文章摘要

乳腺化生性癌合并大汗腺癌临床病理观察

作者: 1罗斌, 1何惠华, 1黄文先, 1阎红琳, 1袁静萍
1 武汉大学人民医院病理科,武汉 430060
通讯: 袁静萍 Email: yuanjingping2003@aliyun.com
DOI: 10.3978/j.issn.2095-6959.2019.12.034
基金: 武汉市科技计划项目(2017060201010172)。

摘要

报告1例乳腺化生性癌合并大汗腺癌患者,分析其临床表现、彩超、组织病理学、免疫表型和预后特点,并复习相关文献进行讨论。患者,女,62岁,临床表现为双侧乳腺肿物进行性增大。彩超示左侧乳腺局部腺体结构紊乱、回声减低,右侧乳腺实性包块伴钙化斑。行HE染色,显微镜镜下可见左侧乳腺组织导管内细胞核呈多形性,染色质粗大,核仁明显,核分裂象常见。右侧乳腺正常结构被破坏,囊腔内壁衬附具有不同程度核异形和多形性的鳞状细胞,部分肿瘤细胞由大汗腺癌细胞构成,细胞质丰富、颗粒状,呈强嗜酸性,细胞核大,核仁明显。免疫组织化学结果显示左侧乳腺肿瘤细胞P120(胞膜),E-cadherin,ER,PR,HER-2均阳性表达,CK5/6阴性表达;右侧乳腺鳞状细胞癌成分ER,PR和HER-2均阴性表达,CK5/6和p63均阳性表达,Ki-67增殖指数约为40%。大汗腺癌细胞成分ER和PR阴性表达,AR,GCDFP-15,HER-2均阳性表达,Ki-67增殖指数约为40%。结合该患者临床资料、乳腺彩超、组织病理学特征及免疫组织化学结果确诊为左侧高级别导管原位癌(粉刺型);右侧乳腺含有鳞状细胞癌分化的乳腺化生性癌合并大汗腺癌的特殊亚型乳腺癌。乳腺化生性癌是一组有异源性成分的癌,诊断依赖组织病理学特征和免疫表型,治疗上以手术切除为主。
关键词: 乳腺肿瘤;乳腺化生性癌;鳞状细胞癌;大汗腺癌

Clinicopathological observation of metaplastic carcinoma combined with apocrine carcinoma of breast

Authors: 1LUO Bin, 1HE Huihua, 1HUANG Wenxian, 1YAN Honglin, 1YUAN Jingping
1 Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, China

CorrespondingAuthor: YUAN Jingping Email: yuanjingping2003@aliyun.com

DOI: 10.3978/j.issn.2095-6959.2019.12.034

Foundation: This work was supported by the Science and Technology Planning Project of Wuhan, China (2017060201010172).

Abstract

To investigate the clinicopathological features, immunophenotypic characteristics, diagnosis and differential diagnosis of special subtype breast cancer containing metaplastic carcinoma and apocrine carcinoma, a case of metaplastic carcinoma combined with apocrine carcinoma of breast was collected. The clinical manifestations, Color Doppler ultrasound, histopathology, immunophenotype and prognosis characteristics were analyzed, and the relevant literatures were reviewed for discussion. The clinical manifestations of a 62-year-old female patient were progressive enlargement of bilateral breast masses. Color Doppler ultrasound showed local glandular structure disorder and echo reduction in the left breast, and solid mass in the right breast with calcified plaque. Microscopically, the luminal nucleus of the left breast tissue was pleomorphic, large chromatin and obvious nucleoli. Nuclear fission was common, and the normal structure of the right breast was destroyed. The inner wall of the cyst was lined with squamous cells with different degrees of nuclear abnormity and polymorphism. Some tumor cells were composed of cancer cells differentiated from apocrine glands. Microscopically, the cytoplasm was rich and had acidophilic granules, and tumor cells had large nuclei and obvious nucleoli. The results of immunohistochemistry showed that P120 (membrane), E-cadherin, ER, PR and HER-2 were positively expressed, and CK5/6 was negatively expressed in the left breast tumor cells; in the right breast tissue, squamous cell carcinoma was negative for ER, PR and HER-2, but positive for CK5/6 and p63. The proliferation index of Ki-67 was about 40%. The carcinomas with apocrine differentiation was negative for ER and PR, but positive for AR, GCDFP-15 and HER-2. The proliferation index of Ki-67 was about 40%. Combined with the clinical data, breast Color Doppler ultrasound, histopathological features and immunohistochemistry results of the patient, metaplastic carcinoma combined with apocrine carcinoma of breast was diagnosed. Metaplastic carcinoma of the breast is a group of cancers with heterogeneous components. The diagnosis depends on histopathological features and immunophenotype. The main treatment is surgical resection.
Keywords: breast neoplasms; metaplastic breast cancer; squamous cell carcinoma; apocrine carcinoma