乳腺腺样囊性癌与涎腺腺样囊性癌的临床病理分析及比较

目的 分析比较乳腺腺样囊性癌(adenoid cystic carcinoma of the breast,BAdCC)和涎腺腺样囊性癌(salivary glands adenoid cystic carcinoma,SGAdCC)的临床特点、组织形态、免疫表型、生物学行为及预后的异同点.方法 收集8例BAdCC和12例SGAdCC的临床资料,行光镜观察及免疫组化染色,对两组病例进行生存分析.结果 BAdCC患者平均年龄51岁,临床常表现为缓慢的膨胀性生长的肿块,偶伴有疼痛,神经周围浸润不明显,所有病例计56枚淋巴结均未见转移,1例在术后5年复发;SGAdCC患者平均年龄53.5岁,半数患者出现疼痛和麻木,神经周围及邻近骨胳常浸润常见,27枚淋巴结有5枚转移(18.5%),术后短期复发常见,二者的无复发生存率差异有显著性.结论 BAdCC非常罕见,BAdCC与SGAdCC在组织形态和免疫表型上无明显的差异,但二者的生物学行为明显不同,BAdCC呈惰性临床过程,而SGAdCC具有明显的侵袭性,导致这种差异的原因需进一步研究.     

不典型乳腺腺样囊性癌1例

<正>患者女性,75岁,体检发现左侧乳腺肿块4年,因偶有疼痛不适就诊。体格检查未见乳房皮肤明显红肿、破溃、乳头溢血和溢液。超声检查：左侧乳腺内上象限实质性团块,大小28 mm×19 mm, USBI-RADS:4A类。穿刺活检病理考虑为硬化性腺病,建议肿块完整切除后再次评估。患者入院后行左侧乳腺肿块切除术。病理检查 眼观：灰白色结节1枚,最大径约2.5 cm, 切面质硬,界不清。     

伴有腺样囊性癌转化的乳腺微腺腺病

微腺腺病 (microglandularadenosis,MGA)是一种少见的增生性乳腺病变 ,组织学特征是弥漫性浸润的小圆腺泡杂乱分布于胶原化的纤维组织或脂肪组织中。根据作者观点 ,是否出现肌上皮层不影响MGA的诊断 (尚有争议 )。作者描述了 17例与腺样囊性癌 (adenoidcysticcarcinoma ,ACC)并存的伴有非典型增生的MGA。此组患者均为女性 ,年龄 4 0- 86岁 ,临床查体均触及包块。病变大小 0 .6cm - 11cm ,呈界限清楚的灰褐色包块或混杂脂肪组织的质硬区。组织学观察 :11例患者出现普通型MGA ,其腺体弥漫性分布或灶性分布于病变周缘 ,伴或不伴有菲薄的…     

乳腺腺样囊性癌临床病理特点及文献复习

目的 探讨乳腺腺样囊性癌的临床病理特点及鉴别诊断要点。方法观察4例乳腺腺样囊性癌的临床病理和免疫组化特点，并复习相关文献。结果 4例乳腺腺样囊性癌大体上均表现为界限清楚的肿块。该肿瘤在结构上可以分为筛孔型、管状-小梁状型和实体型三种类型，并需与一系列乳腺良恶性病变相鉴别，如胶原小球病、筛状癌、小细胞癌等。结论 乳腺腺样囊性癌是一种少见肿瘤，具有其独特的组织病理学特点，预后较好。     

乳腺腺样囊性癌与浸润性筛状癌的形态及免疫组化比较

目的探讨具有筛状结构的乳腺腺样囊性癌与浸润性筛状癌的形态和免疫组化特点及诊断、鉴别诊断要点。方法对具有筛状结构的乳腺腺样囊性癌及浸润性筛状癌各3例进行形态和免疫组化比较观察。结果在常规HE染色下,乳腺腺样囊性癌的筛状结构与浸润性筛状癌十分相似,但它们的免疫标记谱不同。乳腺腺样囊性癌的导管上皮细胞表达c-kit;肌上皮细胞表达p63、SMA;不表达ER、PR。浸润性筛状癌不表达c-kit,p63及SMA;总是表达ER、PR。结论乳腺腺样囊性癌是罕见的肿瘤,它的筛状结构与浸润性筛状癌非常相似。免疫组化标记c-kit;p63、SMA及ER、PR有助于它们的鉴别。     

