中央坏死性乳腺癌7例临床病理分析

Centrally necrotizing carcinoma of the breast:a clinicopathological analysis of seven cases

目的探讨中央坏死性乳腺癌(CNC)的临床及病理学特征。方法应用常规病理检查和免疫组化方法,观察中央坏死性乳腺癌的组织病理学特征。结果7例中央坏死性乳腺癌均为女性,占同期乳腺癌1.1%(7/636)。年龄32~77岁,平均58岁。病程10天~3年,71.4%(5/7)位于左侧乳腺外上象限,28.6%(2/7)位于右侧,均为单发病灶。临床主要症状是无痛性包块,57.1%(4/7)有肿块进行性增大病史。组织学以肿瘤中央出现大片坏死或无细胞区为显著特点,肿瘤边缘残留少量癌组织,残留的癌组织呈巢状或条索状排列。7例中央坏死性乳腺癌中,7例(100%)癌细胞CK8/18(+),5例(71.4%)例CK5/6(+),4例(57.1%)P63(+),7例(100%)Ki-67密集区增殖指数≥30%。结论中央坏死性乳腺癌是一种少见的具有独特结构特征的浸润性癌,正确认识该肿瘤可避免漏诊和误诊。

Objective To investigate the clinicopathological characeristics of centrally necrotizing carcinoma of the breast(CNC).Methods Seven cases of centrally necrotizing carcinoma of the breast were studied by HE and immunhistochemical staining.Results There were 7 cases of centrally necrotizing carcinoma of the breast,all female,accounting for 1.1%of the 636 cases of breast cancinoma in the same period.Their ages at the onset of the illness were 32 to 77 years(average 58 years).The duration of the illness before operation were 10 days to 3 years,71.4%(5/7)was located in the upper quadrant outside the left breast,and 28.6%(2/7)was located on the right side,all of which were single lesions.The main clinical symptoms were painless masses,and 57.1%(4/7)had a history of progressive enlargement of masses.Microscopically,the tumour was characterized by a large necrotic or accellular area in the center of the tumor,and a small amount of cancerous tissue remaining in the margin of the tumor,which was arranged in a stripe-like or nested patten.Immunohistochemical study of 7 cases(100%)showed positive E-cad,5(71.4%)showed positive CK5/6,4(57.1%)showed positive P63,and 7(100%)ki-67 had index≥30%.Conclusion Centrally necrotizing cancinoma of the breast is an invasive cancer with unique structural characteristics,which is relatively rare,the correct understanding of this tumor can avoid undiaosis or misdiagnosis.