乳腺浸润性乳头状癌4例临床病理观察及文献复习

摘要

Objective To investigate the clinicopathologic features of invasive papillary carcinoma (IPC) of the breast,and their relationship with diagnosis,treatment and prognosis Methods The clinical and pathological data of four cases of IPC were collected.The clinical pathological features,immunophenotype and molecular changes were analyzed by HE staining,immunohistochemistry and in situ hybridization,and the relative literature reviewed.Results The tumor had an irregular boundary and showed a fine papillary structure in cross section.Under microscope,tumor cells broke through the reactive interstitial area and infiltrated into the stroma of the breast.The tumor cells showed a complex papillary arrangement and multiple branches,with a thin fibrous vascular axis.The nipples were covered by a single or double layer of tumor cells.The cells were eosinophilic,and mitotic figures were rare.Of all the four cases,the tumor cells were positive for ER (strong),PR (strong) and HER-2 (1+),and Negative for calponin,CK5/6 and p63,indicating absence of myoepithelium.The proliferation index of Ki-67 was low.FISH showed no amplification of HER-2 gene.Conclusion Breast IPC is a rare type of tumor with less lymph node metastasis,having a relative good prognosis.Its histologic characteristics and immunohistochemical staining facilitates its diagnosis and differential diagnosis.%目的 探讨乳腺浸润性乳头状癌(invasive papillary carcinoma,IPC)的临床病理特征、诊断、治疗及预后.方法 收集4例乳腺浸润性乳头状癌的临床病理资料,应用HE染色、免疫组织化学和原位杂交技术,分析其组织病理学特征及免疫、分子表型,并复习相关文献.结果 巨检观察到肿块界限欠清楚,切面呈细乳头状.镜下组织学特征表现为肿瘤细胞突破反应性间质区域,浸润至乳腺间质,肿瘤细胞呈多分支复杂的乳头状排列,乳头中央可见纤细的纤维血管轴心,乳头上附有单层或复层肿瘤细胞.细胞嗜酸性,核分裂象少见.四例患者免疫组织化学结果相同,均显示雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)(强+),人类表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2) (1+),Calponin、CK5/6、p63表达阴性,提示肌上皮缺失;Ki-67指数显示为低增殖指数.HER-2的荧光原位杂交(fluorescence in situ hybridization,FISH)结果显示HER-2基因无扩增.结论 乳腺浸润性乳头状癌较为罕见,预后较好,淋巴结转移率低,其特征性的组织形态、免疫组织化学表型有助于诊断和鉴别诊断.