乳腺透明细胞癌:一种罕见的乳腺癌亚型

Glycogen-rich clear cell carcinoma of the breast: a rare subtype of breast cancer

目的探讨乳腺透明细胞癌(glycogen-rich clear cell carcinoma of breast,GRCCC)的临床病理特征和诊断要点。方法报道1例GRCCC的临床病理、免疫组织化学结果及预后,并复习相关文献。结果患者,女性,44岁,2016年7月因发现右乳无痛性包块3年余,于外院行右乳改良切除术,病检提示乳腺癌,右乳癌术后化疗后6月余,发现全身多发骨转移,后来我院会诊。镜下显示乳腺浸润性癌,细胞排列成巢索状,间质为毛细血管,肿瘤细胞具有丰富透明的胞浆,呈多边形,边界清楚,核深染,核仁明显,肿瘤伴大片坏死,可见多处淋巴管及血管内癌栓。免疫组织化学染色显示肿瘤呈ER、PR和Her-2三重阴性,CK5/6局灶阳性,GATA-3阳性,P120细胞膜阳性,E-cadherin阳性,标记血管的CD34阳性,标记淋巴管的D2-40阳性,GCDFP-15阴性。会诊结果诊断为乳腺透明细胞癌。最初的局部治疗6个月后,病人出现多发骨和远处淋巴结转移。结论乳腺富糖原的透明细胞癌是乳腺癌一种罕见的组织学亚型,通常预后较差。

Objective To explore the clinicopathological features and diagnostic criteria of glycogen-rich clear cell carcinoma (GRCCC). Methods The clinical pathology, immunohistochemistry results and prognosis of one case of GRCCC were reported, and related literatures were reviewed. Results A female patient, 44 years old, underwent a modified right breast resection in other hospital due to the discovery of a pain-free mass in the right breast for more than 3 years in July 2016. The pathological examination indicated the disease was breast cancer. 6 months after postoperative chemotherapy for right breast cancer, multiple bone metastases occurred in the patient. Later, the patient came to our hospital for consultation. Microscopic examination showed invasive breast cancer. The cells were arranged in a nest-like shape. The interstitial was capillary. The tumor cells were rich in transparent cytoplasm. They were polygonal, with clear boundaries, deep nuclear staining and obvious nucleoli. Massive necrosis was seen in the center of cancer cells. Tumor thrombus was observed in multiple lymphatic vessels and vascular. Immunohistochemistry results showed that the tumor was triple negative breast cancer (ER, PR and Her-2) were all negative, abbreviated as (-), CK5/6 focal positive (+), GATA-3 (+), P120 Membrane (+), E-Cadherin (+), CD 34 (+) for labeled blood vessels, D2 (-) for labeled lymphatic vessels and GCDFP-15 (-). The result of consultation was diagnosed as glycogen-rich clear cell carcinoma of the breast. 6 months after the initial topical treatment, the patient developed multiple bone and distant lymph node metastases. Conclusion Glycogen-rich clear cell carcinoma of the breast is a rare histological subtype of breast cancer with poor prognosis generally.