涎腺腺样囊性癌和基底细胞腺瘤的免疫表型及临床病理特征

目的观察CK7、Calponin、CD117、Ki-67在涎腺腺样囊性癌(adenoid cystic carcinoma,ACC)和基底细胞腺瘤(basal celladenoma,BCA)中的免疫表型及其病理组织形态学差异,以提高对该类肿瘤鉴别诊断的认识。方法对发生于涎腺的26例BCA和17例ACC进行临床和病理组织形态观察并免疫组化标记(CK7、Calponin、CD117、Ki-67)。结果临床特点为两种肿瘤的发病年龄相似,但发生部位不同,ACC好发于腮腺以外的小涎腺,BCA多数发生于腮腺;病理特点为前者表现为浸润性生长并累及周围组织;免疫组化显示两种肿瘤存在免疫表型差异:其中CD117在ACC和BCA之间的强阳性率差异有统计学意义(P<0.05);Ki-67在BCA和ACC之间的强阳性率差异有统计学意义(P<0.01)。结论 ACC具有浸润性生长的生物学特征,病理特点上与BCA鉴别主要基于两者的生长方式和组织形态学检查,CD117和Ki-67免疫组化标记有助于其鉴别诊断。     

涎腺腺样囊性癌40例临床病理特征及预后分析

目的 探讨涎腺腺样囊性癌(salivary adenoid cystic carcinoma,SACC)的临床病理学特征及其与预后的关系.方法 回顾性分析40例SACC的临床病理资料,采用免疫组化EnVision两步法检测Ki-67、CD117、CK19、p63、SMA、S-100、β-catenin、LEF-1及D2...     

乳腺腺样囊性癌临床病理学特征及生物学行为

目的探讨乳腺腺样囊性癌(adenoid cystic carcinoma,ACC)的临床病理学特征、诊断及预后,以提高对该病的认识水平。方法收集3例乳腺ACC,标本均充分取材,完善临床及预后资料,观察临床病理学特点,行PAS、AB-PAS法特殊染色和免疫组化SP法检测。结果 3例患者均为女性,年龄49～65岁,平均56岁,临床以乳腺无痛性肿块或触痛为主要症状就诊,肿块多位于乳晕区。眼观:肿块与周围乳腺组织分界清楚,无包膜,切面呈灰白、淡黄、棕褐或粉红色;直径1.0～3.0 cm,平均2.2 cm。镜检:肿瘤细胞形成许多大小不等的管腔结构,肿瘤细胞较小,胞质少,核深染,核分裂象少见,核仁不明显。间质可见疏松黏液样改变。免疫表型:CD117、CK5/6、CK(34βE12)、SMA、Calponin、p63均强阳性,S-100呈局灶表达,Ⅳ型胶原基膜阳性,ER、PR、HER-2均呈阴性,Ki-67增殖指数5%～8%。AB-PAS和PAS染色均阳性。结论 ACC多见于唾腺,发生于乳腺者罕见,属于低度恶性、生长缓慢的实体肿瘤,预后较好,但免疫表型将其大多数归入三阴型乳腺癌中,常误诊为其他类型的癌,结合临床特征、HE形态、特殊染色及免疫组化有助于正确诊断。     

宫颈腺样囊性癌合并鳞状细胞癌临床病理及免疫表型分析

目的探讨宫颈腺样囊性癌合并鳞状细胞癌的临床病理特点、免疫表型及可能的发生机制。方法对1例宫颈腺样囊性癌合并鳞状细胞癌的临床、病理组织学及免疫表型进行观察并文献复习。结果宫颈腺样囊性癌合并高-中分化鳞状细胞癌,肿瘤侵及宫颈近全层,盆腔淋巴结未见肿瘤转移。免疫表型:腺样囊性癌成分p63、CK7、S-100均(+);HHF-35、34βE12、CK17、ER、PR均(-),鳞状细胞癌成分34βE12、p63(+);CK17、S-100、CK7、HHF-35、ER、PR均(-)。结论发生于宫颈的腺样囊性癌合并鳞状细胞癌非常罕见,该肿瘤术前诊断易出现漏诊,确诊主要靠术后病理检查。     

