CAJ | 학술논문

目的探讨中央坏死性乳腺癌的临床病理和免疫表型特征及其与基底细胞样型乳腺癌的关系.方法观察35例中央坏死性乳腺癌的临床病理特点,并采用ER、PR、HER2、CK8/18、高相对分子质量CK(34βE12)、CK5/6、CK14、CK17、平滑肌肌动蛋白(SMA)、P63、波形蛋白、表皮生长因子受体(EGFR)进行EnVision法免疫组织化学染色.结果 35例患者的发病年龄为30～82岁,平均54.2岁.大体观察,肿物表现为边界较清楚的单中心结节,直径1.0～5.0 cm,平均2.4 cm.镜下,肿瘤中央有大片坏死或无细胞区,残留癌组织呈缎带状环绕在坏死区周围.中央坏死区表现为三种形态:24例主要由肿瘤性凝固性坏死组成,伴不同程度的纤维化或玻璃样变;8例以纤维化或瘢痕组织为主,见少量坏死癌组织残影;3例为梗死.周围残留癌组织32例为浸润性导管癌3级,3例为2级.20例伴有导管原位癌,5例伴有浸润性微乳头状癌,17例肿瘤周边见淋巴细胞浸润.31例中央坏死性乳腺癌中,基底细胞样标记(83.9%,26例)的阳性率明显高于肌上皮标记(38.7%,12例).基底细胞样型所占比例(20例,64.5%)显著高于管腔A型(3例,9.7%)、管腔B型(3例,9.7%)、HER2过表达型(4例,12.9%)和不表达型(1例,3.2%).20例基底细胞样型癌中,基底细胞样标记中CK5/6阳性18例,其余依次为CK17(8/10)、CK14(14/19)、EGFR(8/16).10例获得随访资料,随访15～42个月,平均21.5个月.9例疾病进展(因乳腺癌复发、转移或死亡),中位无病生存和总生存时间分别为14.0和18.0个月.平均和中位疾病进展时间分别为16.6和13.0个月.结论中央坏死性乳腺癌具有独特的、容易识别的形态特点,大多显示基底细胞样免疫表型,预后差,是基底细胞样型乳腺癌的典型代表.
목적 탐토중앙배사성유선암적림상병리화면역표형특정급기여기저세포양형유선암적관계.방법 관찰35례중앙배사성유선암적림상병리특점,병채용ER、PR、HER2、CK8/18、고상대분자질량CK(34βE12)、CK5/6、CK14、CK17、평활기기동단백(SMA)、P63、파형단백、표피생장인자수체(EGFR)진행EnVision법면역조직화학염색.결과 35례환자적발병년령위30～82세,평균54.2세.대체관찰,종물표현위변계교청초적단중심결절,직경1.0～5.0 cm,평균2.4 cm.경하,종류중앙유대편배사혹무세포구,잔류암조직정단대상배요재배사구주위.중앙배사구표현위삼충형태:24례주요유종류성응고성배사조성,반불동정도적섬유화혹파리양변;8례이섬유화혹반흔조직위주,견소량배사암조직잔영;3례위경사.주위잔류암조직32례위침윤성도관암3급,3례위2급.20례반유도관원위암,5례반유침윤성미유두상암,17례종류주변견림파세포침윤.31례중앙배사성유선암중,기저세포양표기(83.9%,26례)적양성솔명현고우기상피표기(38.7%,12례).기저세포양형소점비례(20례,64.5%)현저고우관강A형(3례,9.7%)、관강B형(3례,9.7%)、HER2과표체형(4례,12.9%)화불표체형(1례,3.2%).20례기저세포양형암중,기저세포양표기중CK5/6양성18례,기여의차위CK17(8/10)、CK14(14/19)、EGFR(8/16).10례획득수방자료,수방15～42개월,평균21.5개월.9례질병진전(인유선암복발、전이혹사망),중위무병생존화총생존시간분별위14.0화18.0개월.평균화중위질병진전시간분별위16.6화13.0개월.결론 중앙배사성유선암구유독특적、용역식별적형태특점,대다현시기저세포양면역표형,예후차,시기저세포양형유선암적전형대표.
Objective To study the clinicopathologic features and immunopbenotype of centrally necrotizing carcinoma (CNC) of breast; and to study its relationship with basal-like breast cancer. Methods The clinical and pathologic characteristics of 35 cases of CNC were analyzed. Immunohistochemical study for estrogen receptor, progesterone receptor, HER2, CK8/18, 34βE12, CK5/6, CK14, CK17, smooth muscle actin, p63, vimentin and epidermal growth factor receptor was performed using EnVision method. The surival information of 10 case were obtained. Results The age of patients with CNC ranged from 30 to 82 years (mean = 54. 2 years). Macroscopically, all tumors were relatively circumscribed, with a mean diameter of 2. 4 cm. Histologically, there was a prominent central, necrotic or acellular zone surrounded by a narrow rim of viable tumor cells. The central necrotic foci had the following morphologic patterns: ( 1 ) coagulative tumor necrosis associated with various degree of fibrosis or hyaline degeneration (24 cases ), (2) predominance of fibrous and scar tissue, with small amount of necrotic debris (8 cases), and (3) infarction (3 cases). The peripheral zone of tumor cells showed features of grade 3 invasive ductal carcinoma in 32 cases and grade 2 in 3 cases. Twenty cases of CNC were associated with ductal carcinoma in-situ. A component of invasive micropapillary carcinoma was identified in 5 cases. Peripheral lymphocytic infiltrates were seen in 17 cases. Immunohistochemical study of 31 cases showed that the expression rate of basal-like markers (83.9% ,26 cases) was higher than that of myoepithelial markers (38.7%, 12 cases). The percentage of basal-like subtype (64. 5% ,20 cases) was higher than luminal-A (9. 7%, 3 cases), Iuminal-B (9. 7%, 3 cases), HEB2 over-expression ( 12. 9%, 4 cases) and null ( 3.2%, 1 case) subtypes. In 20 cases of basal-like carcinoma, the expression ratio of CK.5/6 was highest amongst basal-like markers (18 cases), the other markers ratios of CK17, CKI4 and epidermal growth factor receptor were 8/10, 14/19 and 8/16, respectively. Follow-up data were available in 10 patients. The follow-up duration ranged from 15 to 42 months (mean =21.5 months). The median disease-free and overall survivals were 14. 0 and 18.0 months, respectively. Disease progression (as defined by the presence of recurrence, metastasis or tumor-related death) occurred in 9 patients. The mean and median time to disease progression was 16. 6 and 13.0 months, respectively. Conclusions CNC is a rare subtype of breast carcinoma and has distinctive, easily discernible morphologic features. The majority of CNC exhibits basal-like inununophenotype and carries a poor prognosis. CNC is the typical representative of basal-like breast cancer.