起源于乳腺微腺体腺病的浸润性癌3例临床病理学观察

目的 探讨乳腺起源于微腺体腺病的浸润性癌(MGACA)的临床病理学特征、免疫表型、诊断和鉴别诊断.方法 收集3例MGACA患者的临床和病理资料,对标本进行病理形态学观察,免疫组织化学(EnVision)染色[CK7、S-100蛋白、雌激素受体(ER)、孕激素受体(PR)、HER2、平滑肌肌动蛋白(SMA)、肌特异性肌动蛋白(MSA)、p63]和PAS特殊染色,并复习文献.结果 (1)形态学:3例MGACA标本均观察到不同阶段形态的连续发展过程:从微腺体腺病到不典型微腺体腺病,到导管原位癌,到浸润性癌.例1的浸润性癌成分为浸润性导管癌,例2和例3的浸润性癌成分部分区域为浸润性导管癌,部分区域为产生基质的癌.(2)免疫组织化学和特殊染色:3例MGACA中不同病变区域的所有上皮细胞均呈现CK7和S-100蛋白阳性,ER和HER2阴性.例1和例2 PR阴性,例3 PR弱阳性.SMA、MSA和p63染色显示所有病变区域腺体周围均无肌上皮围绕.PAS染色显示在微腺体腺病、不典型微腺体腺病和导管原位癌区域腺体周围有完整的基底膜围绕,而在浸润性癌区域上皮周围基底膜消失.结论 MGACA是一类少见的乳腺肿瘤,具有独特的形态学和免疫表型特征,其生物学行为有待进一步研究.

Abstract：

Objective To study the clinicopathologic features, immunophenotypes and differential diagnoses of invasive carcinoma arising in breast microglandular adenosis (MGACA). Methods Clinical and pathologic findings of 3 cases of MGACA were analyzed by histomorphology and immunohistochemical staining of CK7, S-100 protein, ER, PR, HER2, SMA, MSA, p63 and PAS. Literatures were reviewed. Results (1) Histologically, 3 tumors all showed a spectrum of glandular proliferations ranging from microglandular adenosis (MGA) to atypical microglandular adenosis (AMGA) to in situ carcinoma (DCIS) to invasive carcinoma. The invasive carcinoma component was ductal in case 1, and matrix-producing in case 2 and case 3. (2) All epithelial cells in MGA, AMGA, DCIS and MGACA were positive for CK7 and S-100 protein, but were negative for ER and HER2. PR was negative in case 1 and case 2 but was low positive in case 3. Myoepithelial cell differentiation was not demonstrated in MGA, AMGA, DCIS and MGACA by immunohistochemical staining for SMA, MSA or p63. PAS staining showed the presence of basement membrane in MGA, AMGA and DCIS, except MGACA. Conclusions MGACA is an extremely rare tumor of the breast and has distinct morphological and immunohistochemical features. Further studies are needed to evaluate the clinical behavior of this rare neoplasm.

Invasive carcinoma arising in breast microglandular adenosis: a clinicopathologic study of three cases and review of the literatureSHUI

Objective To study the clinicopathologic features, immunophenotypes and differential diagnoses of invasive carcinoma arising in breast microglandular adenosis (MGACA). Methods Clinical and pathologic findings of 3 cases of MGACA were analyzed by histomorphology and immunohistochemical staining of CK7, S-100 protein, ER, PR, HER2, SMA, MSA, p63 and PAS. Literatures were reviewed. Results (1) Histologically, 3 tumors all showed a spectrum of glandular proliferations ranging from microglandular adenosis (MGA) to atypical microglandular adenosis (AMGA) to in situ carcinoma (DCIS) to invasive carcinoma. The invasive carcinoma component was ductal in case 1, and matrix-producing in case 2 and case 3. (2) All epithelial cells in MGA, AMGA, DCIS and MGACA were positive for CK7 and S-100 protein, but were negative for ER and HER2. PR was negative in case 1 and case 2 but was low positive in case 3. Myoepithelial cell differentiation was not demonstrated in MGA, AMGA, DCIS and MGACA by immunohistochemical staining for SMA, MSA or p63. PAS staining showed the presence of basement membrane in MGA, AMGA and DCIS, except MGACA. Conclusions MGACA is an extremely rare tumor of the breast and has distinct morphological and immunohistochemical features. Further studies are needed to evaluate the clinical behavior of this rare neoplasm.