乳腺典型髓样癌与不典型髓样癌临床病理分析

目的探讨乳腺典型与不典型髓样癌的临床病理特征和生物学行为差异。方法对乳腺典型髓样癌及不典型髓样癌各20例临床病理资料进行分析，并采用S-P法检测nm23、E-cad、p53、ER、PR、c—erbB—2、CD45RO和CD20的表达。结果典型髓样癌组，癌细胞合体性结构〉75％，无腺管结构，间质见弥漫性淋巴细胞浸润；不典型髓样癌组，可见腺管结构，间质无或少量淋巴细胞浸润。免疫组化检测典型髓样癌nm23、E—cad阳性表达均高于不典型髓样癌。典型组随访12～84月（平均37个月），均无腋下淋巴结转移，均健在；不典型组随访9～84月（平均29．5个月），腋下淋巴结转移4／20例，其中4例分别于术后1—3年内死亡。结论①要严格掌握乳腺典型髓样癌与不典型髓样癌的病理诊断标准。②不典型髓样癌不完全等同“乳腺浸润性导管癌伴髓样特点。”③乳腺典型与不典型髓样癌的预后不同，前者明显优于后者。

Typical and atypical medullary carcinomas of breast: a clinicopathological analysis

Purpose To explore the clinicopathological feature and the difference in biological behavior between typical and atypical medullary carcinomas of the breast. Methods We studied the clinical pathology data from 20 patients of typical and the atypical medullary carcinomas of breast with immunostaining (S-P method) for nm23, E-cad, p53, ER, PR, CD45RO and CD20. Results In the typical group, we found that the syncytial structure of cancer cells were more than 75%. There were no the glandular duct structures. Diffuse lymphocytic infiltration was detected in the stroma. In the atypical group, the structure of glandular duct could be detected and there were less or no the lymphocytic infiltration in the stroma. The positive rates of nm23 and E-cad were higher in typical medullary carcinoma than those in atypical medullay carcinoma. Following-up for 12 to 84 months (mean 37 months) showed that all patients had no metastasis to axillary lymph node, and all survived in typical group. In atypical group, after following-up for 9 to 84 months (mean 29.5 months), 4 cases (4/20) had metastases to axillary lymph nodes, and 4 cases were dead 1 to 3 years after operation. Conclusions The pathological diagnosis criteria of typical and atypical medullary carcinomas should be strictly handled, and the latter is not equal to invasive ductal carcinoma with medullary features in the breast. Both of the tumors have different prognosis, and the former is better than the latter.