中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2014年
4期
231-235
,共5页
周淑玲%于宝华%成宇帆%徐晓丽%水若鸿%毕蕊%陆洪芬%涂小予%杨文涛
週淑玲%于寶華%成宇帆%徐曉麗%水若鴻%畢蕊%陸洪芬%塗小予%楊文濤
주숙령%우보화%성우범%서효려%수약홍%필예%륙홍분%도소여%양문도
乳腺肿瘤%肿瘤转移%免疫组织化学%预后
乳腺腫瘤%腫瘤轉移%免疫組織化學%預後
유선종류%종류전이%면역조직화학%예후
Breast neoplasms%Neoplasm metastasis%Immunohistochemistry%Prognosis
目的 探讨转移至乳腺的恶性肿瘤的临床病理特点、诊断及鉴别诊断.方法 收集2004至2012年间28例转移至乳腺的恶性肿瘤病例,完善临床及预后资料,观察临床病理学特点,EnVision法进行免疫组织化学检测.结果 (1)28例中女性27例,男性1例;发病年龄16 ～ 77岁(平均45.8岁).26例(92.9％)以原发肿瘤初诊,2例(7.1％)以乳腺病变初诊.原发肿瘤至出现乳腺转移的间隔时间为0 ～ 228个月,平均32个月.15例(53.6％)在确诊乳腺转移之前或同时发现其他部位转移.(2)肿瘤大体上表现为境界较清楚的质硬、实性肿块,直径0.6～12.0 cm,平均4.0 cm.28例原发肿瘤组织学类型分别为:肺腺癌8例(28.6％),卵巢高级别浆液性腺癌5例(17.8％),胃腺癌3例(10.7％),直肠腺癌2例(7.1％),胰腺神经内分泌肿瘤和前列腺癌各1例(3.6％),恶性黑色素瘤和间叶源性恶性肿瘤各4例(14.3％),间叶源性恶性肿瘤中胚胎性横纹肌肉瘤3例,上皮样恶性周围神经鞘膜瘤1例.(3)镜下肿瘤多表现原发肿瘤的形态学特征,19例见脉管侵犯.免疫表型与原发肿瘤一致,而乳腺来源标志物囊泡病液体蛋白15和乳腺珠蛋白均阴性.8例转移性肺腺癌甲状腺转录因子-1均阳性,卵巢高级别浆液性腺癌PAX8(5/5)和WT1(4/5)阳性,胃癌CDX2(3/3)和绒毛蛋白(1/3)阳性,2例直肠癌CDX2均阳性,1例胰腺神经内分泌肿瘤突触素和嗜铬粒素A阳性,1例前列腺癌雄激素受体、前列腺特异抗原、P504S均阳性,恶性黑色素瘤HMB45(2/3)和S-100蛋白(3/3)阳性,3例横纹肌肉瘤波形蛋白、结蛋白、myoD1均阳性,1例上皮样恶性周围神经鞘膜瘤S-100蛋白阳性.(4)本组17例有随访资料,中位随访时间54个月;中位生存期24个月.7例死亡.结论 转移至乳腺的恶性肿瘤罕见,多表现原发肿瘤的形态学特征,有时易误诊为原发乳腺癌,需结合临床病史、组织形态学特点及免疫表型等进行诊断和鉴别诊断.
目的 探討轉移至乳腺的噁性腫瘤的臨床病理特點、診斷及鑒彆診斷.方法 收集2004至2012年間28例轉移至乳腺的噁性腫瘤病例,完善臨床及預後資料,觀察臨床病理學特點,EnVision法進行免疫組織化學檢測.結果 (1)28例中女性27例,男性1例;髮病年齡16 ～ 77歲(平均45.8歲).26例(92.9％)以原髮腫瘤初診,2例(7.1％)以乳腺病變初診.原髮腫瘤至齣現乳腺轉移的間隔時間為0 ～ 228箇月,平均32箇月.15例(53.6％)在確診乳腺轉移之前或同時髮現其他部位轉移.(2)腫瘤大體上錶現為境界較清楚的質硬、實性腫塊,直徑0.6～12.0 cm,平均4.0 cm.28例原髮腫瘤組織學類型分彆為:肺腺癌8例(28.6％),卵巢高級彆漿液性腺癌5例(17.8％),胃腺癌3例(10.7％),直腸腺癌2例(7.1％),胰腺神經內分泌腫瘤和前列腺癌各1例(3.6％),噁性黑色素瘤和間葉源性噁性腫瘤各4例(14.3％),間葉源性噁性腫瘤中胚胎性橫紋肌肉瘤3例,上皮樣噁性週圍神經鞘膜瘤1例.(3)鏡下腫瘤多錶現原髮腫瘤的形態學特徵,19例見脈管侵犯.免疫錶型與原髮腫瘤一緻,而乳腺來源標誌物囊泡病液體蛋白15和乳腺珠蛋白均陰性.8例轉移性肺腺癌甲狀腺轉錄因子-1均暘性,卵巢高級彆漿液性腺癌PAX8(5/5)和WT1(4/5)暘性,胃癌CDX2(3/3)和絨毛蛋白(1/3)暘性,2例直腸癌CDX2均暘性,1例胰腺神經內分泌腫瘤突觸素和嗜鉻粒素A暘性,1例前列腺癌雄激素受體、前列腺特異抗原、P504S均暘性,噁性黑色素瘤HMB45(2/3)和S-100蛋白(3/3)暘性,3例橫紋肌肉瘤波形蛋白、結蛋白、myoD1均暘性,1例上皮樣噁性週圍神經鞘膜瘤S-100蛋白暘性.(4)本組17例有隨訪資料,中位隨訪時間54箇月;中位生存期24箇月.7例死亡.結論 轉移至乳腺的噁性腫瘤罕見,多錶現原髮腫瘤的形態學特徵,有時易誤診為原髮乳腺癌,需結閤臨床病史、組織形態學特點及免疫錶型等進行診斷和鑒彆診斷.
