乳腺分泌性癌15例临床病理特征及预后分析
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摘要
[目的]探讨乳腺分泌性癌的临床病理特征、免疫组织化学表达特点及临床预后。[方法]分析15例乳腺分泌性癌的临床表现及病理特征;采用PAS、D-PAS及阿辛蓝染色技术进行细胞分泌物染色,免疫组织化学检测ER、PR、c-erbB-2、Ki-67、p53、EGFR和CK5/6在肿瘤细胞中的表达,并对11例患者进行随访。[结果]乳腺分泌性癌平均年龄49岁,女性患者占93.3%。病理形态学主要特点为癌细胞异型性较小,出现微囊性结构,癌细胞能产生大量分泌物等,对PAS/AB及黏液卡红染色呈现阳性反应。20%患者伴有同侧腋窝淋巴结转移。中位随访38.5个月,未发现肿瘤复发转移和死亡病例。[结论]乳腺分泌性癌为一种罕见的肿瘤,具有明显的组织病理学特征,预后良好。
[Purpose] To analyze the clinicopathological features and prognosis of patients with secretory breast carcinoma(SBC).[Methods] Clinical data and pathological characteristics of 15 patients with breast secretory carcinoma were collected and analyzed. Special staining of mucin carmine(MC),periodic acid-Schiff reaction(PAS) with and without diastase pretreatment and Alcian blue(AB),immunohistochemical staining(ABC method) of ER,PR,c-erbB-2,Ki-67,p53,EGFR and CK5/6 were performed.Eleven patients were followed up after various treatment. [Results] The average age of SBC patients was 49 years,and 14 were women(93.3%). The histopathological characteristics were mild atypia in carcinoma cells,prominent microcystic architecture and large amount of secretion in the cytoplasm and cysts positive for PAS/AB and MC staining. Ipsilateral axillary lymph node metastasis was found in 20% of patients. The median follow-up was 38.5 months,and no tumor recurrence,metastasis or death was observed. [Conclusion] SBC is a rare tumor with typical histopathological features and a favorable prognosis.
[Purpose] To analyze the clinicopathological features and prognosis of patients with secretory breast carcinoma(SBC).[Methods] Clinical data and pathological characteristics of 15 patients with breast secretory carcinoma were collected and analyzed. Special staining of mucin carmine(MC),periodic acid-Schiff reaction(PAS) with and without diastase pretreatment and Alcian blue(AB),immunohistochemical staining(ABC method) of ER,PR,c-erbB-2,Ki-67,p53,EGFR and CK5/6 were performed.Eleven patients were followed up after various treatment. [Results] The average age of SBC patients was 49 years,and 14 were women(93.3%). The histopathological characteristics were mild atypia in carcinoma cells,prominent microcystic architecture and large amount of secretion in the cytoplasm and cysts positive for PAS/AB and MC staining. Ipsilateral axillary lymph node metastasis was found in 20% of patients. The median follow-up was 38.5 months,and no tumor recurrence,metastasis or death was observed. [Conclusion] SBC is a rare tumor with typical histopathological features and a favorable prognosis.
引文
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[2]Horowitz DP,Sharma CS,Connolly E,et al.Secretory carcinoma of the breast:results from the survival,epidemiology and end results database[J].Breast,2012,21(3):350-353.
[3]Noh WC,Paik NS,Cho KJ,et al.Breast mass in a 3-yearold girl:differentiation of secretory carcinoma versus abnormal thelarche by fine needle aspiration biopsy[J].Surgery,2005,137(1):109-110.
[4]Ghilli M,Mariniello MD,Scatena C,et al.Male secretory breast cancer:case in a 6-year-old boy with a peculiar gene duplication and review of the literature[J].Breast Cancer Res Treat,2018,170(3):445-454.
[5]Vasudev P,Onuma K.Secretory breast carcinoma:unique,triple-negative carcinoma with a favorable prognosis and characteristic molecular expression[J].Arch Pathol Lab Med,2011,135(12):1606-1610.
[6]Cadoo KA,Mc Ardle O,O'Shea AM,et al.Management of unusual histological types of breast cancer[J].Oncologist,2012,17(9):1135-1145.
[7]Paeng MH,Choi HY,Sung SH,et al.Secretory carcinoma of the breast[J].J Clin Ultrasound,2003,31(8):425-429.
[8]Benabu JC,Stoll F,Koch A,et al.De-escalating systemic therapy in triple negative breast cancer:the example of secretory carcinoma[J].J Gynecol Obstet Hum Reprod,2018,47(4):163-165.
[9]Lambros MB,Tan DS,Jones RL,et al.Genomic profile of a secretory breast cancer with an ETV6-NTRK3 duplication[J].J Clin Pathol,2009,62(7):604-612.
[10]Liu XL,Chen H,Wang Q,et al.Secretory carcinoma of the breast:clinical histopathologic and biological behaviors[J].Zhonghua Yi Xue Za Zhi,2018,98(30):2434-2437.
[11]Landman Y,Ilouze M,Neiman V,et al.Rapid response to larotrectinib(LOXO-101)in an adult chemotherapy-naive patients with advanced triple-negative secretory breast cancer expressing ETV6-NTRK3 fusion[J].Clin Breast Cancer,2018,18(3):267-270.
[12]Sato T,Iwasaki A,Iwama T,et al.A rare case of extensive ductal carcinoma in situ of the breast with secretory features[J].Rare Tumors,2012,4(4):e52.
[13]Jacob JD,Hodge C,Franko J,et al.Rare breast cancer:246 invasive secretory carcinomas from the National Cancer Data Base[J].J Surg Oncol,2016,113(7):721-725.
[14]Lombardi A,Maggi S,Bersigotti L,et al.Secretory breast cancer:case report[J].G Chir,2013,34(4):125-127.
[15]Richard G,Hawk JC,Baker AS,et al.Multicentric adult secretory breast carcinoma:DNA flow cytometric findings,prognostic features,and review of the world literature(review)[J].J Surg Oncol,1990,44(4):238-244.
[16]Pohlodek K,Me ciarováI,Grossmann P,et al.Secretory carcinoma of the breast:a case report[J].Int J Surg Case Rep,2019,56:74-77.
[17]Herz H,Cooke B,Goldstein D.Metastatic secretory breast cancer.non-responsiveness to chemotherapy:case report and review of the literature[J].Ann Oncol,2000,11(10):1343-1347.
[18]Din NU,Idrees R,Fatima S,et al.Secretory carcinoma of breast:clinicopathologic study of 8 cases[J].Ann Diagn Pathol,2013,17(1):54-57.
[19]Sharma V,Anuragi G,Singh S,et al.Secretory carcinoma of the breast:report of two cases and review of the literature[J].Case Rep Oncol Med,2015,2015:581892.
[20]Lian J,Wang XJ,Xu EW,et al.Secretory breast carcinoma with liver metastatic:report of a case[J].Zhonghua Bing Li Xue Za Zhi,2017,46(2):124-125.