乳腺浸润性微乳头状癌患者的临床病理特征分析

Analysis of clinical and pathological features of patients with invasive micropapillary carcinoma of breast

目的 探讨乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)的临床和病理特征。方法 选取2015年3月至2023年3月首都医科大学宣武医院行乳腺癌根治性手术的IMPC患者55例,根据病理诊断学分类中是否伴有其他类型乳腺恶性肿瘤,分为单纯组(n=10)和混合组(n=45),收集并分析患者的临床和病理资料。结果55例患者平均年龄(57.6±12.4)岁,平均肿瘤大小2.0(1.5,3.6)cm,54例(98.2%)患者的免疫组化的雌激素受体(estrogen receptor,ER)和孕酮受体(progesterone receptor,PR)均为阳性,49例(89.1%)患者的人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)阴性。28例(50.9%)存在腋窝转移。25例(45.5%)存在脉管癌栓。与混合组相比,单纯组患者年龄更高[(60.3±17.5)岁比(57.0±11.1)岁],淋巴结转移总数更多[2.0(1.3,3.5)个比1.8(1.5,4.1)个],差异均有统计学意义(P<0.05)。IMPC患者镜下肿瘤细胞呈“桑葚状”细胞团结构,上皮膜抗原(epithelial membrane antigen,EMA)染色呈“极性倒置”特点。结论 IMPC患者淋巴结受累率较高,对于病理结果为IMPC的患者,应严格腋窝评估和清扫,以期为患者带来更大获益。

Objective To explore the clinical and pathological features of patients with invasive micropapillary carcinoma of the breast(IMPC).Methods A total of 55 IMPC patients who underwent radical mastectomy in Xuanwu Hospital,Capital Medical University from March 2015 to March 2023 were selected,and were divided into simple group(n =10) and mixed group(n = 45) according to the pathological classification of whether they were accompanied by other types of breast malignancies.The clinical and pathological data were collected and analyzed.Results The average age of the 55 patients was(57.6 ± 12.4) years,and the average tumor size was 2.0(1.5,3.6)cm.Both estrogen receptor(ER) and progesterone receptor(PR) were positive in 54 cases(98.2%),while human epidermal growth factor receptor-2(HER-2) was negative in 49 cases(89.1%).Axillary metastasis was found in 28 cases(50.9%).Vascular tumor thrombus was present in 25 cases(45.5%).Compared with the mixed group,patients in the simple group were older [(60.3 ± 17.5) years vs.(57.0 ±11.1) years],and the total number of lymph node metastases was higher [2.0(1.3,3.5) vs.1.8(1.5,4.1)],and the differences were both statistical significant(P<0.05).Microscopically,the tumor cells in IMPC patients showed a "mulberry-like" cell cluster structure,and epithelial membrane antigen staining showed characteristics of polarity inversion.Conclusions The incidence of lymph node involvement is high in IMPC patients.For patients with pathological results of IMPC,axillary evaluation and dissection should be strictly carried out to bring greater benefits to patients.