CAJ | 학술논문

目的对乳腺乳头状癌(SPC)的免疫表型特点、病理特征、鉴别诊断及预后进行探讨.方法收集SPC伴或不伴有浸润的38例临床资料,总结其临床、大体和组织病理特征,免疫组织化学EnVision法染色.选用抗体包括CK、P63、E-cadherin、CD56、Syn、CgA、ER、PR、HER-2、P53、KI-67等.结果该病好发老年女性,平均发病年龄63.2岁,乳头血性溢液为常见症状.在腋窝淋巴结清扫28例中有13例检出癌转移,均为前哨淋巴结.镜检所有标本均见到实性乳头状病变,12例伴有黏液分泌,20例伴发浸润癌.肿瘤基底型CK表达阴性,乳头轴心肌上皮均有部分表达但不完整或不连续,个别呈灶性,神经内分泌标记至少1～2项成片阳性表达,KI-67平均阳性9.6％.ER、PR肿瘤细胞大部分阳性,HER-2大部分阴性.结论乳腺SPC是一种低级别的乳腺导管内癌伴有神经内分泌分化,好发于老年女性,有独特组织形态和免疫表型,部分SPC进展为神经内分泌癌,多项临床病理及免疫组化指标及随访显示SPC具有较为惰性的生物学行为和良好的预后.
목적 대유선유두상암(SPC)적면역표형특점、병리특정、감별진단급예후진행탐토.방법 수집SPC반혹불반유침윤적38례림상자료,총결기림상、대체화조직병리특정,면역조직화학EnVision법염색.선용항체포괄CK、P63、E-cadherin、CD56、Syn、CgA、ER、PR、HER-2、P53、KI-67등.결과 해병호발노년녀성,평균발병년령63.2세,유두혈성일액위상견증상.재액와림파결청소28례중유13례검출암전이,균위전초림파결.경검소유표본균견도실성유두상병변,12례반유점액분비,20례반발침윤암.종류기저형CK표체음성,유두축심기상피균유부분표체단불완정혹불련속,개별정조성,신경내분비표기지소1～2항성편양성표체,KI-67평균양성9.6％.ER、PR종류세포대부분양성,HER-2대부분음성.결론 유선SPC시일충저급별적유선도관내암반유신경내분비분화,호발우노년녀성,유독특조직형태화면역표형,부분SPC진전위신경내분비암,다항림상병리급면역조화지표급수방현시SPC구유교위타성적생물학행위화량호적예후.
Objective To study the clinicopathologic features immunophenotype and the differential diagnosis of solid papillary carcinoma(SPC) of breast.Methods 38 cases of SPC with or without invasive carcinoma were collected.The clinical data and histopathologic features were analyzed with further investigation of immunohistochemical staining (EnVision method).Selected antibodies included CK,P63,E-cadherin,CD56,Syn,CgA,ER,PR,HER-2,P53,KI-67 etc.Results All the patients were females with mean age of 63.2 years.The presenting symptoms were either a palpable nipple blood discharge.13 cases with metastasis were observed in 28 cases who had undergone sentinel axillary lymph nodes dissection.Histologically,the tumor displayed solid papillary growth pattern with mucin production demonstrated in 12 cases,with invasive carcinoma in 20 cases.Immunohistochemical study showed that the tumor cells were negative for basal cell cytokeratin.Positivity for p63 was demonstrated in the myoepithelial of fibrovascular cores.Most cases showed cytoplasmic positivity for neuroendocrine.The proliferating index,as high lighted by Ki-67 immunostaining was 9.6％.The tumor mainly expressed estrogen receptor and progesterone receptor.The staining for HER-2 oncoprotein was in the most cases.Conclusion SPC represents a subgroup of low-grade ductal carcinoma in situ,SPC is associated with neuroendocrine component.Follow-up data suggest that SPC has a good prognosis.