乳腺浸润性微乳头状癌1例及文献复习

目的:探讨乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)临床病理特点和鉴别诊断。方法:对1例乳腺浸润性微乳头状癌进行组织学和免疫表型观察并复习文献,阐述该肿瘤的病理学特征和生物学行为及诊断与鉴别诊断。结果:肉眼观察肿瘤质硬、边界不清,直径5.0 cm,肿瘤组织切面呈灰白粘液样,呈浸润性生长。镜检显示明显扩张的管腔内见微小乳头状或桑葚状的癌细胞簇,缺乏纤维血管轴心,细胞由内向外呈放射状排列,外缘呈锯齿状,部分间隙内可见少量粘液。癌细胞弥漫浸润性生长,呈柱状形或立方形,边界不清,无明显坏死和炎细胞反应。胞质多少不均,淡伊红至强伊红染。细胞核卵圆形,染色较深,有不同程度异型,核分裂少见。同侧腋窝淋巴结见癌转移,淋巴结内见相同形态学改变,淋巴管内见癌栓。免疫组化瘤细胞CK7和EMA表达阳性,ER、PR弱阳性表达,c-erbB-2强阳性表达,E-cadherin表达在癌细胞连接面的胞膜,而在间质面弱阳性表达。结论:I MPC是一种特殊类型的浸润性导管癌,具有独特的形态学特点和高度的淋巴侵袭性。

A case report of invasive micropapillary carcinoma of the breast and literature review

Objective:To study the clinical pathological characteristics and differential diagnosis of breast invasive micropapillary carcinoma(IMPC).Methods: Histopathological and immunohistochemical assay were performed in one case of breast IMPC by reviewing the related literature.Results: The tumor specimen was grossly firm,with ill-defined margin,and approximately 5.0 cm in maxim diameter.Slicing of the tumor revealed whitish and mucus-like lesion with infiltrating growth.Sections under microscope revealed micropapillary feature.The micropapillary component consisted of tufts and micropapillary aggregates without fibrovascular cones,residing in dilated ducts.Cell clusters showed radical arrangement with a minute amount of mucus in the lumen.Tumor cells grew invasively.Focally,tumor cells were cubical and columnar,with obscured margin and pale or eosinophilic cytoplasm.There was neither necrosis nor lymphocytic reaction.Nuclei were of moderate cytologic atypia but with rare mitotic figures.Metastasis happened in the axilla lymph node of the same side,showing the same features as the primary tumor.There were tumor emboli in the lymphatic vessel.Immunohistochemistry staining showed that the cells expressed CK7,EMA,ER and PR slightly,but highly expressed c-erbB-2.E-cadherin were seen expressed in cytoplasma membrane between cancer cells juncture surface,but absence of expression toward the fibrocollagenous stroma.Conclusion: IMPC is a rare subtype of breast carcinoma,which has specific microscopic characteristics and extremely high incidence of lymph node metastases.