乳腺实体型乳头状癌的临床病理研究

目的探讨乳腺实体型乳头状癌（SPC）的临床病理特征和免疫表型特点。方法收集伴或不伴有浸润癌的SPC共21例,总结其临床资料、大体和组织病理特征,并进行免疫组织化学LSAB法染色和阿辛蓝黏液染色。选用抗体包括细胞角蛋白（CK）、肌上皮标记、神经内分泌标记、增殖标记Ki-67和雌激素受体（ER）、孕激素受体（PR）等。结果本组患者均为女性,发病平均年龄66．1岁。肿瘤的临床特征与经典型乳头状肿瘤相似。行腋窝淋巴结清扫术的8例中无1例检出癌转移。镜检所有标本均见到实体乳头状病变,19例存在黏液分泌。肿瘤细胞呈卵圆形、多角形、梭形或旱印戒样。细胞为轻度或中度异型性,15例核分裂象〈5／10HPF。7例伴发细胞学与导管内癌一致的浸润癌。肿瘤均表达CK8,但基底型CK呈阴性。平滑肌肌动蛋白（SMA）d、Calponin和p63在乳头轴心肌上皮的阳性率分别为94．0％、64．7％和58．8％,在导管周缘肌上皮的阳性率分别为94．0％、76．5％和70．6％。CgA和突触素阳性率分别为88．2％和82．4％。Ki-67平均阳性指数为8．1％。17例行ER、PR和pS2染色的肿瘤均呈阳性,c—erbB-2均阴性。获得随访的患者中16例（94％）均未见肿瘤复发或转移。结论乳腺SPC好发于老年女性,具有较独特的病理组织学改变和免疫表型,部分SPC与乳腺黏液癌和神经内分泌癌相关。多项临床病理特征和随访显示SPC具有较为惰性的生物学行为和良好的预后。

Clinicopathologic study of solid papillary carcinoma of breast

Objective To study the clinicopathologic features and immunophenotype of solid papillary carcinoma(SPC)of breast.Methods Clinical and pathologic features of 21 cases of SPC,with or without stromal invasion,were analyzed,Immunohistochemical study(LSAB method,for cytokeratins, myoepithelial markers,chromogranin A,synaptophysin,Ki-67,estrogen receptor,progesterone receptor, c-erbB-2 and pS2)and alcian blue staining were performed.Results All the patients were females with a mean age of 66.1 years.The clinical features were similar to those of classic papillary tumor.Metastasis was not observed in patients who had undergone axillary lymph node dissection.Histologically,the tumor displayed solid papillary growth pattern,with mucin production demonstrated in 19 cases.The tumor cells were oval,polygonal,spindled or signet ring-like and contained mildly to moderately pleomorphic nuclei. The mitotic count measured less than 5 per 10 high-power fields in 15 cases.Seven cases contained foci of invasive carcinoma which showed similar cytologic features as those of the in-situ component. Immunohistochemical study showed that the tumor cells expressed CK8 but not basal cell cytokeratin. Positivity for smooth muscle actin-alpha,calponin and p63 was demonstrated in the myoepithelial layers of fibrovascular cores,as well as around the expanded ductolobular units.Most cases also showed cytoplasmic positivity for chromogranin A(88.2%)and synaptophysin(82.4%).The proliferation index,as highlighted by Ki-67 immunostain,was 8.1%.The tumor expressed estrogen receptor,progesterone receptor and pS2.The staining for c-erbB-2 oncoprotein was negative.Follow up of 16 patients showed no evidence of recurrence or metastasis.Conclusions SPC predominantly affects elderly females and has distinctive pathologic features and immunophenotype.Some cases of SPC are associated with mucinous and neuroendocrine components.Follow-up data suggest that SPC often carries an indolent clinical behavior and favorable prognosis.