乳腺实性乳头状癌伴浸润性癌临床病理分析

目的探讨乳腺实性乳头状癌(solid papillary carcinoma,SPC)伴浸润性癌的临床病理特点、组织学特征和免疫表型。方法收集乳腺SPC伴浸润性癌8例,总结该组病变的临床资料,采用HE及免疫组化En Vision两步法染色检测组织病理学特征。结果乳腺SPC伴浸润性癌好发于老年女性,平均发病年龄55.5岁,其发生率约占SPC总病例的30%。肿瘤最常见的临床特征为乳腺肿块和乳头溢液,伴浸润癌常见的类型为乳腺非特殊类型癌和黏液癌,亦常伴神经内分泌分化。SPC伴浸润性癌时,浸润癌周边及其癌巢内肌上皮染色均为阴性。SPC与伴随的浸润癌区域ER、PR均阳性且阳性率较高(≥70%),HER-2均阴性,Ki-67增殖指数均≤10%。神经内分泌免疫组化标记Cg A及Syn均双阳性或单个阳性。结论 SPC可能是低级别乳头状导管原位癌的变异型,其具有进展为其他类型乳腺浸润性癌的潜能。SPC可能为伴神经内分泌分化乳腺黏液癌及非特殊类型癌原位癌阶段的病变。     

乳腺实性乳头状癌73例临床病理诊断

目的对乳腺实性乳头状癌(solid papillary carcinoma,SPC)的临床病理特征和免疫表型特点、预后和鉴别诊断进行探讨。方法收集伴或不伴有浸润癌的SPC共73例,总结其临床资料、大体和组织病理特征,并行透射电镜观察及免疫组织化学EnVision法染色。选用抗体包括CK、肌上皮标记、神经内分泌标记、增殖标记Ki-67和ER、PR、c-erbB-2等。结果本病好发于老年女性,发病平均年龄64.7岁。肿瘤最常见的临床症状为乳腺肿块和乳头溢液。行腋窝淋巴结清扫术43例中有31例检出癌转移。镜检所有标本均见到实性乳头状病变,25例伴有黏液分泌。周边常可伴有导管内乳头状瘤。肿瘤细胞呈多边形、卵圆形或梭形,呈印戒样。胞质丰富,呈嗜酸性或细颗粒状。细胞核轻度或中度异型,51例核分裂象5个/10HPF。43例伴发浸润癌。肿瘤基底型CK表达呈阴性。平滑肌肌动蛋白SMA、p63在乳头轴心肌上皮的阳性率分别为91.8%、67.1%,在导管周围肌上皮的阳性率分别为91.8%,73.9%。CgA和Syn以及NSE阳性率分别为89.0%,86.3%,95.9%。Ki-67平均阳性指数为10.2%。73例行ER、PR染色的肿瘤大部分呈阳性,Her-2大部分呈阴性。电镜下可见到细胞内的神经内分泌颗粒。结论乳腺SPC是一种低度恶性的乳腺导管内癌,好发于老年女性,有其独特的组织形态、免疫组织化学特征,部分SPC与乳腺黏液癌和神经内分泌癌相关。随访资料显示SPC具有良好的预后。     

乳腺实性乳头状癌78例临床病理特征

目的 探讨乳腺实性乳头状癌(solid papillary carcinoma,SPC)的临床病理学特征及预后.方法 采用免疫组化Ven-tana法对78例乳腺SPC进行检测;采用FISH法对HER-2基因进行检测,并复习相关文献.结果 78例乳腺SPC患者均为女性,平均64.7岁,多以乳头溢液和(或)乳腺肿块就诊.7...     

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。     

乳腺实性神经内分泌癌3例临床病理分析

目的 探讨乳腺实性神经内分泌癌的临床病理特征和免疫表型.方法 对3例乳腺实性神经内分泌癌患者的临床资料进行病理组织学及免疫组化观察并进行文献复习.结果 患者平均年龄62岁,肿瘤直径为1.5～3 cm,均因乳腺肿块入院.镜检:肿瘤细胞排列呈实性巢团或小梁状,被纤细的纤维血管间质分隔开来.免疫组化检测显示:3例肿瘤均表达ER、PR、HER-2、CK7、GCDFP-15和Syn,2例表达CgA、NSE,3例CD56均为阴性.结论 乳腺实性神经内分泌癌是一种少见的乳腺恶性肿瘤,确诊主要依靠病理组织学检查及免疫组化染色.     

