CAJ | 학술논문

背景与目的：实性乳头状癌(solid papillary carcinoma，SPC)是乳腺癌的少见类型，不足乳腺癌的1%。作为乳腺乳头状癌的特殊亚型，SPC表现为实体结节状或膨胀性生长。本研究探讨乳腺SPC的临床病理特征、免疫表型特点及预后。方法：收集32例SPC的患者资料，进行病理组织学观察，免疫组织化学染色(EnVision法)检测ER、PR、C-erbB-2、p63、Calponin、CK5/6、Ki-67、Syn和CgA。结果：32例均为女性，平均年龄67.3岁，主要表现为乳头血性溢液和乳腺肿块。大体观察肿瘤呈结节状，灰褐色或灰白色，质地偏中或软。镜下肿瘤呈实体状或乳头状，实性区内见纤细的纤维血管轴心。肿瘤细胞呈卵圆形、多角形、梭形或印戒样，细胞质丰富嗜酸性，细胞核轻度或中度异型。免疫组化结果显示，所有患者肿瘤细胞ER和PR均强阳性(++～+++)，C-erbB-2均无表达，实性结节内肿瘤细胞均不表达CK5/6、p63和Calponin。Syn和CgA阳性表达率分别为68.8%和78.2%。Ki-67平均阳性指数为7.5%(2%～20%)。27例获得随访资料，随访时间6～84个月，25例患者无瘤生存。1例患者术后复发，再次手术后生存至今，1例患者因发生转移而死亡。结论：乳腺SPC好发于老年女性，具有独特的组织学形态和免疫表型。SPC具有较为惰性的生物学行为，即使伴有浸润切除后也不易复发和转移，预后较好。
배경여목적：실성유두상암(solid papillary carcinoma，SPC)시유선암적소견류형，불족유선암적1%。작위유선유두상암적특수아형，SPC표현위실체결절상혹팽창성생장。본연구탐토유선SPC적림상병리특정、면역표형특점급예후。방법：수집32례SPC적환자자료，진행병리조직학관찰，면역조직화학염색(EnVision법)검측ER、PR、C-erbB-2、p63、Calponin、CK5/6、Ki-67、Syn화CgA。결과：32례균위녀성，평균년령67.3세，주요표현위유두혈성일액화유선종괴。대체관찰종류정결절상，회갈색혹회백색，질지편중혹연。경하종류정실체상혹유두상，실성구내견섬세적섬유혈관축심。종류세포정란원형、다각형、사형혹인계양，세포질봉부기산성，세포핵경도혹중도이형。면역조화결과현시，소유환자종류세포ER화PR균강양성(++～+++)，C-erbB-2균무표체，실성결절내종류세포균불표체CK5/6、p63화Calponin。Syn화CgA양성표체솔분별위68.8%화78.2%。Ki-67평균양성지수위7.5%(2%～20%)。27례획득수방자료，수방시간6～84개월，25례환자무류생존。1례환자술후복발，재차수술후생존지금，1례환자인발생전이이사망。결론：유선SPC호발우노년녀성，구유독특적조직학형태화면역표형。SPC구유교위타성적생물학행위，즉사반유침윤절제후야불역복발화전이，예후교호。
Background and purpose: Solid papillary carcinoma (SPC) is an uncommon histological pattern accounting for <1% of breast carcinomas. It is a distinctive form of papillary carcinoma characterized by closely apposed expansile, cellar nodules. The present study aimed to investigate the clinicopathologic features, immunophenotype and prognosis of SPC of breast. Methods:We retrieved the data of 32 cases of SPC of the breast from pathology files, and determined the expressions of ER, PR, C-erbB-2, p63, Calponin, CK5/6, Ki-67, Syn and CgA by pathohistological observation and immunohistochemical examination. Results:All the patients were females with a mean age of 67.3 years. The clinical features were a palpable mass or bloody nipple discharge. The tumor was observed as a whitish-grey or yellowish-brown, lfeshy ifrm or soft, nodular circumscribed mass on gross examination. Microscopy showed solid and papillary area inside the capsule wall and that fine delicate fibrovascular septa were discovered amid the solid proliferation. The tumor cells were oval, polygonal, spindled or signet ring-like with abundant eosinophilic cytoplasm and contained mildly to moderately pleomorphic nuclei. Immunohistochemically, all tumor cells were strongly positive for ER and PR (++-+++), negative for C-erbB-2 and all cases were negative for CK5/6, p63 and Calponin in the cellular nodules. The positive expression rates of Syn and CgA were 68.8%and 78.2%, respectively. The average positive rate of Ki-67 in tumor cells was 7.5%(2%-20%). Twenty-seven patients were available for follow-up examination from 6 to 84 months and 25 patients were alive and disease free. One patient had tumor recurrence, and was alive after reoperation. Another patient died of the tumor metastasis. Conclusion:SPC is predominantly found in elderly females with distinctive pathological features and immunophenotype. SPC often carries an indolent clinical behavior, and even if accompanied by inifltration, very rare cases have recurrence and metastasis after resection, so its prognosis is better.