乳腺单纯型黏液癌43例临床病理特点及预后因素探讨

Clinical pathological features and prognostic factors of pure mucinous breast carcinoma

目的探讨乳腺单纯型黏液癌的临床病理学特点及预后因素。方法回顾性分析乳腺单纯型黏液癌43例,了解其不同亚型的临床病理特点及预后意义。结果 43例乳腺单纯型黏液癌患者均为女性,平均年龄61岁,>70岁占37%(16/43);其中富细胞型(B型)患者平均年龄为70岁。肿瘤平均大小为2.7 cm(1~7.5 cm)。组织学上,富细胞型、少细胞型和微乳头型分别占37%(16/43)、47%(20/43)和16%(7/43);93%(40/43)为Ⅱ级核。51%为组织学1级(高分化),49%为组织学2级(中分化)。8%(3/37)术前发生同侧腋窝淋巴结转移,其中66.7%(2/3)伴有微乳头状结构。手术方式多样,大部分为改良根治术加化疗和/或内分泌治疗。46%(17/37)为pTNMI期,51%(19/37)为Ⅱ期,3%(1/37)为Ⅲ期。22例获得随访,平均随访时间86个月(46~189个月);其中1例死于乳腺癌肺转移,其组织学为富细胞型单纯型黏液癌,3级核,中分化、Luminal B型。结论乳腺单纯型黏液癌是一组分化较好、淋巴结转移率较低、临床分期较早的乳腺癌,总体预后较其他非特殊型乳腺癌好。其组织学形态多样且具有一定的预后意义,当肿瘤内出现明显的微乳头状结构时,需要警惕同侧腋窝淋巴结转移的可能性;当富细胞型肿瘤伴有高核级时,需要警惕远处转移的可能性。

Objective To investigate the pathological characteristics and prognostic factors of pure mucinous breast carcinoma. Methods Forty-three patients with pure mucinous breast carcinoma were retrospectively analyzed to investigate the pathological characteristics and the prognostic factors of the different subtypes. Results All of the 43 patients were female. The mean age at diagnosis was 61 years with 37%（ 16/43） older than 70 years. For hypercellular variant,the mean age at diagnosis was 70 years. The average size of the tumor was 2. 7 cm（ ranging from 1 to 7. 5 cm） in diameter. Histologically,37%（ 16/43） cases were classified as hypercellular variant,47%（ 20/43） as hypocellular variant,and 16%（ 7/43） as micropapillary variant. Ninety-three percent（ 40/43） of the cases had grade Ⅱ nuclei. Fifty-one percent of the cases were well differentiated and 49% moderately differentiated. Lymph node metastasis occurred in three patients（ 3/43） before surgery,66. 7%（ 2/3） of which showed with micropapillary structure. Most of the patients had received modified radical mastectomy,with accessory chemotherapy and/or endocrine therapy. Forty-six percent（ 17/37）of the cases were classified as stage Ⅰ,51%（ 19/37） as stage Ⅱ and 3%（ 1/37） as stage Ⅲ according to AJCC cancer staging manual. Twenty-two patients were followed up successfully,with mean follow-up time of 86 months（ ranging from 46 to 189 months）. One patient died of lung metastasis by mucinous breast carcinoma of hypercellular variant with high grade nuclei,moderately differentiated and Luminal B. Conclusions Pure mucinous breast carcinoma is characterized by relatively well differentiation,low rate of lymph node metastasis,early TNM staging and good overall survival than other non-special type of breast cancer. Pure mucinous breast carcinoma has variable histologic subtypes,which perhaps mean different prognosis. We should be alert to the ipsilateral axillary lymph node metastasis if micropapillary structure emerges in the tumor mass,as well as to distant metastasis when the hypercellular variant with high nuclear grade.