乳腺包裹性乳头状癌临床诊断学特征分析

Analysis of clinical diagnostic features of encapsulated papillary carcinoma of breast

目的探讨乳腺包裹性乳头状癌(EPC)的临床诊断学特征。方法回顾性分析2014年1月至2018年11月滨州医学院烟台附属医院乳腺外科诊断为乳腺包裹性乳头状癌5例患者的临床影像学和病理学资料,总结其诊断学特征。结果EPC患者均为女性,年龄54~70岁,均因乳房肿块首诊,其中1例乳头溢液,1例乳腺疼痛;肿块最大径1.0~4.0 cm,质地韧、偏硬,表面尚光滑,活动尚可,皮肤无红肿,无酒窝征及橘皮征,腋窝无淋巴结转移。乳腺超声提示肿块为边界清晰,形态不规则的囊实性肿物;磁共振成像(MRI)提示肿块为边界清晰、囊性液体包裹的宽基底、形态不规则的高信号实性肿物。EPC病理学肉眼观察为质脆、类圆形突起的囊实性结节;镜下表现为一层厚纤维包膜围绕的乳头状增生病变,呈蓬乱分枝乳头状结构,管腔均未见肌上皮细胞,免疫组织化学染色示雌激素受体(ER)、孕激素受体(PR)均阳性,4例人类表皮生长因子受体2(Her-2)阴性,1例Her-2阳性,Ki-67%<5%,CK5/6及p63肌上皮染色呈阴性;5例均为Lunimal A型。4例患者行乳腺癌改良根治术,1例行乳腺癌保乳术,均无淋巴结转移。结论EPC好发于老年女性,多因乳房肿块首诊,镜下呈厚纤维包膜围绕的蓬乱分枝乳头状结构,免疫组化染色证实病变周缘肌上皮明显减少甚至缺如,是该病重要的临床诊断学特征。

ObjectiveTo explore the clinical diagnostic features of encapsulated papillary carcinoma(EPC)of breast.MethodsThe clinical data of 5 cases of EPC in Yantai Affiliated Hospital of Binzhou Medical University from January 2014 to November 2018 were analyzed retrospectively.ResultsEPC patients were all female,aged from 54 to 70 years old.The first diagnosis was due to breast mass,including 1 case of nipple overflow and 1 case of breast pain.The maximum diameter of the mass was from 1.0 to 4.0 cm,with tough and hard texture,smooth surface,fair movement,no redness or swelling of skin,no dimple or orange skin signs,and no lymph node metastasis in axilla.Breast ultrasound showed that the mass was a solid mass with clear boundary and irregular shape,while MRI showed that the mass was a solid mass with clear boundary and wide base surrounded by cystic fluid and irregular shape.In 5 cases of EPC pathology,there were crispy,round like cystic solid nodules by perusal.Microscopic appearance:there was a layer of thick fibrous capsule surrounded by papillary hyperplasia,which presented a disordered branching papillary structure.No myoepithelial cells were found in the lumen.Immunohistochemical staining showed that estrogen receptor(ER)and progesterone receptor(PR)were all positive.In 4 cases,human epidermal growth factor receptor 2(HER-2)was negative.In 1 case,HER-2 was positive.In all 5 cases,Ki-67%<5%,CK5/6 and p63 were negative.Four patients were treated with modified radical mastectomy and one with breast conserving surgery.ConclusionsEPC is prone to occur in elderly women.The first diagnosis is mostly due to a breast mass.Under the microscope,it presents a messy branch papillary structure surrounded by thick fibrous capsule.Immunohistochemical staining shows that the myoepithelium around the lesion is significantly reduced or even absent.These are the important clinical diagnostic features of the disease.