CAJ | 학술논문

目的：探讨乳腺实性乳头状癌( solid papillary carcinoma, SPC)的临床病理学特点、组织学特征及预后。方法对9例SPC进行组织形态学观察,行AB-PAS染色和免疫组化MaxVision法染色,对其临床资料进行跟踪随访、分析并复习相关文献。结果9例SPC患者年龄32~83岁,平均69．2岁,其中以乳头溢液发病3例；9例核级别为低~中级别,7例细胞内和细胞外伴黏液分泌,2例伴钙化,3例伴粉刺样坏死。9例ER、PR均阳性且阳性率较高(均>70%),HER-2均阴性。9例SPC中神经内分泌标志物Syn呈弥漫阳性(8例)、灶阳性(1例)；CgA有4例呈弥漫阳性,1例部分阳性,4例呈阴性；6例有部分区域肌上皮标志物表达缺失,3例肌上皮标志物连续表达；Ki-67增殖指数为3%~20%。9例SPC中有1例伴小灶性浸润性导管癌( in-vasive ductal carcinoma, IDC)(最大径2 mm),其余8例均不伴其它类型乳腺癌,前哨和(或)腋窝/锁骨下淋巴结均未见癌转移。9例中有8例进行乳腺癌保乳根治术,1例为局部肿物切除过程中偶然发现微小病灶,未行根治术；9例中有1例因伴有IDC,行4周期TC方案化疗,化疗耐受可,目前处于化疗后恢复期；其余8例术后口服内分泌药物治疗,临床密切随访观察,随访时间3~61个月(平均19.6个月),均未发现复发。结论9例SPC均表现为核级别较低、常伴细胞内外黏液分泌、神经内分泌标志物阳性、淋巴结转移率低等特点,随访未发现复发,提示SPC临床预后较好。
목적：탐토유선실성유두상암( solid papillary carcinoma, SPC)적림상병이학특점、조직학특정급예후。방법대9례SPC진행조직형태학관찰,행AB-PAS염색화면역조화MaxVision법염색,대기림상자료진행근종수방、분석병복습상관문헌。결과9례SPC환자년령32~83세,평균69．2세,기중이유두일액발병3례；9례핵급별위저~중급별,7례세포내화세포외반점액분비,2례반개화,3례반분자양배사。9례ER、PR균양성차양성솔교고(균>70%),HER-2균음성。9례SPC중신경내분비표지물Syn정미만양성(8례)、조양성(1례)；CgA유4례정미만양성,1례부분양성,4례정음성；6례유부분구역기상피표지물표체결실,3례기상피표지물련속표체；Ki-67증식지수위3%~20%。9례SPC중유1례반소조성침윤성도관암( in-vasive ductal carcinoma, IDC)(최대경2 mm),기여8례균불반기타류형유선암,전초화(혹)액와/쇄골하림파결균미견암전이。9례중유8례진행유선암보유근치술,1례위국부종물절제과정중우연발현미소병조,미행근치술；9례중유1례인반유IDC,행4주기TC방안화료,화료내수가,목전처우화료후회복기；기여8례술후구복내분비약물치료,림상밀절수방관찰,수방시간3~61개월(평균19.6개월),균미발현복발。결론9례SPC균표현위핵급별교저、상반세포내외점액분비、신경내분비표지물양성、림파결전이솔저등특점,수방미발현복발,제시SPC림상예후교호。
Purpose To investigate the clinical pathological features, histologic features, and prognosis of solid papillary carcinoma ( SPC) of breast. Methods Nine cases of SPC of breast were analyzed by morphological observation, AB-PAS staining and immuno-histochemical MaxVision staining. The follow-up and analysis of the clinical datas of these nine cases were performed and relevant liter-atures were also reviewed. Results The age of 9 cases of SPC of breast ranged from 32 to 83 years old (mean age is 69. 2 years old). Three cases presented with nipple discharge. Nuclear levels of 9 cases were between low to mid-level. Seven cases were associated with intracellular and extracellular mucus secretion, two cases with calcification, and 3 cases with comedonecrosis. All of these nine cases were ER, PR positive and the positive rates were high ( >70%) , HER-2 was all negative. Syn expression in these nine cases were diffused positive except for one case showing focal positive, 4 with CgA diffused positive, 1 with partial positive and 4 were negative of CgA. Six patients had partial loss of the expression of myoepithelial markers, and 3 cases with complete myoepithelial expression. Ki-67 proliferation index was between 3% and 20%. Except for only one case with small area of invasive ductal carcinoma (IDC) (2 mm in great diameter) , all other cases were not associated with other types of breast cancer, sentinel lymph nodes and/or axillary/supracla-vicular lymph nodes metastasis. 8 patients accepted breast-conserving surgey, one case did not undergo radical mastectomy for small le-sion. All of these cases were accepted further endocrine drugs treatment and only one case accepted chemical therapy simultaneously because of the accompanied IDC. None of them was found to relapse for 3 to 61 months (mean 19. 6 months) of follow-up. Conclusion Nine cases of SPC of breast showed some characteristics such as relatively low nuclear level, often accompanied by intracellular and extracellular mucus secretion, positive for neuroendocrine marker, low lymph node metastasis rate, and no recurrence, which suggest that SPC may have a better clinical prognosis.