单纯型乳腺黏液癌临床病理分析

Clinicopathological features and prognostic factors of pure mucinous breast carcinoma

目的探讨乳腺单纯型黏液癌的病理特征及预后。方法收集我院乳腺癌患者1128例,其中单纯型乳腺黏液癌患者32例(2. 8%),分析单纯型黏液癌的组织形态、免疫组化、淋巴结转移情况及预后,并复习相关文献。结果 32例患者均为女性,年龄41~83岁,中位年龄54岁,平均年龄61岁。肿瘤直径0. 7~8.5cm,中位直径2. 9cm,平均直径3. 5cm。肿瘤细胞均为低-中级别核,40%为富于细胞型黏液癌,60%为少细胞型黏液癌。其中1例出现同侧腋窝淋巴结转移,余病例未见淋巴结转移。ER阳性率100%,PR阳性率100%,Ki-67增殖指数5%~40%,2例Her-2显示过表达。随访9~99个月,3例失访,1例术后(19个月)出现淋巴结转移,1例术后(18个月)出现胸壁复发。该2例单纯型乳腺黏液癌Her-2显示过表达,Ki-67增殖指数分别为30%、15%。结论在ER、PR高表达的黏液癌中,Her-2阳性的单纯型乳腺黏液癌预后差于Her-2阴性的单纯型乳腺黏液癌。

Purpose To investigate the pathological features and prognostic factors of pure mucinous breast carcinoma ( PMBC). Methods In a total of 1128 primary breast carcinomas,32( 2. 8%) were diagnosed as PMBC. Histopathologic features,immunohistochemical stains,lymph node metastasis and prognosis were analysed in the 32 PMBCs,and the related literatures were also reviewed. Results There were 32 PMBC patients,and all of them were female. The median age at diagnosis was 54 years ( ranged from 41 ~ 83 years with mean 61 years). The median tumor diameter was 2. 9 cm ( range,0. 7 ~ 8. 5 cm;mean,3. 5 cm). The PMBC lesions were differentiated nuclear grade,40% PMBC were hypercellular PMBC ( PMBC-B),and 60% PMBC were hypocellular PMBC ( PMBC-A). One patient presented with axillary lymph node metastasis,and other patients had only localized disease without nodal or distant disease. The PMBC cases showed ER positivity in 100% of tumors and PR positivity in 100%,Ki-67 proliferation index ranged 5%~ 40%,and two patients had Her-2 overexpression. Patients were followed up with range 9 ~ 99 months,and three patients had been lost to follow-up. One patient had lymph node metastasis 19 months after surgery and one patient developed local recurrence 18 months after surgery. Two patients had Her - 2 overexpression and the Ki-67 index were 30% and 15% respectively. Conclusion PMBC high expression of ER,PR,Her-2 overex pression in breast mucinous carcinoma suggests poorer prognosis than that of Her-2 negative breast mucinous carcinoma.