【摘要】 目的探讨乳腺分泌性癌的临床病理特征、免疫组织化学表达和特殊染色特点及其生物学意义。方法分析3例乳腺分泌性癌的临床表现和病理特征;用黏液卡红(MC)和PAS/AB(Alcian blue)及淀粉酶消化后PAS/AB染色观察分泌物的性质,同时采用免疫组织化学ABC法检测ER、PR、Ki-67、p53、p63、c-erbB-2、S-100蛋白、CK7、SMA、CK1/3、EMA、CEA和CK34βE12在肿瘤细胞中的表达。结果乳腺分泌性癌仅占同期全部活检乳腺癌的0.36%,平均年龄48.7岁。病理形态学的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。某些病例可以出现印戒样细胞,柱状上皮被覆的腺样结构,及间质广泛透明变性,癌细胞萎缩消失后形成的胶原硬化瘢痕,提示其高分泌活性和相对惰性的生长方式。尽管ER、PR阴性或仅局灶性表达,但预后相关基因p53和c-erbB-2全阴性或仅偶见弱表达,另外,Ki-67反映的增殖指数仅为6.3%,可能同其相对良好的组织形态和较好的预后有关。淋巴结均未见转移。结论乳腺分泌性癌为一种少见的肿瘤,可发生于中老年女性,侵袭性和转移能力弱,预后良好。根据组织学表现,结合特染及免疫组化表达特点,可作出明确的病理诊断。更多还原

【Abstract】 Purpose To study the clinicopathological,immunohistochemical,and special staining features of breast secretory carcinoma(BSC),and to discuss the association of them with the biological behavior.Methods Three cases of breast secretory carcinoma were collected from the archival materials from 1988 to 2005 and analyzed with review of clinical data and H&E slides.Special staining of mucin carmine(MC),periodic-acid-Schiff reaction(PAS)with and without diastase pretreatment and Alcian blue(AB),immunohistochemical staining of ER,PR,Ki-67,p53,p63,c-erbB-2,S-100,CK7,SMA,CK1/3,EMA,CEA and CK34βE12 by ABC method were performed.Results BSC accounted for only 0.36%(3/842)of all breast carcinoma in the same period.The average age was 48.7 years with range of 38～59.They were characterized by mild atypia of carcinoma cells,prominent microcystic architecture and much secretory material in the cytoplasm and cysts positive for PAS,AB and mucin carmine staining.We also found that signet ring cell and some high columnar glandular pattern,as well as diffuse hyaline degeneration and collagen sclerotic scar formation after atrophy and disappearance of cancer cells,which suggested the characteristics of high secretion activity and relatively indolent growth pattern.Although negative or only focal positive reaction to ER,PR,the complete negative or only focal and mild positive to the prognosis associated genes of p53 and c-erbB-2,as well as the low proliferation index of 6.3% by Ki-67,it may be related to the relatively good histology and better prognosis.No positive lymphatic node was observed.Conclusions BSC is a rare tumor and may occur in middle-aged and old women.The aggressiveness and metastatic potential are relatively low and it therefore has better prognosis.By histological pattern,assisted by histochemical and immunohistochemical features,definite pathological diagnosis could be made.更多还原