乳腺化生性癌5例临床病理分析

Metaplastic breast carcinoma:a clinicopathologic study of five cases

目的探讨乳腺化生性癌(MBC)的临床病理特征及预后。方法通过光镜观察及免疫组化染色对5例MBC进行临床病理分析,并复习相关文献。结果 2例为鳞状细胞癌,均伴有腋窝淋巴结转移,其中1例以腋窝肿物首诊,3例均以乳腺肿物就诊,1例病理诊断为梭形细胞癌(部分高核级)),1例为低分化梭形细胞癌伴有低级别腺鳞癌,1例为肌上皮癌,免疫组化ER、PR、HER-2(-),AE1/AE3(+),p63、CK5/6腺上皮(+),Calponin、SMMHC、CK8/18、CD117、S-100局灶(+),Ki-67阳性指数15%~30%。结论 MBC较少见,诊断有一定难度,尤其是形态温和、分化较好时容易误诊或漏诊,需建立正确的诊断思路,严格掌握MBC的诊断指征,并辅助以免疫组化染色,预后主要根据分化方向、分化程度及腋窝淋巴结是否有转移综合评判。

Objective To investigate the clinicopathologic features and prognosis of metaplastic breast carcinoma ( MBC). Methods Five cases of MBC were analyzed through light microscopy and immunohistochemical staining,with review of related articles. Results Two cases were squamous cell carcinoma with axillary lymph node metastasis,one of them was diagnosed as axillary pump initially. Another 3 cases were treated as breast masses. Through pathologic diagnosis, 1 case was spindle cell carcinoma ( high-grade),1 case was poorly-differentiated spindle cell carcinoma with low-grade adenosquamous carcinoma,and the last case was myoepithelial carcinoma. IHC showed that the tumor cells were negative for ER,PR,HER-2 and CK8/18,and positive or partially positive for AE1/AE3,P63,CK5/6,Calponin,SMMHC, CD117 and S-100;Ki-67 positive index was 15%~ 30%. Conclusion MBC is a rare disease entity with difficulties in diagnoses. Misdiagnosis or missed diagnosis occurs easily when MBC has enough differentiation. It is important to have correct diagnosis approach,strict grasping of diagnostic indication of MBC,assisted by immunohistochemical staining. Prognosis can be evaluated mainly based on differentiation direction and degree and axillary lymph node metastasis.