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乳腺包被性乳头状癌的临床病理分析

Clinicopathologic Analysis of Encapsulated Papillary Carcinoma of Breast

  • 摘要: 目的 探讨乳腺包被性乳头状癌(encapsulated papillary carcinoma, EPC)的临床病理学特征、诊断、治疗及预后。方法 回顾性分析新疆医科大学附属肿瘤医院病理科2010年1月—2013年12月间,诊断为囊内乳头状癌或包被性/包裹性乳头状癌35例及48例对照组导管内乳头状癌的临床病理资料及免疫表型。结果 EPC患者均为女性,年龄29~83岁,平均61岁,肿块大小平均2.4 cm (范围0.6~4 cm)。35例EPC中,22例为单纯性EPC、7例伴导管原位癌、4例伴微小浸润癌、2例伴非特殊类型浸润癌。35例EPC与48例导管内乳头状癌病变内部均未见肌上皮细胞,CK5/6及p63肌上皮染色结果显示,EPC病变周围肌上皮数量较导管内乳头状癌导管壁肌上皮数量明显减少,差异具有统计学意义(P<0.05);35例EPC中80%激素受体阳性,5.71%HER2表达阳性。8例(22.86%)EPC患者行肿块切除,27例(77.14%)患者行乳房切除术,3例(8.57%)发生淋巴结转移。术后经随访2~48月,患者均存活。结论 乳腺包被性乳头状癌是一种好发于老年女性的恶性肿瘤,病变周缘肌上皮明显减少甚至缺如,单纯性EPC也可发生淋巴结转移,被认为是一种惰性的浸润癌,生物学行为介于原位癌与浸润癌之间。若单独发生或伴随原位癌及微小浸润癌时,应参照原位癌治疗, EPC伴随浸润癌时,应参照浸润癌的治疗标准进行。

     

    Abstract: Objective To investigate the clinicopathological characteristics, diagnostic criteria, treatment and prognosis of encapsulated papillary carcinoma(EPC) of the breast. Methods We reviewed the clinicopathological information and immunohistochemical staining results of 35 cases of breast intracystic papillary carcinoma/EPC and 48 cases of intraductal papillary carcinoma used as controls. All cases were collected from Xinjiang Medical University Affiliated Cancer Hospital from January 2010 to December 2013. Results All 35 cases of EPC were females, and ages ranged from 29 to 83 years old, with a mean age of 61 years old. The average size of tumors was 2.4cm(0.6-4cm). Among the 35 EPCs, 22 EPCs were of pure type, 7 EPCs with ductal carcinoma in situ(DCIS), 4 EPCs with microinvasion(MI) and 2 EPCs with non-specific invasive carcinoma(IC). Myoepithelial cell staining was negative for CK5/6 and p63 within all cases of EPC and intraductal papillary carcinoma. At the periphery of the tumor nodules, the number of myoepithelium was obviously reduced in 35 EPCs compared with 48 intraductal papillary carcinomas, and the difference was statistically significant(P<0.05). 80% EPCs were positive for hormone receptor, 5.71% EPCs showed +++ staining for HER2. Eight patients(22.86%) underwent lumpectomy and 27 patients(77.14%)received mastectomy; 3 patients(8.57%) had lymph node metastasis. Followed up for 2-40 months after operation, all patients were alive. Conclusion EPC generally occurs in older women; myoepithelial cells are significantl y reduced and even entirely absent at the periphery of tumor. Lymphatic metastasis may be observed in pure EPC. EPC can be regarded as an indolent invasive carcinoma, which is intermediate in nature between DCIS and IC. For the patients with pure EPC or EPC accompanied by DCIS, MI should generally be treated as DCIS; those with EPC accompanied by IC should be treated as IC.

     

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