CAJ | 학술논문

目的：探讨乳腺多形性小叶癌( pleomorphic lobular carcinoma, PLC)的临床病理及免疫表型特点。方法回顾性分析34例浸润性小叶癌( invasive lobular carcinoma, ILC),从中筛选7例PLC；对其进行病理形态学观察,并行免疫组化EnVision两步法检测。结果 PLC患者平均年龄56.6岁(47~74岁)。肿瘤呈结节样肿块,镜下生长方式表现典型或不典型的单行及列兵样排列特点；癌细胞具有显著的多形性和异型性,胞质丰富,嗜酸性或颗粒样,核深染,核膜不规则,核仁明显,核分裂象活跃,肿瘤内可伴导管原位癌( ductal carcinoma in situ, DCIS)及多形性小叶原位癌( pleomorphic lobular carcinoma in situ, PLCIS)；免疫组化及HER-2 FISH检测显示E-cadherin(7/7)失表达及p120(7/7)胞质表达,ER(5/7)、PR(5/7)、HER-2(7/7)失表达,5例表现为三阴性乳腺癌,其中2例具有基底样表型。部分病例有神经侵犯(3/7)及腋窝淋巴结转移(4/7)。结论 PLC是ILC的一种少见亚型,部分病例有神经侵犯及腋窝淋巴结转移。 PLC的诊断主要依据病理形态学及免疫组化标记。
목적：탐토유선다형성소협암( pleomorphic lobular carcinoma, PLC)적림상병리급면역표형특점。방법회고성분석34례침윤성소협암( invasive lobular carcinoma, ILC),종중사선7례PLC；대기진행병리형태학관찰,병행면역조화EnVision량보법검측。결과 PLC환자평균년령56.6세(47~74세)。종류정결절양종괴,경하생장방식표현전형혹불전형적단행급렬병양배렬특점；암세포구유현저적다형성화이형성,포질봉부,기산성혹과립양,핵심염,핵막불규칙,핵인명현,핵분렬상활약,종류내가반도관원위암( ductal carcinoma in situ, DCIS)급다형성소협원위암( pleomorphic lobular carcinoma in situ, PLCIS)；면역조화급HER-2 FISH검측현시E-cadherin(7/7)실표체급p120(7/7)포질표체,ER(5/7)、PR(5/7)、HER-2(7/7)실표체,5례표현위삼음성유선암,기중2례구유기저양표형。부분병례유신경침범(3/7)급액와림파결전이(4/7)。결론 PLC시ILC적일충소견아형,부분병례유신경침범급액와림파결전이。 PLC적진단주요의거병리형태학급면역조화표기。
Purpose To investigate the clinical and morphological features as well as immunophenotype of pleomorphic lobular carcino-ma ( PLC) . Methods Seven cases of PLC were retrieved from 34 cases of invasive lobular carcinoma. The clinical data, histologic features, immunohistochemical findings were analyzed. Results The mean age of the patients was 56. 6 years, with a range of 47 to 74 years. PLC might be nodular mass in general macroscopy. Histologically, PLC retained classical or non-classical single cells, but exhibited a greater degree of cellular atypia and pleomorphism and a higher mitotic rate than classic invasive lobular carcinoma ( ILC) . PLC was accompanied by ductal carcinoma in situ ( DCIS) and pleomorphic lobular carcinoma in situ ( PLCIS) . Immunohistochemistry and HER-2 FISH were detected. PLC showed E-cadherin negative (7/7) and p120 cytoplasmic positive (7/7), ER (5/7), PR (5/7), and HER-2 (7/7) mostly negative. 5 cases were characterized by triple negative breast cancer, two of which are basal-like pheno-type. Some cases could be observed nerve invasion (3/7) and axillary lymph node metastasis (4/7). Conclusion PLC is a very rare subtype of invasive lobular carcinoma. In some cases there are nerve invasion and lymph node metastasis. The diagnosis of PLC de-pends on the pathological morphological and immunohistochemical markers.