乳腺癌子宫内膜转移3例临床病理分析

目的 探讨乳腺癌子宫内膜转移的临床病理特征、治疗及预后。方法 回顾性分析3例乳腺癌子宫内膜转移患者的临床资料并结合文献复习。结果 3例乳腺癌子宫内膜转移患者中乳腺浸润性小叶癌2例,浸润性导管癌1例。子宫内膜转移灶直径为3~8 cm,中位直径4.5 cm。镜下见子宫内膜转移灶癌细胞呈圆形或椭圆形,细胞质较丰富,部分癌细胞异型性明显,排列呈管状。束状或索状分布,部分区域见小叶样结构。原发灶、子宫内膜转移灶ER、PR、Ki-67均呈阳性表达,CerbB-2、GCDFP-15、E-cadherin染色呈差异性表达,CK7、P120呈局灶阳性,CK5/6、SMA、CD10和S-100呈阴性。结论 乳腺癌伴子宫内膜转移临床少见,预后较差,生存期较短,确诊主要依靠病理和免疫组化检查,ER、PR、CK5/6、CK7、CerbB-2及GCDFP-15对子宫内膜原发癌与转移癌有一定鉴别作用。

Clinical pathological analysis of endometrial metastasis of breast cancer

Objective To investigate the clinical pathological characteristics, treatment and prognosis of endometrial metastasis of breast cancer,which is very rare. Methods This retrospective study analyzed the clinical data of 3 patients with endometrial metastasis of breast cancer treated at our hospital ,and relevant literature was reviewed. Results Two patients had breast-infiltrating lobular carcinoma ,while one patient had invasive ductal carcinoma. Endometrial metastatic lesions had a median diameter of 4.5 cm ( range,3-8 cm) . Cancer cells from endometrial metastatic lesions were round or oval under the microscope ,had dense cytoplasm and showed pleomorphism;tumor cells were arranged in tubular ,beam or funicular structures ,with lobular structures in some parts. Primary tumors and endometrial metastatic lesions in all three patients were positive for ER ,PR and Ki-67,while they showed variable staining for CerbB-2,GCDFP-15 and E-cadherin. Primary tumors and endometrial metastatic lesions were positive for p120 and CK7,but negative for CK5/6,SMA,CD10 and S-100. Conclusions Breast cancer patients with endometrial metastasis are rare and have poor prognosis and short survival time. Diagnosis is based mainly on medical history ,pathomorphology and immunophenotype. Staining for ER,PR,CK5/6,CK7,CerbB-2 and GCDFP-15 plays a role in differential diagnosis of uterine endometrial carcinoma in primary and metastatic cancer.