前庭大腺腺样囊性癌1例

患者女性 ,5 2岁。因会阴部持续性钝痛 2年余 ,加重呈烧灼痛及刀割样疼痛伴肛门下坠感 3个月入院。在外医院以“子宫内膜炎”、“肛窦炎”治疗无效。查体 :左侧大阴唇略隆起 ,中下部有一肿块 6cm× 5cm ,界线欠清 ,基底尚可活动 ,阴道下壁僵硬。对左侧大阴唇肿块活检 ,病理报告为腺样囊性癌。手术切除左侧前庭大腺及部分阴道壁组织 ,沿坐骨结节将肿瘤及周围脂肪组织、部分直肠、全子宫切除。　　病理检查　眼观 :送检直肠 ,长 15cm ,附有肛门 ,另送全切子宫及附件。直肠前侧肿块为 4 5cm× 4 0cm× 3 0cm ,肿块下缘距肛门 2 5cm ,肿块被脂…     

Adenoid cystic carcinoma of the breast diagnosed by fine-needle aspiration

Fine-needle aspiration cytology remains a useful tool for preoperative diagnosis of breast lesions. We describe a case of adenoid cystic carcinoma (ACC) of the breast detected by ultrasound-guided fine-needle aspiration (FNA). Subsequent histopathology corroborated the diagnosis. ACC is a rare but distinctive neoplasm of the breast that can be accurately diagnosed by FNA. Its infrequent presentation, favorable prognosis, and relatively conservative management in the breast prompt us to reinforce its features.     

Adenoid cystic carcinoma of the tracheobronchial tree: clinicopathologic and immunohistochemical studies of 21 cases

Aims: To review retrospectively 21 cases adenoid cystic carcinoma of the tracheobronchial tree (TACC) with emphasis on their clinical and pathologic features, treatment and the possible prognostic factors. Methods and results: 21 cases TACC diagnosed by surgical biopsy or resection at the Peking Union Medical College Hospital (PUMCH) over 10 years. Patients aged 24-69 years (median, 49 years), 6 men/15 women. Cough (18/21), dyspnea (14/21) and hemoptysis (10/21) were the most frequent manifestations. 15 patients had tumors in trachea. Ten patients had pathologically positive margin (n = 11). Immunohistochemically, BCL-2, CD117, P16, type IV collagen, SMA and P63 were positive (20/20); GFAP was focally positive (4/20); TTF-1 and P53 were negative (0/20). Ki-67 index ranged from 2% to 35%. Fifteen patients had followed up, 13 of which received postoperative radiotherapy. The median relapse-free survival (RFS) was 56.9 months and the 5-year RFS was 48.6%. By univariate analysis, postoperative radiotherapy had favorable prognostic significance (P < 0.05). Conclusions: TACC, which is mainly located in primary trachea or bronchus, is difficult to be detected at early stage. The tumors are not likely to be completely removed by surgery, and postoperative radiotherapy is helpful for reducing the likelihood of recurrence and metastasis.     

Adenoid cystic carcinoma with collagenous spherulosis-like structures in the breast: report of a case

Adenoid cystic carcinoma (ACC) is rare in breast carcinomas and has a relatively better prognosis than other histological types. Although the tumor shows various growth patterns, such as those of salivary glands or other organs, the papillary growth pattern is uncommon. Collagenous spherulosis (CS), consisting of intraluminal clusters of eosinophilic spherules situated adjacent to, or encompassed by, usually benign proliferative epithelium, is also a rare incidental microscopic finding that ACC must be distinguished from, and it has never been reported in association with ACC. We present a case of ACC arising in mammary ducts with the papillary growth pattern and CS-like structures that should not be mistaken for benign proliferative lesions, especially in the core needle-biopsy specimen, because the adenoid cystic pattern might not always be contained in the specimen. Morphologically and histochemically, the results suggest that the CS-like structures in the present case undergo a similar process to the originally described CS, which the myoepithelium is thought to be associated with. Examination of more cases are necessary to clarify the process of CS and its relationship to mammary proliferative lesions.     

Adenoid cystic carcinoma of the breast: a case with axillary lymph node metastasis

A breast tumour with proven lymph node metastasis is conclusively characterized as an adenoid cystic carcinoma using immunocytochemistry and electron microscopy. The majority of tumour cells showed certain of the characteristic features of myoepithetial cells while the pseudocystic spaces contained large amounts of reduplicated basal lamina. A small proportion of tumour cells, however, showed epithelial differentiation with the formation of true lumina.     

