乳腺实性乳头状癌的临床病理研究

背景与目的：实性乳头状癌(solid papillary carcinoma，SPC)是乳腺癌的少见类型，不足乳腺癌的1%。作为乳腺乳头状癌的特殊亚型，SPC表现为实体结节状或膨胀性生长。本研究探讨乳腺SPC的临床病理特征、免疫表型特点及预后。方法：收集32例SPC的患者资料，进行病理组织学观察，免疫组织化学染色(EnVision法)检测ER、PR、C-erbB-2、p63、Calponin、CK5/6、Ki-67、Syn和CgA。结果：32例均为女性，平均年龄67.3岁，主要表现为乳头血性溢液和乳腺肿块。大体观察肿瘤呈结节状，灰褐色或灰白色，质地偏中或软。镜下肿瘤呈实体状或乳头状，实性区内见纤细的纤维血管轴心。肿瘤细胞呈卵圆形、多角形、梭形或印戒样，细胞质丰富嗜酸性，细胞核轻度或中度异型。免疫组化结果显示，所有患者肿瘤细胞ER和PR均强阳性(++～+++)，C-erbB-2均无表达，实性结节内肿瘤细胞均不表达CK5/6、p63和Calponin。Syn和CgA阳性表达率分别为68.8%和78.2%。Ki-67平均阳性指数为7.5%(2%～20%)。27例获得随访资料，随访时间6～84个月，25例患者无瘤生存。1例患者术后复发，再次手术后生存至今，1例患者因发生转移而死亡。结论：乳腺SPC好发于老年女性，具有独特的组织学形态和免疫表型。SPC具有较为惰性的生物学行为，即使伴有浸润切除后也不易复发和转移，预后较好。

Clinicopathologic study of solid papillary carcinoma of the breast

Background and purpose: Solid papillary carcinoma (SPC) is an uncommon histological pattern accounting for <1% of breast carcinomas. It is a distinctive form of papillary carcinoma characterized by closely apposed expansile, cellar nodules. The present study aimed to investigate the clinicopathologic features, immunophenotype and prognosis of SPC of breast. Methods: We retrieved the data of 32 cases of SPC of the breast from pathology files, and determined the expressions of ER, PR, C-erbB-2, p63, Calponin, CK5/6, Ki-67, Syn and CgA by pathohistological observation and immunohistochemical examination. Results: All the patients were females with a mean age of 67.3 years. The clinical features were a palpable mass or bloody nipple discharge. The tumor was observed as a whitish-grey or yellowish-brown, fleshy firm or soft, nodular circumscribed mass on gross examination. Microscopy showed solid and papillary area inside the capsule wall and that fine delicate fibrovascular septa were discovered amid the solid proliferation. The tumor cells were oval, polygonal, spindled or signet ring-like with abundant eosinophilic cytoplasm and contained mildly to moderately pleomorphic nuclei. Immunohistochemically, all tumor cells were strongly positive for ER and PR (++-+++), negative for C-erbB-2 and all cases were negative for CK5/6, p63 and Calponin in the cellular nodules. The positive expression rates of Syn and CgA were 68.8% and 78.2%, respectively. The average positive rate of Ki-67 in tumor cells was 7.5% (2%-20%). Twenty-seven patients were available for followup examination from 6 to 84 months and 25 patients were alive and disease free. One patient had tumor recurrence, and was alive after reoperation. Another patient died of the tumor metastasis. Conclusion: SPC is predominantly found in elderly females with distinctive pathological features and immunophenotype. SPC often carries an indolent clinical behavior, and even if accompanied by infiltration, very rare cases have recurrence and metastasis after resection, so its prognosis is better.