妊娠相关性乳腺癌和伴妊娠样改变的乳腺癌

A clinicopathological study of pregnancy-associated breast cancer and breast cancer with pregnancy-like change

目的 探讨妊娠相关性乳腺癌和伴妊娠样改变的乳腺癌病理组织学特点及其免疫表型。方法 从 10 5 0例乳腺癌病理资料中查出全部妊娠相关性乳腺癌 18例和伴有妊娠样改变的乳腺癌 9例 ,详细观察HE切片的组织形态学特点 ,用PV90 0 0二步法进行免疫组化染色。结果 妊娠相关性乳腺癌肿瘤直径 1 5～ 6 0cm (中位数 3 8cm) ,淋巴结转移率为84 6 % ;16例为浸润性导管癌 ,2例为黏液癌 ;11例伴有小叶癌化 ,7例有多形性癌成分 ,6例伴有大汗腺癌样改变。伴泌乳样改变的乳腺癌全部为浸润性导管癌 ,肿瘤直径 1 5～ 9 0cm(中位数 4 9cm) ,淋巴结转移率 10 0 % ;有小叶癌化者 7例 ,2例伴有大汗腺癌样改变。免疫组化两者均 10 0 %表达E cadherin ,6 6 7%表达 p5 3,表达ER分别为 4 0 0 %和 77 8% ,PR分别为2 1 4 %和 4 4 4 % ,c erbB 2分别为 4 6 7%和 4 4 4 % ,bcl 2分别为 4 0 0 %和 5 5 5 % ,EGFR分别为 35 7%和 2 2 2 % ,Ki 6 7平均阳性指数为 4 6 87和 39 6 3。结论 妊娠相关性乳腺癌和伴妊娠样改变的乳腺癌在组织形态上有一定特点 ,主要发生于导管癌 ,两者都有较高的小叶癌化率 ;淋巴结转移率都很高 ,PR的表达率较低 ,提示预后不好。

Purpose To study the clinicopathological features and the immunohistochemical phenotypes of pregnancy associated breast cancer (PABC) and breast cancer with pregnancy like change (BCPLC). Methods Eighteen cases of PABC and 9 cases of BCPLC,chosen from 1 050 cases of breast carcinoma, were observed for the histopathological features and immunohistochemically stained by PV9000 method. Results In PABC group, the tumors varied between 1 5 and 6 0 cm(mean 3 8 cm) in the greatest dimension of the tumors, 13 cases(84 6%) had axillary lymph node metastasis, and there were 16 cases of invasive duct carcinoma and 2 cases of mucinous carcinoma. Also, tumors in this group had 11 cases with cancerization of lobules, 7 cases with pleomorphic carcinoma component and 6 cases with apocrine carcinoma like change. In BCPLC group, of which all cases were invasive duct carcinoma and all had axillary lymph node metastasis. The tumors varied between 1 5 and 9 0 cm (mean 4 9cm) in greatest dimension of the tumors, and there were 7 cases with cancerization of lobules and 2 cases with apocrine carcinoma like change. The tumors of the PABC and BCPLC were positive for E cadherin (both 100%), p53 (both 66 7%), ER (40 0% and 77 8%), PR(21 4% and 44 4%), c erbB 2 (46 7% and 44 4%), bcl 2 (44 0% and 55 5%) and EGFR (35 7% and 22 2%), respectively. The mean scores of Ki 67 staining in tumors of the both groups were 46 87% and 39 63%. Conclusions The findings of this study suggest the tumors of PABC and BCPLC have certain characteristics in morphology including that most of them are invasive duct carcinoma and have cancerization of lobules, and they have higher incidence of lymph node metastasis and lower incidence of PR expression, which should be a poor prognosis.