乳腺包裹性乳头状癌17例临床病理观察

目的探讨乳腺包裹性乳头状癌(encapsulated papillary carcinoma,EPC)的临床病理特征。方法回顾性分析17例乳腺EPC的临床病理资料和免疫组化染色结果(抗体包括p63、SMA、CK5/6、ER、PR、HER-2和Ki-67),获取随访患者预后信息。结果 17例EPC中女性16例,男性1例,平均年龄62岁。临床以乳腺肿块和乳头溢液为主要表现。肿瘤最大径1.5～5.5cm(平均2.9 cm),10例肉眼可见囊腔形成。镜下见肿瘤单发或多病灶聚集,肿瘤周围有纤维性包膜。多数EPC以乳头状结构为主,被覆柱状细胞。少数肿瘤伴有筛状、实体结构或以其为主。1例EPC伴有腋窝癌结节。EPC的周缘和乳头轴心均缺乏p63、SMA和CK5/6阳性染色的肌上皮层。肿瘤细胞ER、PR均(+),1例HER-2呈(),其余均(-)。Ki-67平均增殖指数为12%。10例随访患者均无局部复发、远处转移和死亡。结论缺乏周缘肌上皮层的EPC可被视为特殊的浸润癌亚型,其远期预后较好,可参照导管原位癌(ductal carcinoma in situ,DCIS)治疗标准进行临床治疗。     

乳腺浸润性实性乳头状癌3例

例1,患者女,72岁,因“发现乳房肿块3 d”于2020年6月15日入院。患者诉3天前无意间发现左侧乳房肿块1枚,如豌豆大小,无疼痛,伴乳头溢血。查体：双乳对称,双乳头无凹陷,左乳头溢血;左乳可触及一直径约2.5 cm的肿块,质地中等,活动可,边界尚清,无压痛,双侧腋下未触及明显肿大淋巴结。乳腺彩色多普勒超声示：左乳1...     

胰腺实性假乳头状肿瘤临床病理分析

目的 探讨胰腺实性假乳头状瘤（solid-pseudo-papillary tumor of pancreas,SPT）的临床病理学特点及其生物学行为。方法 对6例SPT临床及病理资料进行回顾性复习,光镜观察其形态学特征,并采用免疫组化S-P法检测肿瘤细胞α-AT等9种抗体的表达,并对其中1例做AB／PAS染色。结果 6例SPT中5例为女性、1例为男性,平均年龄34岁,瘤体平均直径9．3cm;光镜下瘤细胞圆形,大小较一致,无明显异型性,排列成实性片状区和假乳头状结构,假乳头轴心黏液变性,囊性区常见出血、坏死;其中1例除上述特征外还出现了大量的印戒细胞样瘤细胞,这些瘤细胞AB／PAS染色阴性,CEA阴性,S-100蛋白阴性,随访至今已4年余,无复发及转移。2例浸润包膜及周围胰腺组织;6例中3例有随访的均健在且无复发及转移。免疫组化检测：6例Vim阳性（6／6）,4例α-AT阳性（4／6）,3例Syn阳性（3／6）,1例CK弱阳性（1／6）、PR阳性（1／6）,ER阴性（o／6）,EMA阴性（0／6）,CEA阴性（0／6）,S-100蛋白阴性（0／6）。结论 SPT好发于年轻女性;组织形态学特征为瘤细胞大小一致,排列成实性片状区与独特的假乳头状结构,偶见瘤细胞呈印戒细胞样,间质可黏液变性;该肿瘤生物学行为交界性或恶性潜能未定的肿瘤,即使出现包膜及周围胰腺浸润,预后亦较好。     

