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目的探讨乳腺髓样癌的组织病理学形态,免疫组化及其诊断和鉴别诊断。方法对12例乳腺髓样癌患者的临床组织病理学和免疫组化特征进行观察,并复习相关文献。结果 12例均为女性,年龄36~69岁(平均年龄51岁)。肿瘤直径1.2~5.1 cm。镜下肿瘤有推挤性边缘,界清。肿瘤细胞呈合体细胞生长方式,细胞间界限不清。细胞核呈圆形空泡状,有明显异型性。肿瘤缺乏间质成分,其背景有明显的淋巴浆细胞浸润。12例中同侧腋窝淋巴结阳性率为16.7%(2/12)。免疫组化检测雌激素受体(ER)阳性率、孕激素受体(PR)阳性率和HER-2、CK5/6、P53的阳性率分别为25.0%(3/12)、16.7%(2/12)和33.3%(4/12)、25.0%(3/12)、41.7%(5/12)。Ki-67(+50%~+60%)。结论乳腺髓样癌的预后较好,乳腺髓样癌是一种呈合体细胞生长方式、缺乏腺管结构、伴有明显淋巴浆细胞浸润、界限清楚的癌。
Objective To investigate the histopathological features, immunohistochemistry, diagnosis and differential diagnosis of medullary carcinoma of the breast. Methods The clinical histopathological and immunohistochemical features of 12 patients with medullary carcinoma were observed and reviewed. Results All 12 patients were female, aged 36-69 years (mean age 51 years). Tumor diameter 1.2 ~ 5.1 cm. Microscopic tumors have push edge, boundary clearance. Tumor cells showed a syncytial growth pattern with unclear intercellular boundaries. The nucleus was round vacuole, with obvious atypia. Tumor lack of interstitial components, the background of significant lymphocyte plasma infiltration. The positive rate of ipsilateral axillary lymph nodes was 16.7% (2/12) in 12 cases. The positive rate of estrogen receptor (ER), the positive rate of progesterone receptor (PR) and the positive rates of HER-2, CK5 / 6 and P53 were 25.0% (3/12) and 16.7% / 12) and 33.3% (4/12), 25.0% (3/12), 41.7% (5/12). Ki-67 (+ 50% ~ + 60%). Conclusions The prognosis of breast medullary carcinoma is better. The medullary carcinoma of the breast is a kind of cancer with syncytial growth pattern, lack of duct structure, obvious infiltration of lymphoplasmacytes and clear borderline.