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目的探讨伴有浸润性微乳头状癌(IMPC)结构乳腺癌的临床病理特征及其诊断和鉴别诊断。方法复习1997年至2007年间乳腺癌存档切片,对其中按2003年WHO乳腺病理学标准诊断含有IMPC结构乳腺癌8例的临床病理资料进行分析。结果8例伴有IMPC结构的乳腺癌无特殊的临床症状及体征,常与浸润性导管癌伴存,其淋巴结转移阳性率73.6%,明显高于浸润性导管癌。组织病理学的特征表现为:肿瘤细胞聚集呈微乳头状癌巢,或呈桑椹状、小腺管样,位于人工间隙内呈中空簇状生长,微乳头缺乏纤维血管轴心。免疫组织化学特点:上皮膜抗原(EMA)着色于细胞团的外表面,而细胞间无着色呈“反极”染色现象,部分瘤细胞可以表达雌激素受体(ER)、孕激素受体(PR)、C-erbB-2。结论伴有IMPC结构的乳腺癌是一种预后较差的恶性肿瘤,具有淋巴管侵袭性强、淋巴结转移率高的特点,无论肿瘤中IMPC结构比例占多少,均应引起重视。诊断时应与乳腺浸润性乳头状癌、黏液腺癌、转移性乳头状癌等相鉴别。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of breast cancer with invasive micro-papillary carcinoma (IMPC). Methods The archives of breast cancer from 1997 to 2007 were reviewed and the clinicopathological data of 8 breast cancer patients with IMPC diagnosed according to the WHO Breast Pathology Standard 2003 were analyzed. Results Eight cases of breast cancer with IMPC had no specific clinical symptoms and signs, often associated with invasive ductal carcinoma. The positive rate of lymph node metastasis was 73.6%, which was significantly higher than that of invasive ductal carcinoma. The histopathological features were as follows: the tumor cells aggregated into micro-papillary neoplasia, or mulberry-like and small gland-like, with hollow clusters growing in the artificial gap, and the micro-nipple lacked the axis of the fibrovascular. Immunohistochemical features: epithelial membrane antigen (EMA) staining on the outer surface of the cell mass, and no intracellular staining was “reverse polarity ” staining phenomenon, part of the tumor cells can express estrogen receptor (ER), progesterone Body (PR), C-erbB-2. Conclusions Breast cancer with IMPC structure is a malignant tumor with poor prognosis. It has the characteristics of strong lymphatic invasion and high lymph node metastasis rate. No matter what proportion of IMPC structure in tumors should be taken seriously. Diagnosis should be breast invasive papillary carcinoma, mucinous adenocarcinoma, metastatic papillary carcinoma phase identification.