乳腺原发性伴印戒细胞分化的癌临床病理分析

Clinicopathological analysis of primary breast carcinoma with signet-ring cell differentiation

目的乳腺原发性伴印戒细胞分化的癌是一类罕见乳腺癌，具有典型的形态特征且侵袭性强，预后差，需与黏液癌等进行鉴别。因此，本研究探讨乳腺原发性伴印戒细胞分化的癌的临床病理特征、免疫表型特点和鉴别诊断。方法收集山东大学附属省立医院2010—05-17—2017-07—13诊治的乳腺原发性伴印戒细胞分化的癌8例，应用HE和免疫组化染色对其进行病理形态学观察和免疫表型分析。结果8例患者均因乳房肿块就诊，其中3例为单纯型印戒细胞癌，l例为印戒细胞性原位癌，4例合并其他类型浸润性乳腺癌。镜下均可见显著的胞质内黏液，将细胞核推挤于一侧，呈印戒细胞状。免疫组化结果显示，8例CK7和GCDFP15均呈强阳性表达；CK20、CDX2和HepPar1均阴性；ER、PR和HER2表达无明显差异；MUC1均阳性，并表现为腔缘加细胞质阳性和细胞质着色伴细胞膜加强着色2种模式，其中后者2例中有1例术后发生骨转移及肝转移去世，其余生存7例中除1例印戒细胞型原位癌复发外均无进展。结论肿瘤细胞具有印戒细胞样特点是诊断乳腺原发性伴印戒细胞分化的癌的主要依据，其免疫组化特点有助于其与转移性印戒细胞癌鉴别，此种类型乳腺癌可以发生复发和远处转移，需要引起临床及病理医师的注意。

OBJECTIVE Primary breast carcinoma with signet-ring cell differentiation is a rare type of breast cancer,with typical morphological characteristics and strong invasiveness,poor prognosis which needed to be identified with mucinous cancer. This article focused on the study of investigating the clinicopathological features, immunophenotypic characteristics and differential diagnosis of primary breast carcinoma with signet-ring cell differentiation. METHODS Clinical pathological data of 8 surgically treated patients who were pathologically confirmed primary breast carcinoma with signet-ring cell differentiation by Shandong Provincial Hospital Affiliated to Shandong University from May 17,2010 to July 13,2017 were collected. Hematoxylin-eosin（HE） and immunohistochemical staining were performed for pathological morphology observation and immune phenotype analysis, com bining with literature review. RESULTS All cases were female with a mean age of 50±13.5 years old and presented with breast lumps. In the microscopic cells, the cytoplasmic vacuoles could be seen and the nucleus was squeezed on one side, which were like signet-rings. Three of eight cases were confirmed to be simple type of signet ring cell carcinoma. Among them,one case was carcinoma in situ while the other 5 cases had also suffered from other types of invasive breast carcinoma. Immunohistochemical staining results confirmed the high expression of CK7 and CK;DFP-15 while CK20, CDX2 and HepPar-1 were negative. There was no significant difference in the expression of estrogen receptor, progesterone receptor, and HER2. MUC1 was positive in 8 cases and presented with two types：luminal and cytoplasmic type and circumferential membranous accentuation type. One of the 2 cases that expressed the latter mode had bone metastasis and liver metastasis after operation and finally passed away,and the other 7 living cases had no progression except 1 cases with recurrence of signet ring cell carcinoma in situ. CONCLUSIONS The characteristics of the morphological and immunohistochemical characteristics of the signet-ring cells are the key points in diagnosis of the breast carcinoma with signet-ring cell differentiation. This type has a strong potential of recurrence and metastasis, which requires the at- tention of clinicians and pathologists.