16例乳腺化生性癌的临床病理分析及EMT相关指标的表达

目的:研究乳腺化生性癌（metaplastic carcinoma of the breast，MBC）的临床病理特征，并探讨上皮间质转化(epithelial-mesenchymal transformation，EMT)指标E-钙黏蛋白（E-cadherin）与波形蛋白（Vimentin）在MBC和乳腺浸润性导管癌（invasive ductal carcinoma of the breast，IDC）中的差异性表达。方法:回顾性分析16例MBC患者的临床病理资料；同时选取与上述MBC临床病理特征匹配的16例IDC作为对照组。采用免疫组化SP法检测上述两组病例癌组织中ER、PR、HER-2、Ki-67、E-cadherin以及Vimentin的表达情况。结果:16例MBC中4例为纯鳞状细胞癌，4例为鳞状细胞癌伴有非特殊性浸润性癌，7例为梭形细胞癌，1例为混合型；患者中位发病年龄51岁，中位最大直径3.8 cm，淋巴结阳性率43.8%；ER/PR阳性率为0，HER-2阳性率为18.8%，13例为三阴性乳腺癌。E-cadherin在MBC组中的正常表达率低于IDC组（0% vs 37.5%，P<0.05）；Vimentin在MBC组中表达增加，强于IDC组（P<0.05）。结论:MBC是一种罕见的特殊类型的浸润性乳腺癌，形态学异质性明显，激素受体低表达，分子分型以三阴性癌为主；另外MBC中EMT程度明显高于IDC，故其预后较IDC差。

An analysis of 16 metaplastic breast carcinomas clinicopathologic features and expression of EMT markers

Objective:To review the clinicopathologic features of patients with metaplastic carcinoma of the breast (MBC) at our institution，and evaluate the differential expression of epithelial-mesenchymal transformation (EMT) makers namely E-cadherin and Vimentin in MBC and invasive ductal carcinoma of the breast (IDC).Methods:Clinical pathologic data of MBC and clinicopathologic-matched IDC were searched from 2008 to 2015.Expression of ER，PR，HER-2，Ki-67，E-cadherin and Vimentin were evaluated by immunohistochemistry.Results:Sixteen MBC were searched，including 4 pure squamous，4 squamous arosed with invasive ductal carcinoma，7 spindled，1 mixed histologic subtypes.The median age at diagnosis of MBC was 51 years，median tumor size was 3.8 cm，and axillary lymph node involvement was 43.8%.All cases were negative for ER and PR，13 out of the 16 cases were triple-negative for ER，PR，and HER-2.Reduction or loss of membranous E-cadherin in 16 MBC，and positive expression of Vimentin was found in 62.5% MBC.The normal expression rate of E-cadherin in MBC was significantly lower than that in IDC (0% vs 37.5%，P<0.05).While expression level of Vimentin in MBC was significantly higher than that in IDC (P<0.05).Conclusion:MBC is a rare type of breast cancer with divergent cellular differentiation and histologic heterogeneity.Most of them are triple-negative with low expression of hormone receptor，and HER-2.And EMT in metaplastic breast cancer was significantly higher than IDC.Thus MBC has worse prognosis than IDC，and is resistant to comprehensive treatment.