목적 탐토전이지유선적악성종류적림상병리특점、진단급감별진단.방법 수집2004지2012년간28례전이지유선적악성종류병례,완선림상급예후자료,관찰림상병이학특점,EnVision법진행면역조직화학검측.결과 (1)28례중녀성27례,남성1례;발병년령16 ～ 77세(평균45.8세).26례(92.9％)이원발종류초진,2례(7.1％)이유선병변초진.원발종류지출현유선전이적간격시간위0 ～ 228개월,평균32개월.15례(53.6％)재학진유선전이지전혹동시발현기타부위전이.(2)종류대체상표현위경계교청초적질경、실성종괴,직경0.6～12.0 cm,평균4.0 cm.28례원발종류조직학류형분별위:폐선암8례(28.6％),란소고급별장액성선암5례(17.8％),위선암3례(10.7％),직장선암2례(7.1％),이선신경내분비종류화전렬선암각1례(3.6％),악성흑색소류화간협원성악성종류각4례(14.3％),간협원성악성종류중배태성횡문기육류3례,상피양악성주위신경초막류1례.(3)경하종류다표현원발종류적형태학특정,19례견맥관침범.면역표형여원발종류일치,이유선래원표지물낭포병액체단백15화유선주단백균음성.8례전이성폐선암갑상선전록인자-1균양성,란소고급별장액성선암PAX8(5/5)화WT1(4/5)양성,위암CDX2(3/3)화융모단백(1/3)양성,2례직장암CDX2균양성,1례이선신경내분비종류돌촉소화기락립소A양성,1례전렬선암웅격소수체、전렬선특이항원、P504S균양성,악성흑색소류HMB45(2/3)화S-100단백(3/3)양성,3례횡문기육류파형단백、결단백、myoD1균양성,1례상피양악성주위신경초막류S-100단백양성.(4)본조17례유수방자료,중위수방시간54개월;중위생존기24개월.7례사망.결론 전이지유선적악성종류한견,다표현원발종류적형태학특정,유시역오진위원발유선암,수결합림상병사、조직형태학특점급면역표형등진행진단화감별진단.
Objective To investigate the clinicopathologic characteristics and differential diagnosis of the metastases to the breast from non-mammary malignancies.Methods Twenty-eight cases were collected from 2004 to 2012; microscopic pathologic examinations and immunohistochemistry (EnVision method) were performed.Results (1) All except one patients were female,ranging from 16 to 77 years old (average 45.8 years).Twenty-six (92.9％) patients initially presented with the primary site lesions; while the other two (7.1％) patients initially presented with breast lesions.The mean interval from primary diagnosis to detection of metastatic breast lesions was 32 months (0-228 months).Fifteen patients (53.6％) had other metastases detected simultaneously or preceded the breast lesions.(2) Macroscopically,all the tumors were relatively circumscribed,with a mean diameter of 4.0 cm (0.6-12.0 cm).The histological types of the corresponding primary tumors were as follows:eight (28.6％) cases from lung adenocarcinoma,five (17.8％) from high-grade ovarian serous carcinoma,three (10.7％) from gastric adenocarcinoma,two (7.1％) from rectal adenocarcinoma,one (3.6％) from pancreatic neuroendocrine carcinoma,one (3.6％) from prostatic carcinoma,four (14.3％) from melanoma,and four (14.3％) from mesenchymal malignant tumors (three rhabdomyosarcomas and one epithelioid malignant peripheral nerve sheath tumor,MPNST).(3) Histologically,the metastatic tumors showed the morphologic characteristics of the primary tumors.Lymph-vascular invasion was observed in 19 cases.Immunohistochemical features of metastatic tumors were consistent with the primary tumors.Molecular markers for breast such as GCDFP15 and mammaglobin were negative.Metastatic tumors from lung adenocarcinoma expressed TTF-1 (8/8).Ovarian serous carcinoma metastases were positive for PAX8 (5/5) and WT1 (4/5).Gastric adenocarcinoma metastases were positive for CDX2 (3/3) and villin (1/3).Rectal adenoearcinoma metastases were positive for CDX2 (2/2).Pancreatic neuroendocrine tumor metastasis was positive for Syn and CgA (both 1/1).Prostate carcinoma metastasis was positive for AR,PSA and P504S (all 1/1).Melanoma metastases were positive for HMB45 (2/3) and S-100 protein (3/3).Rhabdomyosarcoma metastases were positive for vimentin,desmin and myoD1 (all 3/3).MPNST metastasis was positive for S-100 protein (1/1).(4) Follow-up data was available in 17 patients,with median follow-up time 54 months.The median survival from diagnosis to breast metastasis was 24 months.Seven of 17 patients died.Conclusions Metastases to the breast from non-mammary malignancies are rare and show pathologic features of primary tumors.It is usually presumed to be a primary breast carcinoma.Histopathologic features and clinical history in conjunction with the immunohistochemical results should be considered in differentiating a secondary mass from a primary breast carcinoma.
