混合性化生性乳腺癌2例临床病理分析并文献复习

Mixed metaplastic breast carcinoma: a clinicopathological analysis of 2 cases and literature review

目的探讨混合性化生性乳腺癌的临床特征、病理学特征、免疫表型、鉴别诊断、治疗及预后。方法应用光学显微镜及免疫组织化学方法分析2例混合性化生性乳腺癌的临床病理特点及免疫表型,并总结相关文献。结果患者均为老年女性,年龄分别为54岁和50岁。肿瘤大小分别为12cm×11cm×6cm、3.5cm×2.5cm×2cm。一例切面为灰白胶冻样,局部区域呈鱼肉状,另一例质中及灰黄伴局灶坏死。混合性化生性癌的构成成分分别为梭形细胞癌+骨肉瘤、鳞状细胞癌+非特殊型浸润性癌+软骨肉瘤。免疫表型:2例中,癌的成分均表达CK、EMA,其中鳞状细胞癌和梭形细胞癌成分均表达P63;肉瘤成分均表达vimentin、SMA、CK5/6,均不表达ER、PR、Her-2,Ki67增殖指数均较高,分别为40%、60%。结论混合性化生性乳腺癌的报道较少,预后较差,应广泛取材。当组成成分为3种及3种以上时,预后往往更差,应在报告中加以体现,免疫组织化学有助于不同组成成份的鉴别。

Objective To investigate the clinical features,pathological features,immunophenotype,differential diagnosis,treatment and prognosis of mixed metaplastic breast carcinoma.Methods The clinicopathological features and immunophenotypes of 2 cases of mixed metaplastic breast carcinoma were analyzed by light microscopy and immunohistochemistry,and the related literatures were summarized.Results All the patients were elderly women,aged 54 and 50 years,respectively.The sizes of tumors were 12 cm×11 cm×6 cm and 3.5 cm×2.5 cm×2 cm,respectively.One case had a gray-white gelatinous section with a fish-like local area,and the other case had a gray-yellow section with focal necrosis.The components of mixed metaplastic carcinoma were spindle cell carcinoma+osteosarcoma,squamous cell carcinoma+nonspecific invasive carcinoma+chondrosarcoma,respectively.Immunophenotypic analysis showed that CK and EMA were expressed in all cancer components,P63 was expressed in squamous cell carcinoma and spindle cell carcinoma,Vimentin,SMA and CK5/6 were expressed in sarcoma,ER,PR and Her-2 were negative in all cancer components;The Ki67 proliferation index was higher in both cases,40%and 60%,respectively.Conclusion There are few reports of mixed metaplastic breast carcinoma,and the prognosis is poor.The tissues should be collected widely.When the components are three or more,the prognosis is often worse,which should be reflected in the report.Immunohistochemistry is helpful for the identification of different components.