研究原著 文章编号:100022790(2006)0820706203

乳腺浸润性微乳头状癌4例临床病理特征

张润岐1

,张冠军2

,田　蓉3

　(1陕西医专基础部病理学教研室,陕西西安710068,2西安交通大学第一医院病理科,陕西西

安710061,3空军总医院皮肤科,北京100036)

收稿日期:2006201218;　接受日期:2006202218

作者简介:张润岐.副教授.Tel:(029)88462772　Email:zhangrun 2

qi1957@163.com

C li n i ca l and pa tholog i ca l character isti cs

of i n va si ve m i cropap ill ary carc i n oma of the brea st:4ca ses report

ZHAN G Run 2Q i 1

,ZHAN G Guan 2Jun 2

,TI AN Rong

3

1

Depart m ent of Pathol ogy,School of Basic Medicine,Shaanxi Medical College,Xi πan 710068,China,2

Depart m ent of Pathol ogy,First Hos p ital,Xi πan J iaot ong University,Xi πan 710061,China,

3

Depart m ent of Der mat ol ogy,A ir Force General Hos p ital,Beijing

100036,China

【Abstract 】A I M :To observe the clinical and pathol ogical

characteristics of 4cases with invasive m icr opap illary carcinoma (I M PC )of the breast and in combinati on with literatures t o exp l ore the pathomor ogical features,diagnosis,differential diagnosis,i m munohist oche m ical features and p r ognosis of I M PC .M ETH ODS:I m munohist oche mical SP method and light micr oscopy were adop ted t o make an observati on and analysis f or the 4I M PC cases based on literatures .RESUL TS:Compared with infiltrating ductal carcinoma,the 4I M PC cases were not significantly different in clinical sy mp t om s,signs and general check 2up.W hat was ob 2served under a light m icr oscope included:

tu mor cells were

mulberry 2and m icr opap illary 2shaped or it was of glandule tubular arrange ment;there was obvi ous inters pace bet w een cancer nest and neighboring areas;m icr opap illary was emp ty of fiber bl ood vessel axes;i m munohist oche m ical staining showed E MA positive l ocati on was both at out w ard surface of glandule duct and atm icr o 2pap illary 2like cancer nest .CO NCL US I O N:I M PC is a kind of rare invasive breast cancer with such bi ol ogic behavi ors as a str ong attacking on ly mphatic and high p r obability of ly mph node transfer and poor p r ognosis .

【Keywords 】breast neop las m s;

adenocarcinoma,pap illary;

invasive carcinoma

【摘　要】目的:观察4例乳腺浸润性微乳头状癌(I M PC )的临床病理学特点,结合文献探讨乳腺浸润性微乳头状癌的病理形态学特征、诊断、鉴别诊断及免疫组化特点和预后.方法:采用光镜和免疫组化SP 法对4例I M PC 进行观察并结

合文献分析.结果:4例乳腺I M PC 与浸润性导管癌相比无特殊的临床症状、体征及大体检查.光镜下特征性表现为肿瘤细胞呈桑椹状、微乳头状或小腺管样排列,癌巢与周围间质形成明显的空隙.微乳头缺乏纤维血管轴心.免疫组化染色

E MA 阳性部位在癌细胞巢团或微乳头状、腺管的外表面.

结论:浸润性微乳头状癌是一种少见类型的浸润性乳腺癌,具有淋巴管侵袭性强、淋巴结转移率高、预后差的生物学行为.【关键词】乳腺肿瘤;腺癌,乳头状;浸润癌【中图号】R730.261　　　【文献标识码】A

0　引言

乳腺浸润性微乳头状癌(invasive m icr opap illary

carcinoma,I M PC ),以往只是被作为浸润性导管癌的一种特殊形态学表现,而近年来由于其生物学行为表现与一般浸润性导管癌不同,具有明显的淋巴管侵袭性、高淋巴结转移率和预后差等特性,故引起国内外越来越多学者的重视

[1-3]

.2003年WHO 乳腺癌新

分类将其归为乳腺上皮性肿瘤独立一型.本组报道4例,并结合文献分析其临床病理学特点.

1　对象和方法

1.1　对象　I M PC 4例,3例为西安交通大学第一医

院手术切除标本,1例为外院会诊病例.

1.2　方法　标本经甲醛液固定,常规脱水,石蜡包埋

切片,HE 染色光镜观察;免疫组化检查一抗为CK,E MA,ER,PR,NSE,Cg A ,Syn,CerbB 22,P53,采用SP 法,试剂购自福州迈新生物技术开发公司和上海

长岛生物公司.

2　结果

2.1　临床资料　本组4例均为女性,患者年龄43～74(平均58.8)岁,均以发现右侧乳腺肿块为主诉就

诊,病程14d ～1a .肿块位于乳腺外上象限3例,位于内上象限1例,乳头无明显下陷.4例同侧腋窝均可触及肿大的淋巴结.行乳腺癌改良根治切除术3例,行肿块单纯切除术1例.患者均无明确内脏病灶.随访0.5～2a,均未发现复发或远处转移.2.2　病理学检查　肿瘤呈结节状,直径2～5(平均