伴有微腺体腺病的乳腺浸润性癌临床病理观察

Clinicopathological features of breast microglandular adenosis with carcinoma

目的探讨伴有微腺体腺病的乳腺浸润性癌(MGACA)的临床病理特点、诊断及鉴别诊断。方法回顾性分析3例MGACA的临床特征、形态学特点、免疫组化,并复习相关文献。结果 3例患者年龄43~63岁,B超示乳腺结节US-BIRADS 2-4b类,肿瘤直径1. 2~2. 8 cm,边界部分清楚或模糊不清。组织学上浸润性癌成份,2例为浸润性导管癌,1例为腺样囊性癌,周边乳腺组织见微腺体腺病(MGA)、非典型微腺体腺病(AMGA)背景。免疫组化示S-100(+),腺体周边缺乏肌上皮,浸润性癌ER、PR、Her-2均(-),S-100蛋白表达随着病变从MGA、AMGA、MGACA的发展逐渐下降。对患者随诊5个月至6年,2例未见复发及转移,1例复发及腋窝淋巴结转移。结论MGACA是一种罕见肿瘤,形态学及免疫组化具有特征性,预后很难确定。

Objective To investigate the pathological features, diagnosis and differential diagnosis of breast microglandular adenosis with carcinoma( MGACA). Methods The clinical,morphological,immunohistochemical features of three cases of MGACA were analyzed retrospectively,and related literatures were reviewed. Results The three patients aged 43-63 years. Mammary nodules were found incidentally by B-type ultrasound examination,and classified as US-BIRADS 2-4 B. The diameters of the tumors were 1. 2-2. 8 cm;the boundary was clear or blurred.Histologically,the invasive component was invasive ductal carcinoma in two cases and adenoid cystic carcinoma in one case. Microglandular adenosis( MGA) and atypical microglandular adenosis( AMGA) were seen in the surrounding breast tissue. MGA expressed S-100,lack of myoepithelium around gland;ER,PR and Her-2 were negative in invasive cancer;S-100 protein gradually decreased as the lesions progressed from MGA to atypical MGA and carcinoma. Clinical follow-up time ranged from 5 months to 6 years;one patient was found recurrence and axillary lymph node metastasis;two patients survived without recurrence or distant metastasis. Conclusions MGACA is an extremely rare tumor with morphological and immunohistochemical features,and the prognosis is difficult to determine.