乳腺神经内分泌癌13例临床病理分析

目的 探讨乳腺原发性神经内分泌癌的临床病理特征，以加深对其认识。方法光镜观察13例乳腺神经内分泌癌的组织学特征，用En Vision法进行神经内分泌标记物（CgA、Syn和NSE）等免疫组化染色。结果13例女性，年龄43-79（平均66．5）a，60a以上9例（69．2％）。肿瘤直径1．2-3．0（平均1．65）cm。组织学类型为1例神经内分泌型导管原位癌，11例为实性型（2例形态似粘液癌，9例与浸润性导管癌形态交叉重叠），1例为小细胞型。全部病例50％以上肿瘤细胞表达2种以上的神经内分泌标记物。11例ER、PR阳性，不足半数病例表达P53、C-erbB-2，多数病例Ki-67表达指数较低。临床分期为12例Ⅰ期，1例ⅡA期。11例术后随访时间9-100（平均42）mo，均无肿瘤复发转移。结论乳腺神经内分泌癌好发于老年妇女。在形态上呈多向性，与普通型乳腺癌交叉重叠。在临床上预后较好。

Clinnical and pathological analysis of 13 cases of primary neuroendocrine carcinoma in breast

Objective To explore clinical and pathological characteristics of neuroendocrine carcinoma （NEC） in breast for well understanding those breast tumors. Methods The histopathological features in 13 cases of breast NEC were observed by light microscopy and immunohistochemical staining （EnVision method） for neuroendocrine markers （CgA, Syn, NSE）. Results The patients who were all women aged from 43 to 79 （mean 66.5）, 9 patients were over 60. The size of tumors was 1.2-3cm （mean 1.65）. The histopathological types were： 1 case of endocrine ductal carcinoma-in site, 11 cases of solid type （the histopathological morphology of 2 cases resembles mucinous carcinoma, 9 cases crossed and overlapped invasive ductal carcinoma）, and 1 case of small cell type. In all cases more than 50% of the tumor ceils expressed over 2 neuroendocrine markers. ER and PR were expressed in 11 cases while CerbB-2 and P53 in less than 50% of 13 cases, and Ki-67 index were low in most cases. There were stage Ⅰ of 12 cases and stage ⅡA of 1 case. The follow-up of 11 cases from 9 to 100 months （mean 42 months） were performed postoperatively, and the tumors were not recurrence or metastasis. Conclusions The breast NEC primarily occurs in elderly women. It is found multidirectional differentiation in morphology that crossed and overlapped with the usual type of breast carcinoma. Its clinical prognosis is good.