中央坏死性乳腺癌的临床病理观察

Clinicopathological observation of centrally necrotizing carcinoma of breast

目的探讨中央坏死性乳腺癌(CNC)的临床病理特征、免疫表型和预后。方法收集2012年3月至2018年6月诊治的7例CNC的临床病理资料,并进行随访。结果7例患者年龄34~70岁,中位年龄52岁。大体均见单一结节。镜下肿瘤中央呈大片凝固性坏死或纤维化,癌组织呈窄带样环绕坏死区,6例为浸润性导管癌3级,1例为浸润性微乳头状癌伴浸润性导管癌2级结构。免疫组化染色显示,4例ER、PR、HER-2阴性,3例ER(+)、HER-2(+/++),基底细胞和肌上皮标记呈不同程度阳性。HER-2 FISH检测显示1例阳性。6例接受辅助治疗,术后随访14~49个月,其中4例无病生存,1例术后24个月出现肺转移,1例术后18个月出现肝转移,1例失访。结论CNC具有相对独特的病理组织学形态,大多为高级别浸润性导管癌并显示基底细胞样免疫表型。CNC预后较差,易发生肺、脑等远处转移,需严密监测。

Objective To investigate the clinicopathological features,immunophenotype and prognosis of centrally necrotizing carcinoma of breast(CNC).Methods The clinicopathological data of 7 cases of CNC diagnosed from March 2012 to June 2018 were collected,and the prognosis was followed-up.Results The age of 7 patients was 34-70 years,and the median age was 52 years.All tumors presented a single well-circumscribed nodule in gross examination.Microscopically,a large area of coagulative necrosis or fibrosis was found in the center of the tumor,and the tumor tissues showed a narrow band surrounding the necrotic area.Six cases were grade 3 invasive ductal carcinoma and 1 case was invasive micropapillary carcinoma with grade 2 structure of invasive ductal carcinoma.Immunohistochemical results showed that 4 cases were negative for ER,PR and HER-2.Three cases were positive for ER and HER-2(+/++).Basal cells and myoepithelial markers were positive in varying degrees.HER-2 FISH test showed one positive case.Six surgical cases were followed up for 14-49 months,of whom 4 cases survived without disease,1 case had lung metastasis 24 months after operation,1 case had liver metastasis 18 months after operation,and 1 outpatient surgical case was lost follow-up.Conclusion CNC has a relatively specific histopathological morphology,most of which is high-grade invasive ductal carcinoma and displays basal cell like immunophenotype.The prognosis of CNC is poor,and it is prone to distant metastasis,which needs close monitoring.