged in a beam,interlacing and wavy manner with rich cytoplasm,the nucleus was round and oval,and nucleolus was prominent.Some tumor cells were composed of metaplastic squamous cells.The immunihistochemistry indicated that the expressions of ER,PR and cerB-2 were negative in the tumor cells,the expression of epithelial cell CK5/6 was positive,the expression of Vimentin in the mesenchymal cells was positive and the proliferation of Ki67 was more than 90%.Integration of color ultrasonography,histopathology and immunohistochemistry test results confirmed metaplastic breast carcinoma. Conclusion Metaplastic breast carcinoma is a rare malignant breast neoplasm,the diagnosis must rely on immunohistochemistry and electron microscopy,and mastectomy is an appropriate choice for surgery treatment.