乳腺富于脂质癌临床病理分析

Clinicopathological analysis of lipid-rich breast carcinoma

关键词:  乳腺癌  乳腺富于脂质癌  临床病理特征

Key words:  breast cancer  lipid-rich breast carcinoma  clinicopathological features

摘要:

目的　探讨乳腺富于脂质癌（lipid-rich carcinoma, LRC）的临床病理特征。 方法　总结2例乳腺LRC的病理形态和临床资料，患者均为女性，年龄分别为68岁和74岁。临床表现为乳腺实质内单发的无痛性肿块，均行乳腺改良根治切除术。用免疫组织化学方法和AB-PAS法鉴别诊断。结果　巨检示肿物与周围组织界限不清，切面灰白色，质地硬脆。光镜下肿瘤细胞呈巢状和片状生长，癌细胞体积较大，胞浆宽大呈空泡状和泡沫状，部分嗜酸性，细胞核圆形和卵圆形，核分裂像多见。导管内癌显示有异型性的泡沫样上皮细胞充满导管或取代单层的导管上皮。免疫表型上，2例肿瘤癌细胞ER、PR、HER-2、GCDFP-15、P53及S-100蛋白均阴性，Ki-67蛋白增殖指数均为30%，1例肿瘤细胞CK5/6阴性，另1例CK5/6部分阳性。AB-PAS染色显示肿瘤细胞均阴性。患者行乳腺改良根治术后进行了放疗和化疗，生存时间分别为35个月和40个月。结论　乳腺LRC恶性度高，患者预后较差。熟悉其病理特征和分子特点，避免误诊尤为重要。

Abstract:

Objective　To study the clinical and pathological features of lipid-rich breast carcinoma (LRC). 　Methods　Two LRC cases were reviewed. Both patients were females aged 68 and 74 years. The main clinical manifestation was single painless breast mass. Immunohistochemical staining and AB-PAS staining were used in differential diagnosis. 　Results　In both cases, solid and hard tumor was with not clear boundary and white section. Histologically, tumors were composed of nests and sheets of large cells. Cytoplasm were rich with vacuolated, foamy and eosinophilic changes. The nuclei were round and oval, and mitotic figure was often seen. Ductal carcinoma in situ showed epithelial cells with atypia with foamy cytoplasm filled with duct or replaced by single layer ductal epithelium. The tumor cells were negative for ER, PR, HER2, GCDFP-15, P53 and S-100. Proliferation index by Ki-67 was 30% in two cases. The tumor cells were negative for CK5/6 in the first case and partial positive for CK5/6 in the second case. AB-PAS staining were negative in two cases. The patients were treated with radiotherapy and chemotherapy after modified radical mastectomy. The survival time was 35 months and 40 months respectively. 　Conclusions　LRC is a rare type of breast cancer with high malignancy and poor prognosis. It was particularly important to learn its pathological features and molecular characteristics in order to avoid misdiagnosis.