分泌性乳腺癌6例临床病理分析

Secretory breast carcinoma: a clinicopathological study of 6 cases

目的探讨分泌性乳腺癌(secretory breast carcinoma,SBC)的临床病理特点、诊断、鉴别诊断及预后。方法收集6例SBC的临床病理资料及随访资料,光镜下观察HE切片,采用免疫组化、FISH技术检测ETV6基因,并复习相关文献。结果 6例患者中男性1例,女性5例,发病年龄6～76岁,平均38. 7岁。左侧乳腺2例,右侧乳腺4例。5例表现为无痛性乳腺肿块,1例表现为乳头溢液。肿瘤直径1. 0～3. 1 cm,平均2. 0 cm,边界较清,但无包膜。镜下实性巢状、微囊状、腺管样或乳头状排列的肿瘤细胞被玻璃样变的纤维组织分隔,呈多结节状生长;胞质内含嗜酸性分泌物或分泌小泡。免疫表型:6例CK7、CEA、S-100均阳性,ER、PR、HER-2均阴性,Ki-67增殖指数10%～40%; 1例分子检测存在ETV6基因易位。2例行肿块切除术; 4例行乳腺癌改良根治术,其中2例有淋巴结转移(3/15、1/16)。5例随访6个月～20年,1例发生肺转移。结论 SBC属于临床经过相对惰性、预后较好的罕见乳腺肿瘤,依据典型的病理学形态及免疫表型可明确诊断,特征性的ETV6基因易位有重要的鉴别诊断价值。

Purpose To describe the clinicopathologic features,diagnosis and differential diagnosis,and prognosis of secretory breast carcinoma(SBC).Methods Clinicopathological and follow-up data of six SBC patients were collected.Histopathologic analysis was performed on hematoxylin and eosinstained(HE)section.Immunohistochemical staining was performed by EnVision two-step method and ETV6 gene detected by fluorescence in situ hybridization(FISH),then relevant literatures were reviewed.Results The ages of the patients ranged from 6 to 76 years with a mean age of 38.7 years,including one male and five female patients.The right breast was involved in 4 cases,and the left,in 2 cases.Five cases showed painless breast mass while one presented with a nipple discharge.The tumor size ranged from 1.0 to 3.1 cm with a mean size of 2.0 cm.Most of the tumors were circumscribed,solid gray white to light brown.Histologically,tumor showed solid nested microcystic,glandular or papillary pattern separating by hyaline fibrous tissue and growed in multiple nodular from.The cytoplasm contains abundant eosinophilic secretions or secretory vesicles.Immunhistochemistry,all cases were positive for CK7,S-100 and CEA,but negative for estrogen and progesterone receptors(ER and PR)and HER-2,and the proliferation index Ki-67 ranged from 10%to 40%.Molecular testing confirmed the presence of the EVT6 gene translocation in one case.Lumpectomy was performed in 2 cases and modified radical mastectomy in 4 cases,two of them had lymph node metastasis(3/15,1/16).Five cases were followed up for 6 months to 20 years,1 case had lung metastasis.Conclusion SBC is a rare breast tumor with relatively indolent clinical and good prognosis.It can be diagnosed according to typical pathological morphology and immunohistochemical characteristics.The characteristic EVT6 gene translocation also has important differential diagnostic value.