具中间腺细胞分化特征并含小圆细胞成分的三阴性乳腺癌临床病理观察

Clinicopathological features of triple negative breast cancer with intermediary glandular cell differentiation coexistence of small round cell components

目的 探讨具有中间腺细胞分化特征并含小圆细胞成分的三阴性乳腺癌(triple negative breast carcinoma with intermediary glandular cells differentiation coexistence of small round cell components, IGS-TNBC)的临床病理特点。方法 收集2019年1月至2021年1月间南阳市中心医院收治的3例IGS-TNBC的临床资料,对其进行组织学观察和免疫组化染色分析并进行文献复习。结果 3例IGS-TNBC分别为73岁、40岁、35岁女性患者,大体均为右乳灰白质韧,边界不清的肿块,镜下癌巢主要含有3种肿瘤细胞成分:(1)主要位于外周的A型细胞成分:小圆细胞,核深染、胞质少、无核仁;免疫组化强表达CD10,弱表达CK5/6和CK8/18。(2)B型细胞成分:多位于A细胞内侧,核染色浅淡,有模糊的或清晰的核仁,少量淡染胞质,细胞间界限不清,核分裂象多见,对CK5/6、CK8/18、CD10不同程度表达。(3)分化的腺管,多位于癌巢中心区,B型细胞内侧,对CK5/6和CK8/18均强表达。CK8/18由A细胞至B细胞到腺管表达逐渐增强。Ki-67在B细胞区均≥50%;P53在B细胞和腺管弥漫强表达,在A细胞不表达。3例均未见淋巴结转移。结论 IGS-TNBC为具有肿瘤干细胞分化特征的三阴性乳腺癌,其具有高增殖活性;小圆细胞成分可能为肿瘤分化原始细胞,基于TP53基因突变等分子机制向中间腺细胞分化并形成腺管。

Objective To investigate the clinicopathological features of triple negative breast cancer with intermediary glandular cell differentiation coexistence of small round cell components(IGS-TNBC). Methods The clinical data of three cases of IGS-TNBC were reported and analyzed by histological observation and immunohistochemical staining in Nanyang Central Hospital from January 2019 to January 2021. Results Three cases of IGS-TNBC occured in female patients at the age of 73 years, 40 years, and 35 years, respectively. All of them had a mass located in the right breast with ill-defined borders and grayish-white solid cut surface grossly. On histology, the tumors nests mainly contained three kinds of cell components from periphery to center successively, including type A cells composed of small round cells with scant cytoplasm, round deep-stained nuclei, containing no nucleoli, strongly expressed CD10 and weaker expression of CK5/6 and CK8/18;type B cells which had light stained cytoplasm and pale nuclei with brisk mitotic activity, inconspicuous to prominent nucleoli, indistinct borders, expression in varying degrees of CK5/6, CK8/18 and CD10;glandular duct of which cells morphologically were similar to type B cells but with a lower mitotic index, strong expression of CK5/6 and CK8/18. P53 was strongly expressed in type B cells and glandular duct cells, but not in type A cells. No lymph node metastasis was found in three cases. Conclusion IGS-TNBC is of triple negative breast cancer with the characteristics of cancer stem cell differentiation, which has high proliferation;the small round cells may be tumor progenitor cells which can differentiate into intermediary glandular cells and glandular structure based on molecular mechanisms such as TP53 gene mutation.