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目的探讨乳腺梭形细胞化生性癌(MC)的临床病理和免疫组化特征,提高对该病的诊断与鉴别诊断。方法回顾我科2005—2014年底存档的7例乳腺梭形细胞化生性癌临床病理资料,观察其组织学形态和免疫表型,并复习相关文献。结果 7例患者均为女性,中位年龄59岁,首发症状均为可触及的无痛性乳腺肿块。肿瘤平均直径5.4 cm,7例患者均行改良根治乳腺手术,同侧腋窝淋巴结转移1例,肺转移3例,肝转移1例,平均随访33个月,死亡3例。镜下:肿瘤组织主要由梭形细胞构成,梭形细胞形态及排列多样。免疫组化肿瘤细胞ER、PR、Her-2均(-),CKpan、CK5/6、vimintin均(+),6例p63(+),4例SMA(+),Ki-67阳性率5%~73%。结论乳腺梭形细胞化生性癌罕见,病理形态多样,激素受体不表达,可表达肌上皮标记,多数患者Ki-67指数高,预后较差,腋窝淋巴结转移率低,易发生远处转移。严格规范取材及免疫组化有助于诊断与鉴别诊断。
Objective To investigate the clinicopathological and immunohistochemical features of spindle cell metaplastic carcinoma (MC) in breast and to improve the diagnosis and differential diagnosis of the disease. Methods The clinical and pathological data of 7 cases of breast spindle cell metaplasia, which were archived from the end of 2005 to the end of 2014, were retrospectively reviewed. The histological morphology and immunophenotype were observed. The related literatures were reviewed. Results All 7 patients were female, with a median age of 59 years. The first symptom was palpable breast mass. The mean tumor diameter was 5.4 cm. Seven patients underwent modified radical mastectomy. One case was ipsilateral axillary lymph node metastasis, three lung metastases and one liver metastasis. The average follow-up was 33 months and 3 died. Microscope: Tumor mainly composed of spindle cells, spindle cells and arranged in a variety of forms. Immunohistochemistry showed that the positive rates of ER, PR, Her-2, CKpan, CK5 / 6, vimintin, 6 cases of p63 and 4 cases of SMA and Ki- ~ 73%. Conclusion The spindle cell metaplasia of breast is rare, the pathological morphology is diverse, the hormone receptor is not expressed and the myoepithelial marker can be expressed. Most patients have high Ki-67 index, poor prognosis, low axillary lymph node metastasis and distant metastasis. Strict norms drawn and immunohistochemical diagnosis and differential diagnosis.