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目的探讨乳腺腺样囊性癌(ACC)的临床病理特征、免疫表型和鉴别诊断。方法对3例乳腺ACC的临床病理资料进行回顾性分析,并复习相关文献。结果 3例乳腺ACC年龄分别为41、61和77岁,平均60岁。肿瘤最大径为2.5 cm、1.5 cm和3.5 cm。镜下:肿瘤由腺上皮细胞和肌上皮细胞组成,可见3种结构模式:筛状、管状-小梁状和实性结构。例1,2肿瘤呈筛状和管状-小梁状分布,未见实性结构,其中例1伴有导管内钙化;例2局灶筛状结构区域核分裂象2个/10HPF,肿瘤细胞侵犯神经;例3肿瘤大部分呈实性片状和巢状分布,伴有少量筛状和管状结构,细胞轻~中度异型,可见多灶坏死,核分裂象>10个/10HPF,周围间质透明变性。免疫组化:腺上皮细胞CK5/6、CK14、EGFR和CD117均(+),肌上皮细胞p63和SMA(+),而ER、PR和Her-2均(-),Ki-67阳性指数分别为5%、10%和25%。结论乳腺ACC少见,具有独特的病理学特点,诊断与鉴别诊断依靠病理形态学和免疫组化,预后较好。
Objective To investigate the clinicopathological features, immunophenotype and differential diagnosis of breast adenoid cystic carcinoma (ACC). Methods The clinicopathological data of 3 cases of breast adenocarcinoma were retrospectively analyzed and relevant literatures were reviewed. Results The ACC ages of the three cases were 41, 61 and 77 years old, with an average of 60 years. The maximum diameter of tumor was 2.5 cm, 1.5 cm and 3.5 cm. Microscopically, the tumor consisted of glandular epithelial cells and myoepithelial cells. Three types of structures were observed: sieve-like, tubular-trabecular and solid structures. Cases 1 and 2 tumors were filiform and tubular - trabecular distribution, no solid structure, including cases with intraductal calcification in Example 1; 2 focal sieve-like areas of mitosis as 2 / 10HPF, tumor cell invasion of nerves ; 3 most of the tumors were solid flaky and nested distribution, accompanied by a small amount of mesh-like and tubular structure, mild to moderate type of cells, showing multifocal necrosis, mitotic figures> 10 / 10HPF, peripheral interstitial degeneration . Immunohistochemical staining showed that the positive rates of CK5 / 6, CK14, EGFR and CD117 in glandular epithelial cells, p63 and SMA (+) in myoepithelial cells and the positive rates of ER, PR and Her-2 5%, 10% and 25%. Conclusions Breast ACC is rare and has unique pathological features. The diagnosis and differential diagnosis depend on pathomorphology and immunohistochemistry, and the prognosis is good.