CAJ | 학술논문

目的探讨乳腺以微乳头状结构为特点的单纯型黏液癌的临床病理特点.方法收集26例以微乳头状结构为特点的乳腺单纯型黏液癌患者的临床病理资料,对组织形态、免疫表型及临床情况进行分析.结果 26例患者的发病年龄30～ 77岁,其中资料完整的12例平均年龄54岁,肿物最大径0.8 ～ 9.0 cm,平均3.2 cm,淋巴结转移3例,皮肤浸润2例.组织形态与浸润性微乳头状癌类似,上皮细胞膜抗原细胞外缘阳性,微乳头与间质的空隙内充填数量不等的黏液.不同病例的癌细胞具有不同的核级,19例具有低级别核,2例具有中级别核,5例具有高级别核;22例以大微乳头为主,4例以小微乳头为主.12例周围可见导管内癌;8例出现钙化及沙砾体.免疫表型具有激素受体高表达、HER2阴性的特点;Ki-67阳性指数为1％～ 70％;6例伴有神经内分泌分化.结论乳腺具有微乳头状结构的单纯型黏液癌多发生在较年轻的女性,其侵袭性较普通的单纯型黏液癌可能要强,至少是具有高级别核的病例如此,应该将其从普通型的单纯型黏液癌中区分出来,以免贻误治疗.
목적 탐토유선이미유두상결구위특점적단순형점액암적림상병리특점.방법 수집26례이미유두상결구위특점적유선단순형점액암환자적림상병리자료,대조직형태、면역표형급림상정황진행분석.결과 26례환자적발병년령30～ 77세,기중자료완정적12례평균년령54세,종물최대경0.8 ～ 9.0 cm,평균3.2 cm,림파결전이3례,피부침윤2례.조직형태여침윤성미유두상암유사,상피세포막항원세포외연양성,미유두여간질적공극내충전수량불등적점액.불동병례적암세포구유불동적핵급,19례구유저급별핵,2례구유중급별핵,5례구유고급별핵;22례이대미유두위주,4례이소미유두위주.12례주위가견도관내암;8례출현개화급사력체.면역표형구유격소수체고표체、HER2음성적특점;Ki-67양성지수위1％～ 70％;6례반유신경내분비분화.결론 유선구유미유두상결구적단순형점액암다발생재교년경적녀성,기침습성교보통적단순형점액암가능요강,지소시구유고급별핵적병례여차,응해장기종보통형적단순형점액암중구분출래,이면이오치료.
Objective To study the clinicopathologic features of pure mucinous carcinomas of the breast with diffuse micropapillary pattern.Methods Twenty-six cases of micropapillary variant of pure mucinous carcinoma of the breast were retrospectively reviewed by light microscopy,immunohistochemistry and clinical data analyses.Results The age of 26 female patients ranged from 30 to 77 years old,of which 12 cases with clinical details available were mean 54 years old.The tumor diameter ranged from 0.8 to 9.0 cm (mean 3.2 cm).Ipsilateral axillary nodal metastases were identified in 3 cases.Cutaneous involvement was also found in 2 cases.The tumor cells showed the similar architectural arrangement as in invasive micropapillary carcinoma,with peripheral borders of the cell clusters highlighted by epithelial membrane antigcn.Various amount of mucin occupied the retraction spaces around the tumor cells.Compared with conventional pure mucinous careinoma of the breast,mucinous carcinomas with micropapillary pattern showed different nuclear grades (19 cases of grade Ⅰ,2 cases of grade Ⅱ,5 cases of grade Ⅲ).The micropapillary cell clusters varied in size (22 cases of big micropapillary and 4 cases of small).Intraductal carcinoma was observed in 12 cases.Calcification and psammoma bodies were observed in 8 cases.Immunophenotyping,the tumor cells were with higher expression of hormonc rcccptors,but HER2 were negative.Ki-67 positive index was 1％～ 70％.Neuroendocrine differentiation was observed in 6 cases.ConcLusions The micropapillary variant of pure mucinous carcinoma of the breast,which mainly occurs in younger women,may carry the similar propensity for angioinvasion and nodal metastasis as infiltrating micropapillary carcinoma at least in cases with high nuclear grade.This morphologic subtype needs to be distinguished from conventional pure mucinous carcinoma of the breast and treated properly.