乳腺包裹性乳头状癌3例报告并文献复习

Encapsulated papillary carcinoma of breast:3 cases report and review of the literature

目的探讨乳腺包裹性乳头状癌(EPC)临床病理特征、预后情况,以期加深理解EPC,并为EPC的诊治提供一些思路。方法回顾性分析扬州市妇幼保健院2021年1月至2022年12月收治的3例EPC病人的临床病理资料,同时结合相关文献进行系统复习。结果3例病人均为绝经后女性,发病年龄范围为57~64岁,肿瘤长径1.5~3.0 cm,均因发现乳房肿块就诊。超声多表现囊实性、混合性包块,边缘呈角或模糊,RI值均大于0.7;组织学多见扩张囊腔、厚纤维包膜,腔内乳头状病变为主,细胞成实性或筛状排列。免疫组化均示雌激素受体(ER)阳性(90%~100%)、孕激素受体(PR)阳性(80%~90%),增殖细胞核抗原(Ki-67)(5%~10%),肌上皮标志物钙调蛋白(Calponin)、细胞角蛋白(CK)5/6、p63阴性。其中,EPC伴浸润性导管癌(IDC)1例,EPC伴导管原位癌(DCIS)2例,均行患侧全乳房切除术加腋窝前哨淋巴结活检术,均未见淋巴结转移。EPC伴IDC病人术后行化疗、内分泌治疗,EPC伴DCIS病人术后行预防性内分泌治疗。随访11~27个月,病人均无局部复发、远处转移或死亡。结论EPC是一种好发于老年女性的罕见乳腺肿瘤,表现为恶性程度低、淋巴结转移少等惰性生物行为,预后一般较好。但仍需警惕EPC伴浸润性癌的可能,避免误诊、漏诊。其个体化、精准化治疗策略尚有待进一步深入研究。

Objective To explore clinicopathological characteristics and prognosis of encapsulated papillary carcinoma(EPC)in order to deepen the understanding of EPC and provide some ideas for the diagnosis and treatment of EPC.Methods The clinicopathological data of 3 EPC patients admitted to Yangzhou Maternal and Child Health Hospital from January 2021 to December 2022 was retrospectively analyzed,and the relevant literature was systematically reviewed.Results All three patients were postmenopausal women,aged from 57 to 64,with a tumor diameter of 1.5 cm to 3.0 cm.Ultrasound showed cystic solid and mixed masses,angular or blurred edges,and RI values were greater than 0.7.Histology was more likely to include dilated cystic cavity,thick fibrous capsule,mainly papillary lesions in the cavity,and solid or sieve arrangement of cells.Immunohistochemistry showed positive ER(90%-100%),PR(80%-90%),Ki-67(5%-10%),and negative myoepithelial markers such as calponin,CK5/6,p63.One case of EPC with invasive ductal carcinoma(IDC)and 2 cases of EPC with ductal carcinoma in situ(DCIS)underwent total mastectomy plus axillary sentinel lymph node biopsy,and lymph node metastasis was not seen.The patient with IDC received chemotherapy and endocrine therapy after surgery,and other patients only received endocrine therapy.At follow-up of 11 to 27 months,none of the patients had local recurrence,distant metastases,or death.Conclusions EPC is a rare breast tumor and often occurs in elderly women,with an excellent prognosis for its less lymph node metastasis,and other inert biological behaviors.More attention should be paid to the possibility of EPC with invasive carcinoma and the study of individual therapy or precise treatment.