Adenoid cystic carcinoma of the breast: a tumour commonly devoid of oestrogen receptors and related proteins

AIM: Adenoid cystic carcinoma (ACC) of the breast is an uncommon well-differentiated tumour with good prognosis, and sometimes difficult to distinguish from in-situ and invasive cribriform carcinoma (ICC) which are relatively more common. Recently, we encountered a case of ACC that proved to be totally oestrogen receptor (ER) negative by immunohistochemistry. We investigated the possibility that this may be a consistent feature that can help in differentiating ACC from ICC which are usually ER positive. METHODS AND RESULTS: The immunoperoxidase technique was used to study the expression of ER and other related proteins in six cases of ACC and two cases of ICC. All ACC cases were negative for oestrogen (ER) and progesterone (PgR) receptors whereas the two ICC were strongly positive for ER and showed a variable degree of PgR positivity. In addition, ACC cases were pS2 negative and showed minimal expression of prolactin receptors (PrlR), while the two ICC showed widespread and strong staining for pS2 and PrlR. The percentages of cells staining positively for Ki67 and p27 were generally lower in ACC than in ICC. Both tumour types were c-erbB-2 negative, but p53 was weakly to moderately positive. CONCLUSIONS: The findings suggest that a negative immunoperoxidase staining for ER would confirm the diagnosis of ACC in contrast to the positive staining which is always seen in ICC. The findings also raise the issue of the presence of a specific class of ER negative breast carcinomas which are negative not because of poor differentiation, but because of their derivation from, or differentiation along, an ER negative cell lineage.     

Adenoid cystic carcinoma of the right main bronchus showing squamous differentiation and mimicking mucoepidermoid carcinoma: a case report

Complete dissection of tracheobronchial adenoid cystic carcinoma (TACC) by surgery alone is sometimes difficult and has a greater propensity than tracheobronchial mucoepidermoid carcinoma (TMEC) for its surgical margin to become positive. In addition, TACC is more likely to present distant metastases than TMEC. Considering these facts, TACC and TMEC should be differentiated based on histopathological examination of biopsy specimens. Herein, we present a case of 54-year-old woman with a tumor in the right main bronchus, whose biopsy specimen was difficult to diagnose as TACC or TMEC. The specimen from the rounded protrusion of the tumor showed squamous differentiation, along with the presence of glandular and basaloid cells, making morphological examination alone ineffective in rendering a definite diagnosis. Thus, the addition of immunohistochemical analysis, αSMA and CD43 expression in basaloid cells and c-kit expression in glandular cells, was useful for accurately diagnosing TACC in this case. The squamous component was considered to be neoplastic because of its increased expression of cyclin D1 and overexpression of p16. The surgically resected specimen contained typical morphology of ACC, and the diagnosis of TACC was definitely confirmed.     

涎腺腺样囊性癌中ADAM-17的表达及临床意义

目的探讨ADAM-17在涎腺腺样囊性癌(salivary adenoid cystic carcinoma,SACC)中的表达及临床意义。方法收集48例SACC石蜡组织和20例新鲜组织,分别采用免疫组化EnVision两步法和RT-PCR法检测SACC组织中ADAM-17蛋白和mRNA表达水平,并分析其与临床病理学参数之间的相关性。结果 ADAM-17蛋白在48例SACC组织中阳性率为72.9%(35/48),ADAM-17mRNA水平在20例SACC中平均相对表达量为(0.40±0.18),两者的表达均高于正常对照组,差异具有统计学意义(P<0.001),两者的表达与肿瘤的大小、TNM分期和患者的生存时间均有相关性。结论 ADAM-17在SACC中高表达,可能介导癌组织生长、侵袭和转移,其有望成为一个新的治疗靶点。     

Fine-needle aspiration cytodiagnosis of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer with a good prognosis. Its morphology is identical to its counterpart in the salivary glands. In this brief report, two cases of ACC of the breast are presented in which the diagnosis was established on a fine-needle aspiration cytology (FNAC) and correlated with subsequent examination of cell blocks of aspirate and tissue. The cytodiagnostic criteria for ACC of the breast are discussed. Diagn Cytopathol 1996;14:328–330. © 1996 Wiley-Liss, Inc.