具有微乳头结构的乳腺单纯型黏液癌8例临床病理分析

Clinicopathologic features of pure mucinous carcinoma with micropapillary pattern: report of eight cases

目的探讨具有微乳头结构乳腺单纯型黏液癌(MUMPC)的临床病理特点。方法分析8例MUMPC患者的临床病理资料、组织学形态和免疫表型,并复习相关文献。结果 8例患者中1例为男性,其余均为女性;年龄37～60岁,平均46岁。肿物最大径2.5～8 cm,平均直径4.6 cm(n=6),4例伴有淋巴结转移,1例伴有砂砾体形成。MUMPC的主要形态学特点包括:①存在大量细胞外黏液;②肿瘤细胞微乳头状排列;③中～高级别核;④鞋钉样细胞;⑤易出现砂砾体。免疫组化:激素受体高表达,Ki-67阳性指数1%～40%(平均14%,n=7)。结论 MUMPC可发生于年轻到老年女性,倾向于年轻女性。与乳腺单纯型黏液癌(PMBC)相比,MUMPC侵袭性强,淋巴结转移率高,细胞核级较高,术后建议辅助放、化疗。

Objective To investigate the clinicopathologic features of pure mucinous carcinoma with micropapillary pattern(MUMPC) of the breast. Methods The clinicopathologic characteristics were investigated in 8 cases of pure mucinous carcinoma with micropapillary pattern of the breast. The histologic and immunohistochemical data were retrospectively analyzed with review of the related literatures. Results One case was male and the others were female, aged from 37 to 60 years(average 46 years, n=8). The maximum diameters of the tumors were 2.5-8 cm(average 4.6 cm, n=6),in which 4 cases had lymph node metastasis and 1 case had psammoma body formation. The main morphological features of MUMPC included:(a)there was a large amount of extracellular mucus;(b)a distinctive micropapillary pattern was formed outside cells;(c)intermediate to high-grade nuclei were noted;(d)hobnail cells were present;(e)psammomatous calcifications were found. Immunohistochemistrally, the expression of hormone receptor was detected;the proliferation rate of Ki-67 was 1-40%(average 14, n=7) in the tumor cells. Conclusion MUMPC occurs in females from young to old and commonly tends to young woman. Compared with the PMC,MUMPC is more invasive, and the metastatic rate of lymph node and the nuclear grade are higher in MUMPC. Adjuvant radiotherapy and chemotherapy are recommended after surgery.