乳腺實性乳頭狀癌的臨床病理觀察

熊丹婷　孫利兵　張莎莎　繆俊俊　李靜　劉標

[摘要] 目的 探討乳腺實性乳頭狀癌的臨床病理特征、免疫表型、鑒別診斷及預后。 方法 收集江蘇省蘇州市立醫院東區2013年1月～2017年10月病理診斷為乳腺實性乳頭狀癌20例，進行組織學觀察及免疫組織學化學染色，分析其臨床病理特征，并進行隨訪。 結果 患者19例女性，1例男性。年齡40～78歲，平均（61.8±7.9）歲。16例表達突觸素，10例表達嗜鉻素，3例表達CD56，6例肌上皮缺失。隨訪時間1～10個月，14例隨訪均無復發或遠處轉移。 結論 乳腺實性乳頭狀癌具有獨特的組織學形態、免疫表型和臨床特點，需與多種乳頭狀腫瘤進行鑒別診斷，預后良好，對于肌上皮缺失的實性乳頭狀癌是原位或是浸潤性腫瘤尚無定論。

[關鍵詞] 實性乳頭狀癌;乳腺;免疫組織化學;預后

[中圖分類號] R737.9? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0101-04

Clinicopathologic characteristics of observation solid papillary carcinoma of the breast

XIONG Danting? ?SUN Libin? ?ZHANG Shasha? ?MIAO Junjun? ?LI Jing? ?LIU Biao

Department of Pathology， Eastern District of Suzhou Municipal Hospital， Jiangsu Province， Suzhou? 215001， China

[Abstract] Objective To investigate the clinicopathological features， immunophenotype， differential diagnosis and prognosis of solid papillary carcinoma of the breast. Methods Clinicopathological data of 20 cases with solid papillary carcinoma of breast were collected and reviewed during January 2013 to October 2017 in Eastern District of Suzhou Municipal Hospital in Jiangsu Province. Immunohistochemical stainings were performed， clinicopathological feature was analyzed and follow-up was conducted. Results There were 19 females and 1 male with age between 40 and 78 years old [average of （61.8±7.9） years]. Immunohistochemical staining showed that the cases of expression of synaptophysin， chromograninA， and CD56 was 16， 10， 3， respectively. 6 cases presented with absence of myoepithelial cell markers. 14 cases had the follow-up data， and no one showed the recurrence or metastasis during the follow-up periods of 1-10 months. Conclusion With the distinctive histological features， immunophenotyping and clinicopathologic characteristics， solid papillary carcinoma has good prognosis and should be distinguished from the other papillary lesions of breast. Categorizing SPC without myoepithelial cells as in situ versus invasive carcinoma is not elucidated.

[Key words] Solid papillary carcinoma; Breast; Immunohitstochemistry; Prognosis

乳腺實性乳頭狀癌是一類較少見的惡性腫瘤，在所有乳腺惡性腫瘤中不足1%[1]。這類腫瘤具有獨特的形態學特征及免疫表型，多伴有神經內分泌分化，大多腫瘤周圍肌上皮細胞缺失。在2012版WHO乳腺腫瘤分類中將其歸類于原位癌[1]，但目前對于無肌上皮細胞的實性乳頭狀癌的分類仍存在爭論。本研究總結了20例乳腺實性乳頭狀癌，結合文獻對其臨床病理特征進行分析探討。

1 資料與方法

1.1 一般資料

收集江蘇省蘇州市立醫院東區2013年1月～2017年10月診斷的乳腺實性乳頭狀癌20例，其中會診病例2例。所有病例存檔資料均由2名高年資病理診斷醫師復片確診。20例中19例為女性，1例為男性;年齡40～78歲，平均（61.8±7.9）歲;其中14例位于左乳，6例位于右乳。……