乳腺实性乳头状癌中Ki-67的表达变化及其临床意义

Change of Ki-67 expression in solid papillary carcinoma and its clinical significance

目的实性乳头状癌(SPC)是一种少见的特殊类型乳腺癌,占所有乳腺癌的1.3%,病理组织学有其独特特点。本研究探讨SPC临床病理特征及免疫表型,从而进一步了解这种少见类型的肿瘤。方法收集广东省妇幼保健院2014—2019年诊断的49例SPC患者,回顾性分析其临床病理特征及免疫表型。结果本组患者的中位数年龄为58岁(范围20~78岁);其中21例为原位SPC,28例为SPC伴浸润;35(71.4%)例患者行前哨淋巴结活检,仅1例发现孤立性肿瘤细胞,余34例未发现淋巴结转移。免疫组化显示所有病例ER弥漫强(+)、HER-2(-),48(98%)例患者PR(+),48例表达神经内分泌指标突触素和/或嗜铬素A;Ki-67表达水平差异较大(增殖指数1%~80%),其表达水平与患者年龄相关,年龄<58岁的患者Ki-67高表达率为60.9%(14/23),显著高于年龄≥58岁组15.4%(4/26,P=0.001),而Ki-67表达水平与SPC是否伴浸润无关。结论SPC是一种少见类型的乳腺癌,好发于老年妇女,也可发生于年轻女性,SPC具有其独特的组织学特点,通常表达激素受体和神经内分泌标志物,Ki-67表达水平与SPC患者年龄密切相关,较年轻患者的Ki-67表达水平显著高于年老组,而年轻SPC患者中Ki-67高表达的预后意义还有待进一步深入研究。

Objectives Solid papillary carcinoma(SPC)is a rare subset of breast carcinoma accounting for 1.3%of all patients with breast cancer.It has distinctive histological pattern.Here,we analyzed the clinicopathologic characteristics and immunophenotype of SPC to improve our understanding more about this uncommon tumour.Methods A total of 49 patients with SPC of the breast from the Guangdong Women and Children Hospital between 2014 and 2019 were enrolled in this study.Retrospective analysis of the clinicopathologic characteristics and immunophenotype was performed.Results Median age for all patients was 58 years(range 20-78 years).Among these cases,21 cases were diagnosed as SPC in situ and 27 cases were confirmed as SPC with invasion.The sentinel lymph node biopsy(SLNB)was performed in 35(71.4%)cases.Only one of them was with isolated tumour cells and no metastasis was found in other cases.Immunohistochemical staining was strongly and diffusely positive for ER and negative for HER-2 in all of the cases.48(98%)cases were positive for PR.Chromogranin A and/or synaptophysin were positive in 48 cases.The proliferation index of Ki-67 varied,ranging from 1%to 80%.Interestingly,Ki-67 expression in young patients(<58 years)was significantly higher than the old patients(≥58 years,P=0.001).However,no differences were observed between SPC in situ and SPC with invasion for Ki-67 expression(P=0.305).Conclusion SPC represents a distinct entity of breast carcinoma.It affects primarily elderly women,and it also can affect younger patients.It has distinctive histological pattern and is frequently positive for hormone receptor and neuroendocrine markers.The expression of Ki-67 is associated with the age of patients.Ki-67 index is higher in younger women than that in elderly ones.The prognostic value of high exprssion of Ki-67 in younger women with SPC needs further research.