乳腺神经内分泌癌的临床病理学特点

目的 探讨具有神经内分泌特征乳腺癌的临床病理特点，加深对其认识。方法 观察5例乳腺神经内分泌癌的组织学特征并进行免疫组化染色，判定标准为≥50％肿瘤细胞表达Syn、CgA或NSE。结果 4例女性，1例男性。年龄54～90岁(平均70岁)。肿瘤直径2．5～5．5cm(平均3．5cm)。有淋巴结转移者2例。组织学形态包括富于细胞的黏液型、实性岛状型、弥漫实性粘附型、非典型类癌型和小细胞癌型。5例均表达Syn、CgA、NSE、AE1/AE3和EMA；2例表达Lue-7，2例表达CK7；3例表达E-cad；S-100蛋白均阴性，2例ER和PR阳性，3例p53阳性，1例表达c-erbB-2，4例表达bcl-2，Ki-67阳性率17％～85％。随访时间4～69个月(平均32．2个月)，除小细胞癌患者死亡外，均存活。结论 乳腺神经内分泌癌易发生在老年人，除小细胞癌外其他类型预后较好，它们在形态、功能和表型上常呈多向性，应该将它们从普通型的乳腺癌中区分出来。     

具有包裹性乳头状癌结构特征的高级别乳腺癌临床病理分析

目的 探讨具有包裹性乳头状癌(encapsulated papillary carcinoma, EPC)结构特征的高级别乳腺癌临床病理特征、诊断及鉴别诊断。方法 收集8例具有EPC结构特征的高级别乳腺浸润性癌的临床资料,采用HE、免疫组化EnVision两步法染色,并复习相关文献。结果 8例患者均为女性,发现单侧乳腺肿块是最常见的临床症状,2例出现乳头溢血,肿块最大径1.5～4.3 cm, B超示乳腺囊性肿块3例,囊实混合性肿物5例,镜下形态均为有包膜的囊实性混合肿块,伴特征性的推挤性边缘,囊内有乳头结构,瘤细胞异型性明显,呈高核级特征,7例免疫组化示基底样表型,1例为HER2过表达型,Ki-67增殖指数较高(30%～80%)。8例中有7例获得随访资料,均无局部复发转移和死亡。结论 具有EPC结构特征的高级别乳腺癌表现出明确侵袭性相关的病理学特征,临床有更大的复发转移倾向,预后较好。     

Composite encapsulated papillary carcinoma and solid papillary carcinoma

Encapsulated papillary carcinoma (EPC) and solid papillary carcinoma (SPC) are distinctive variants of intraductal papillary carcinomas, each accounting for <1% of breast carcinomas. Here we report a composite carcinoma consisting of EPC and SPC. A 73‐year‐old woman was found to have a high density mass in the left breast on mammogram. A biopsy showed intermediate to high grade ductal carcinoma in situ (DCIS). Gross examination of the lumpectomy specimen revealed a solid, multinodular mass. Microscopic examination demonstrated two morphologically distinct intraductal carcinomas intermingled with each other. One had delicate papillae in multi‐cystic spaces surrounded by thick fibrous capsule, consistent with EPC. The other had solid tumor nests with delicate fibrovascular cores. The cells were monotonous with round nuclei and salt and pepper‐like chromatin, characteristic of SPC. The lack of myoepithelial cells within the papillae and at the periphery of the lesion was confirmed by immunostaining for p63 and CK5/6. Neuroendocrine differentiation of SPC was demonstrated by neuron specific enolase staining. To our knowledge, this is the first reported case of composite EPC and SPC. It raises an interesting question as to a possible common pathway of carcinogenesis of these two rare variants.     

Loss of myoepithelium is variable in solid papillary carcinoma of the breast

AIMS: Reports on the frequency of myoepithelial loss in solid papillary carcinoma (SPC) of the breast, an unusual variant of papillary carcinoma with a solid pattern of expansile growth, have been strikingly contradictory. The aim was to clarify the frequency of myoepithelial loss in cases of SPC diagnosed at our institution. METHODS AND RESULTS: Eleven cases of SPC with available blocks or unstained slides were retrieved from the M. D. Anderson archives or obtained from outside contributors. Immunohistochemistry for smooth muscle actin (SMA) and p63 was evaluated on the circumscribed nests that appeared to be non-invasive by haematoxylin and eosin morphology. Three of the 11 cases (27%) were positive for both SMA and p63 at the periphery of all such foci, whereas eight cases (73%) lacked staining for both myoepithelial markers in at least one focus. Of these eight cases, one was diagnosed with only microinvasion, yet metastatic tumour resembling the circumscribed primary SPC was identified in two ipsilateral axillary lymph nodes. CONCLUSIONS: SPC of the breast frequently lacks myoepithelial markers at the tumour-stromal interface in spite of a circumscribed non-invasive appearance. Metastases from such tumours are infrequent, but can occur in cases that lack myoepithelial marker expression by immunohistochemistry.     

