乳腺原发性腺泡细胞癌的临床病理观察及文献复习

Clinicopathological observation and literature review of primary acinic cell carcinoma in breast

探讨乳腺原发性腺泡细胞癌(acinic cell carcinoma,ACCA)的临床病理学特点、免疫表型、特殊染色特征及鉴别诊断。应用HE、免疫组织化学和特殊染色对1例乳腺原发性ACCA进行分析,并复习相关文献。患者女,41岁,因左乳肿块就诊。镜下见肿瘤组织形态多样,呈巢片状、腺泡状、小管状或微腺样等结构,在周围的纤维脂肪组织中浸润性生长。巢片状分布的肿瘤组织中癌细胞有明显的异型性和高分裂活性,细胞核级较高,胞质呈粗颗粒状,嗜碱性;而呈腺泡状分化较好的肿瘤组织中癌细胞形态温和,胞质为均一的细颗粒状,较空亮。微腺样结构区域可见腔内的嗜酸性胶样分泌物,类似于微腺型腺病。免疫组织化学显示:S-100,CK7,EMA均阳性,ER,PR,HER-2及肌上皮标志物CK5/6,p63,Calponin均阴性。PAS染色呈阳性。乳腺ACCA十分少见,与涎腺的ACCA极其相似,与三阴型非特殊类型的乳腺浸润性癌相比,有比较好的预后,但其组织学发生仍需要进一步的研究来阐明,为更好的治疗方式提供策略。

To investigate the clinicopathological features, immunophenotype, special staining features and differential diagnosis of primary acinic cell carcinoma (ACCA) of the breast, a case of primary ACCA of the breast was analyzed by HE, immunohistochemistry and special staining, and the related literature was reviewed. The patient, a 41-year-old female, was treated for a mass in her left breast. Microscopically, the tumors had various morphologies, such as nest-like, alveolar, tubular or microadenoid structures, and infiltrated into the surrounding fibrous and adipose tissues. Tumor cells with nest-like patches had obvious atypia and high mitotic activity, with higher nuclear grade, coarse granular cytoplasm and basophilic cytoplasm, while those with better alveolar differentiation had mild morphology and homogeneous granular cytoplasm. The eosinophilic colloidal secretions in the cavity can be seen in the area of microadenoid structure, which is similar to microadenopathy. Immunohistochemistry showed that S-100, CK7 and EMA were positive, while ER, PR, HER-2 and myoepithelial markers, such as CK5/6, p63 and Calponin were negative. PAS staining was positive. ACCA of the breast is very rare. It is very similar to ACCA of the salivary gland. Compared with triple negative invasive breast cancer, it has a better prognosis, but its histogenesis still needs further study to clarify and provide strategies for better treatment.