CAJ | 학술논문

目的对乳腺实性乳头状癌(solid papillary carcinoma,SPC)的临床病理特征和免疫表型特点、预后和鉴别诊断进行探讨.方法收集伴或不伴有浸润癌的SPC共73例,总结其临床资料、大体和组织病理特征,并行透射电镜观察及免疫组织化学EnVision法染色.选用抗体包括CK、肌上皮标记、神经内分泌标记、增殖标记Ki-67和ER、PR、c-erbB-2等.结果本病好发于老年女性,发病平均年龄64.7岁.肿瘤最常见的临床症状为乳腺肿块和乳头溢液.行腋窝淋巴结清扫术43例中有31例检出癌转移.镜检所有标本均见到实性乳头状病变,25例伴有黏液分泌.周边常可伴有导管内乳头状瘤.肿瘤细胞呈多边形、卵圆形或梭形,呈印戒样.胞质丰富,呈嗜酸性或细颗粒状.细胞核轻度或中度异型,51例核分裂象5个/10 HPF.43例伴发浸润癌.肿瘤基底型CK表达呈阴性.平滑肌肌动蛋白SMA、p63在乳头轴心肌上皮的阳性率分别为91.8%、67.1%,在导管周围肌上皮的阳性率分别为91.8%,73.9%.CgA和Syn以及NSE阳性率分别为89.0%,86.3%,95.9%.Ki-67平均阳性指数为10.2%.73例行ER、PR染色的肿瘤大部分呈阳性,Her-2大部分呈阴性.电镜下可见到细胞内的神经内分泌颗粒.结论乳腺SPC是一种低度恶性的乳腺导管内癌,好发于老年女性,有其独特的组织形态、免疫组织化学特征,部分SPC与乳腺黏液癌和神经内分泌癌相关.随访资料显示SPC具有良好的预后.
목적 대유선실성유두상암(solid papillary carcinoma,SPC)적림상병리특정화면역표형특점、예후화감별진단진행탐토.방법 수집반혹불반유침윤암적SPC공73례,총결기림상자료、대체화조직병리특정,병행투사전경관찰급면역조직화학EnVision법염색.선용항체포괄CK、기상피표기、신경내분비표기、증식표기Ki-67화ER、PR、c-erbB-2등.결과 본병호발우노년녀성,발병평균년령64.7세.종류최상견적림상증상위유선종괴화유두일액.행액와림파결청소술43례중유31례검출암전이.경검소유표본균견도실성유두상병변,25례반유점액분비.주변상가반유도관내유두상류.종류세포정다변형、란원형혹사형,정인계양.포질봉부,정기산성혹세과립상.세포핵경도혹중도이형,51례핵분렬상5개/10 HPF.43례반발침윤암.종류기저형CK표체정음성.평활기기동단백SMA、p63재유두축심기상피적양성솔분별위91.8%、67.1%,재도관주위기상피적양성솔분별위91.8%,73.9%.CgA화Syn이급NSE양성솔분별위89.0%,86.3%,95.9%.Ki-67평균양성지수위10.2%.73례행ER、PR염색적종류대부분정양성,Her-2대부분정음성.전경하가견도세포내적신경내분비과립.결론 유선SPC시일충저도악성적유선도관내암,호발우노년녀성,유기독특적조직형태、면역조직화학특정,부분SPC여유선점액암화신경내분비암상관.수방자료현시SPC구유량호적예후.
Purpose To study the clinicopathologic features, immunophenotype and differential diagnosis of solid papillary carcinoma (SPC) of breast.Methods 73 cases of breast SPC with or without invasive carcinoma were collected, and the clinical data and histopathologic features were analyzed with further investigation of transmission electron microscopy and immunohistochemical staining (EnVision method). Selected antibodies included cytokeratin (CK), myoepithelial markers, neuroendocrine markers, proliferation marker Ki-67 and ER,PR,c-erbB-2,etc.Results All the patients were females with mean age of 64.7 years.The presenting symptoms were either a palpable breast mass or nipple discharge.Metastasis was observed in 43 cases who had undergone axillary lymph node dissection. Histologically, the tumor displayed a solid-papillary growth pattern, with mucin production demonstrated in 25 cases. Intraductal papilloma was not uncommon at the peripheral area of the tumor. The tumor cells were polygonal, oval, spindled or signet ring-like and contained abundant eosinophilic to granular cytoplasm and mildly to moderately pleomorphic nuclei. More than 5 mitotic figures/10 HPF were observed in 51 cases. 43 cases contained foci of invasive carcinoma which showed similar cytologic features as those of in-situ component. Immunohistochemical study showed that the tumor cells were negative for basal cell cytokeratin; positivity for smooth muscle actin-alpha and p63 were demonstrated in the myoepithelial layers of fibrovascular cores, as well as around the expanded ductolobular units.Most cases also showed cytoplasmic positivity for chromogranin A (89.0%), synaptophysin (86.3%) and neuron-specific enolase (95.9%).The proliferatiing index, as highlighted by Ki-67 imnunostaining, was 9.2%.The tumor mainly expressed estrogen receptor and progesterone receptor. The staining for c-erbB-2 oncoprotein was negative in the most cases. Neuroendocrine granules were seen under transmission electron microscope in the cytoplasm.Conclusions SPC represents a subgroup of low-grade ductal carcinoma in situ.SPC predilection in older women is associated with mucinous and neuroendocrine components. Follow-up data suggest that SPC has a good prognosis.