23例乳腺具有髓样特征的癌临床病理分析

Clinicopathological analysis of breast carcinoma with medullary features: 23 cases

目的探讨乳腺具有髓样特征的癌(breast carcinoma with medullary features)的临床病理特征、治疗及预后。方法回顾性分析2008年1月至2018年1月常州市第二人民医院收治的23例具有髓样特征的癌患者的临床病理资料。结果 23例具有髓样特征的癌占同期治疗的浸润性乳腺癌的5.0%(23/463),均为女性,年龄32～67岁(中位发病年龄50岁),包括髓样癌13例(56.5%)、非典型髓样癌5例(21.7%)及伴髓样特征的非特殊型浸润性癌5例(21.7%)。23例患者的肿瘤形态学特点相似,肿块直径1～5 cm,呈结节状,其中:20例肿块界限清楚,3例肿块边界欠清;2例肿块切面呈囊性,21例为实性。髓样癌镜下表现:肿瘤有膨胀性边缘,边界清楚;肿瘤细胞呈合体细胞生长方式,细胞间界限不清;细胞核呈圆形空泡状,有明显异型性;肿瘤缺乏间质成分,其背景有明显的淋巴细胞浸润。非典型髓样癌及伴髓样特征的非特殊型浸润性癌镜下表现为肿瘤细胞呈合体细胞生长方式,肿瘤边界欠清,有浸润性边缘,出现腺管结构,间质内见大量淋巴细胞浸润。患者的腋窝淋巴结阳性率为30.4%(7/23)。免疫组织化学检测ER、PR、HER-2、EGFR和CK5/6的阳性率分别为4.3%(1/23)、4.3%(1/23)、4.3%(1/23)、43.5%(10/23)和26.1%(6/23),Ki67增殖指数为20%～98%。23例患者均接受手术治疗和辅助化疗, 2例辅以局部放射治疗,1例辅以内分泌治疗,1例辅以曲妥珠单克隆抗体靶向治疗。随访时间为6～96个月,中位随访时间为58个月,除4例失访,其余患者术后定期复查未见复发和转移。结论乳腺具有髓样特征的癌临床发病率较低,分子分型多为三阴性乳腺癌,肿瘤细胞形态属于高级别,但恶性程度低,临床预后好,手术加辅助化疗是治疗的重要手段。

Objective To investigate the clinicopathology, management and prognosis of breast carcinoma with medullary features. Methods The clinicopathological data of 23 patients with breast carcinoma with medullary features in Second People’s Hospital of Changzhou City from January 2008 to January 2018 were retrospectively analyzed. Results Twenty-three patients were histopathologically diagnosed with breast carcinoma with medullary features, accounting for 5.0% of all 463 invasive breast cancer patients in the same period. They were female, at the age of 32-67 years(median 50 years).There were 13(56.5%) cases of medullary breast carcinoma(MBC), 5(21.7%)atypical MBC and 5(21.7%) non-specific invasive carcinoma with medullary features. The morphological characteristics of all 23 patients were similar. The tumor diameter was 1-5 cm and the tumor was nodular. The border of the tumor was clear in 20 cases, and unclear in 3 cases. The tumor was cystic in 2 cases and solid in other 21 cases. The MBC had a expansible margin and clear border;tumor cells were in a syncytial cell growth mode, and the intercellular border was unclear;the nucleus was round and vacuolated, with obvious abnormity;the tumor lacked stromal components, with significant lymphocyte infiltration peripherally. The atypical MBC and non-specific invasive carcinoma with medullary features were in a syncytial cell growth mode, with unclear border, invasive margin, glandular structure and a large number of lymphocytes infiltrated in the stroma. The positive rate of axillary lymph nodes was 30.4%(7/23). In immunohistochemistry, the positive rate of ER,PR,HER-2,EGFR and CK5/6 was 4.3%(1/23),4.3%(1/23),13.0%(3/23),43.5%(10/23),26.1%(6/23),respectively. Ki67 proliferation index was 20%-98%. All 23 patients were treated with surgery and adjuvant chemotherapy. Local radiotherapy was given in two cases, endocrine therapy in one case and targeted therapy(trastuzumab) in one case. All patients were followed up for 6-96 months(median 58 months). Four cases were missed during the follow-up. No recurrence and metastasis were found in other nineteen patients. Conclusion The breast carcinoma with medullary features is mostly triple-negative, with low clinical incidence. In spite of advanced staging based on cell morphology, it has low malignancy and good prognosis, usually treated by surgery combined with adjuvant chemotherapy.