CAJ | 학술논문

目的研究乳腺管状小叶癌(TLC)的临床病理特征及免疫表型特点.方法收集北京协和医院2005年1月至2010年3月间病理诊断包含乳腺浸润性小叶癌的病例97例,从中筛选出8例TLC.对8例TLC的临床病理资料进行回顾性分析,并采用免疫组织化学方法检测雌激素受体(ER)、孕激素受体(PR)、HER2、p53、E-cadherin,CK34βE12及CK8在TLC中的表达.结果 TLC的发生率占同期乳腺癌患者的1.0％ (8/880).患者平均年龄59岁(45～ 79岁),多无临床症状而于体检时发现.乳腺B超常表现为形态不规则的低回声结节,边缘多有毛刺；镜下由均匀一致的小细胞交织排列成小管状、单排索条状或单个散在细胞,浸润纤维性间质或小时间及小叶内间质,并围绕导管呈环靶状排列.近周边可伴有细胞形态相似的低-中级别上皮内肿瘤:包括小叶原位癌、导管内癌及导管内乳头状癌等.免疫组织化学多表达ER(7/8)、PR(8/8),均不表达HER2和p53.不论管状结构还是条索状结构,多一致地表达E-cadherin(7/8)、CK34βE12(5/8)及CK8(8/8).8例中有2例出现腋窝淋巴结转移.所有患者均行乳腺癌改良根治术,其中7例术后随访28 ～ 75个月,患者身体状况均良好,除1例术后60个月发现对侧乳腺新生肿物,但至今未予治疗外,其余病例均未见进展性病变.结论 TLC是一种极少见的兼具小管癌及小时癌病理形态特征的特殊类型的浸润性乳腺癌,免疫组织化学常一致地表达ER、PR、E-cadherin、CK34βE12及CK8等.充分认识TLC有助于及时准确地做出病理诊断.
목적 연구유선관상소협암(TLC)적림상병리특정급면역표형특점.방법 수집북경협화의원2005년1월지2010년3월간병리진단포함유선침윤성소협암적병례97례,종중사선출8례TLC.대8례TLC적림상병리자료진행회고성분석,병채용면역조직화학방법검측자격소수체(ER)、잉격소수체(PR)、HER2、p53、E-cadherin,CK34βE12급CK8재TLC중적표체.결과 TLC적발생솔점동기유선암환자적1.0％ (8/880).환자평균년령59세(45～ 79세),다무림상증상이우체검시발현.유선B초상표현위형태불규칙적저회성결절,변연다유모자；경하유균균일치적소세포교직배렬성소관상、단배색조상혹단개산재세포,침윤섬유성간질혹소시간급소협내간질,병위요도관정배파상배렬.근주변가반유세포형태상사적저-중급별상피내종류:포괄소협원위암、도관내암급도관내유두상암등.면역조직화학다표체ER(7/8)、PR(8/8),균불표체HER2화p53.불론관상결구환시조색상결구,다일치지표체E-cadherin(7/8)、CK34βE12(5/8)급CK8(8/8).8례중유2례출현액와림파결전이.소유환자균행유선암개량근치술,기중7례술후수방28 ～ 75개월,환자신체상황균량호,제1례술후60개월발현대측유선신생종물,단지금미여치료외,기여병례균미견진전성병변.결론 TLC시일충겁소견적겸구소관암급소시암병리형태특정적특수류형적침윤성유선암,면역조직화학상일치지표체ER、PR、E-cadherin、CK34βE12급CK8등.충분인식TLC유조우급시준학지주출병리진단.
Objective To study the clinical and morphological features as well as immunophenotype of tubulolobular carcinoma of the breast (TLC).Methods Eight cases of TLC were retrieved from 97 cases of invasive lobular carcinoma between January 2005 and March 2010 in the Peking Union Medical College Hospital.The clinical features and pathologic findings were studied and immunohistochemistry was performed for the expression of ER,PR,HER2,p53,E-cadherin,CK34βE12 and CK8.Results Among the breast cancer patients,the incidence of TLC was about 1.0％ (8/880).The mean age of the patients was 59 years,with a range of 45 to 79 years.All patients were asymptomatic,with incidental finding of a mass in the breast on health examination.Common findings on sonography included a hypoechoic nodule with irregular shape and spiculated margin.Histologically,the small uniform tumor cells were arranged in a mixed pattern showing single cells,single-cell files or cords,small round to angulated tubules,and infiltrating lobular or targetoid patterns around ducts that were specific for classical invasive lobular carcinoma.Low or intermediate grade intraepithelial neoplasms which had similar cellular morphology with the invasive tumor often appeared in the periphery,including ductal carcinoma in situ,lobular carcinoma in situ and intraductal papillary carcinoma.Immunohistochemistry of the tumor cells showed intense reactivity to ER (7/8) and PR (8/8),but no reactivity to HER2 or p53.Both the tubules and single-cell file or cords expressed E-cadherin (7/8),CK34βE12 (5/8),and CK8 (8/8) with a uniform staining pattern.All patients underwent modified radical mastectomy and 2/8 patients had metastatic carcinoma in the axillary lymph nodes.Seven patients were followed up for 28 to 75 months and remained well,including one patient that had a new breast mass 60 months after surgery,but had no treatment up to now.Conclusions TLC is a rare variant of invasive breast cancer and reveals mixed histologic features of both tubular and lobular carcinoma with common expression of E-cadherin,CK8 and CK34βE12.A better understanding of TLC would enable pathological diagnosis to be made reasonably and accurately.