Cytological study of 20 cases of solid-papillary carcinoma of the breast

Solid-papillary carcinoma (SPC) of the breast is a rare variant of low-grade intraductal carcinoma but there are few cytological studies. We examined 20 cases of SPC of the breast, aged 31-80 (mean age 66.0 yr), to define the cytological features. In each of the cytological specimens, we could find both malignant and benign cytological features; the former were characterized by hypercellularity, highly discohesive clusters, numerous isolated cells, and severe overcrowding cells, while the latter were marked by small and bland nuclei, a low nuclear-cytoplasmic ratio, and inconspicuous nucleoli. Neither abnormal naked nuclei of tumor cell origin nor oval naked nuclei of myoepithelial cell origin were seen.We also reviewed the cytological findings of SPC as well as neuroendocrine carcinomas with intraductal components that had been reported and we concluded that the coexistence of malignant and benign features was the most characteristic cytological feature of SPC.     

Fine‐needle aspiration cytology of solid papillary carcinoma of the breast

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra‐ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra‐ductal tumour suggested low‐grade carcinoma. Additional findings of mucin production and rosette‐formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low‐grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.     

Encapsulated apocrine papillary carcinoma of the breast: Case report with clinicopathologic and immunohistochemical study

We describe a case of encapsulated papillary carcinoma (EPC), apocrine variant in a 50‐year‐old woman. The patient presented a cystic lesion in her right breast, measuring 8 cm in diameter, containing three solid papillary nodules. A fine‐needle aspiration showed isolated apocrine cells containing round nuclei, irregular nuclear membranes, fine chromatin, and prominent macronucleoli. The lesion was excised and showed a pure papillary apocrine carcinoma, which stained diffusely with GCDFP‐15 and androgen receptors. The lesion was totally devoid of myoepithelial cells (smooth muscle actyn, p63, calponin, and collagen IV stains were negative). With MIB1 the proliferative activity was 10%. To the best of our knowledge, this is the first report of EPC apocrine variant with cytologic and immunohistochemical study. This lesion must be included in the list of apocrine lesions of the breast. Diagn. Cytopathol. 2010. © 2010 Wiley‐Liss, Inc.     

Composite metastatic carcinoma in lymph nodes of patients with concurrent medullary and papillary thyroid carcinoma: A report of two cases

Synchronous occurrence of medullary and papillary carcinoma of the thyroid gland is very rare. We describe two cases of synchronous medullary and papillary carcinoma of the thyroid. In both cases, medullary carcinoma and papillary carcinoma were separate in the thyroid but mixed in some of the lymph node metastases. A review of the literature and our own cases revealed that composite medullary and papillary carcinoma metastases in the lymph nodes is a common feature of patients with synchronous medullary and papillary carcinoma of the thyroid gland.     

Solid-papillary carcinoma of the breast: clinicopathological study of 20 cases

The purpose of the present paper was to evaluate the clinicopathological and biological features of 20 Japanese patients with solid-papillary carcinoma of the breast (SPC) or SPC associated with invasive breast cancer. All the patients were Japanese women, including two sisters. The mean age was 66.0 years. The incidence of SPC among all the breast cancers treated at two institutions was 1.1% and 1.7%, respectively. The mean disease-free interval was 4 years 11 months. Axillary lymph node metastasis or tumor recurrence did not occur in any of the cases. Fifteen cases of SPC contained invasive cancers that ranged from <5% to 60% of the entire tumor area. Histological types of invasive cancers were mucinous carcinoma in five cases and neuroendocrine cell carcinoma in 10 cases. These results indicate that SPC is a potential precursor lesion for neuroendocrine carcinoma as well as mucinous carcinoma. When all the cases were classified and analyzed according to both the 2002 tumor node metastasis (TNM) classification system and the Nottingham histological grade, SPC patients, even those with invasive cancers, seemed to have longer disease-free survival compared to patients with the other invasive breast cancers of matching grade and stage. Clinicopathologically, SPC could be regarded as a separate type of ductal carcinoma in situ.