乳腺浸润性微乳头状癌临床病理学观察及免疫组化分析

目的：探讨乳腺浸润性微乳头状癌（IMPC）的临床病理特征、免疫组化表达、诊断及鉴别诊断。方法：对11例IMPC患者的临床病理资料进行观察分析,运用免疫组化方法分析这组病例ER、PR、Her-2、EMA、E-Cadherin、CD31、p53、Ki-67的表达。结果：11例IMPC患者无特殊临床症状和体征。特征性组织学表现为肿瘤细胞呈微乳头状或腺样排列,细胞呈里面朝外（inside-out）的排列方式;肿瘤细胞团由纤细的纤维组织分隔,形成主间质分离。印片细胞特征性形态学表现为桑葚体样细胞球表面细胞质呈微绒毛样改变。11例中7例有血管淋巴管癌栓,淋巴结转移率63.64%。免疫组化EMA线状表达于微乳头和腺样结构的外侧缘;E-Cadherin肿瘤细胞间连接面的细胞膜强表达,而间质面的细胞膜表达减弱。Ki-67表达率平均30.3%。ER阳性率81.81%,PR阳性率72.73%。Her-2阳性率（＋＋＋）18.18%。结论：IMPC为一种具有特殊形态学表现的高增殖、高转移潜能的乳腺癌。特征性组织形态学结合免疫组化E-Cadherin、EMA等检测有助于IMPC的诊断和鉴别诊断。

Clinical Pathologic Observation and Immunohistochemical Analysis of Invasive Micropapillary Carcinoma of the Breast

Objective：To discuss the clinical and pathological features,immunohistochemical expression, diagnosis and differential diagnosis of invasive micropapillary carcinoma of the breast（IMPC）.Method：The clinicopathologic information of 11 cases of IMPC were studied,and the expression of ER,PR,Her-2,EMA,E-Cadherin, CD31,p53 and Ki-67 of this group were analyzed by immunohistochemistry staining.Result：11 cases of IMPC were not special clinical symptoms.Histological findings were characterized that tumor cells were arranged like micro-papillary or glandular mode,and inside cells were outward arrangement （inside-out）.Tumor cells were separated by slender fibrous septa,and formed the main interstitial separation.The characteristic performance of the imprint cytology usually showed modula-like cluster,and the cytoplasm on the cell surface was microvilli-like.Among the 11 cases of IMPC studied,7 cases had lymphatic tumor emboli.The incidence of regional lymph node metastasis was 63.64%.Immunohistochemical EMA was expressed in the outer rim of the Micro papillary and adenoid structure.E-Cadherin was strong expressed in the membrane of contiguous surfaces among carcinoma cells but the expression of interstitial surface membrane decreased. Expression rate of Ki-67 was 30.3% on average.Positive rate of ER was 81.81%.Positive rate of PR was 72.73%.Positive rate of Her-2 was 18.18% （＋＋＋）.Conclusion：IMPC is special morphology type of invasive breast cancer with high proliferation and metastasis potential.Combining with EMA,E-Cadherin markers,histomorphology characteristic of IMPC is helpful to its the diagnosis and differential diagnosis.