乳腺分泌性癌8例临床病理分析

Secretory carcinoma of the breast: a clinicopathological study of 8 cases

目的探讨乳腺分泌性癌(secretory breast carcinoma,SBC)的临床病理特征、免疫组织化学特点、鉴别诊断和预后。方法收集SBC 8例,对其临床、病理及免疫组织化学资料进行分析及文献复习。结果 8例SBC,1例男性,7例女性,发病年龄8~76岁(中位年龄43.2岁)。临床主要表现为无痛性乳房内包块。大体上肿块多数边界清楚,质稍硬,直径0.6~4.0cm;镜下瘤细胞呈实性、微囊状和导管样排列,胞质丰富,嗜酸性颗粒状。瘤细胞胞质内外含有丰富均质的嗜伊红分泌物。阿辛蓝染色呈蓝色,PAS染色呈红色。核分裂像少见,未见肿瘤性出血及坏死。免疫组织化学:肿瘤细胞主要表达CK7和S-100蛋白,CK5/6、p63、CEA和CD10绝大多数呈阴性反应,Ki-67指数相对较低。结论 SBC是乳腺癌的一种少见亚型,通常预后较好,形态学需与乳腺粘液癌,富于脂质癌,泌乳腺瘤等相鉴别,确诊依据HE染色形态和免疫组织化学,必要时可结合ETV6-NTRK3融合基因检测结果。

Objective To study the clinicopathological features,immunohistochemical characteristics,differential diagnosis and prognosis of secretory carcinoma of the breast(SBC).Methods The clinicopathological data and immunohistochemical information of eight SBC cases were analyzed,and related literature was reviewed.Results Eight cases,one male and seven female,aged18-76years(mean43.2),the main clinical manifestations being painless breast masses.The masses mostly had clear boundaries,slightly hard texture and0.6-4.0cm diameters.Histologically,the tumor cells were in a solid,microcystic and ductal arrangement,had abundant cytoplasm,eosinophilic granules,and large amounts of intracellular and extracellular eosinophilic secretions,Alcian blue staining(AB)and periodic acid-Schiff(PAS)staining both being positive.Mitotic activity was rare.Hemorrhage and necrosis were not observed.Tumor cell immmunhistochemitry:CK7and S-100were positive;CK5/6,CEA,p63and CD10were negative in almost all cases;Ki-67index was relatively low.Conclusion SBC is a rare subtype of breast cancer and has relatively good prognoses.Morphologically,it needs to be differentiated from mucinous carcinoma,lipid rich carcinoma,lactating adenoma,etc.Definite diagnosis depends on HE morphology and immunohistochemistry.ETV6-NTRK3fusion gene detection results should be referred to when necessary.