摘要目的 观察基底细胞样型浸润性乳腺癌的形态特点,为该类型癌的诊断提供依据.方法 收集109例乳腺浸润性导管癌存档蜡块,用单克隆抗体CK56、CK14、CK818、CK34βE12、calponin、p63、CD10、ER、PR和c-erbB-2进行免疫组织化学Max VisionTM法染色,按照免疫表型将本组分为5种类型:腺腔A型(ER+HER2-),腺腔B型(ER+HER2+),正常乳腺样型(ER-HER2-),HER2过表达型和基底细胞样型(至少表达一种基底细胞角蛋白和(或)肌上皮标记物,且ER-HER2-).重点观察基底细胞样型的组织形态表现.结果 腺腔A型48例(44.0%),腺腔B型15例(13.8%),HER2过表达型15例(13.8%),正常乳腺型10例(9.2%),基底细胞样型19例(17.4%).2例除肌上皮标记物外,还同时表达c-erbB-2和(或)ER,组织类型暂未定.在19例基底细胞样型中有16例表达CK56,17例表达CK818,11例表达CK14,18例表达CK34βE12,5例表达p63,6例表达CD10,1例表达calponin.肿瘤直径1.2～7.0 cm(平均3.9 cm);其中＞5 cm者6例.除1例病变以高级别导管内癌为主外,组织学分级为2级者9例,3级者9例,与非基底细胞样型相比3级者显著增多(P＜0.01).基底细胞样型主要组织形态表现包括:13例癌组织呈单纯推挤性(膨胀性)生长,各例边缘均可见到淋巴细胞,18例肿瘤以巢状和(或)片状排列为主,17例核分级为3级,并可见到散在巨核和(或)怪核细胞,7例呈合体细胞样生长,17例有粉刺样坏死,上述形态出现率与非基底细胞样癌比较均显著增多(P＜0.01).结论 基底细胞样型浸润性乳腺癌最有诊断性价值的形态特点是推挤性浸润边缘、周边有显著的淋巴组织、粉刺样坏死、散在巨怪细胞、大巢或片状组织结构和呈合体细胞样生长.

abstractsObjective To summarize the morphological features of basal-like subtype of invasive breast carcinoma(BLSIBC),and to look for diagnostic clues for its recognition.Methods Immunohistochemistry was performed in 109 cases of invasive ductal carcinoma,with CK56,CK14,CK818,34βE12,calponin,p63,CD10,ER,PR and c-erbB-2 monoclonal antibodies.Five subtypes were classified according to immunophenotypes:luminal A subtype(ER+HER2-),luminal B subtype(ER+HER2+).normal breast-like subtype(ER-HER2-),HER2-overexpressing subtype and BLSIBC which was identified with at least one kind of basal-like cytokeratins or markers of myoepithelium and ER-HER2-.The microscopic features of basal-like subtype were also analyzed.Results The number of luminal A case was 48(44.0%),luminal B 15(13.8%),HER2 over-expressing 15(13.6%),normal breast-like 10 ( 9.1%).basal-like subtype 19(17.4%).Besides,the other two cases expressed c-erbB-2 orand ER plus markers for myoepithelium.thus were excluded from all the five mentioned subtypes.Of the 19 basal-like subtype.CK56 was expressed in 16 cases,CK818 in 17 cases,CK14 in 11 cases,34βE12 in 18 cases,p63 in 5 cases,CD10 in 6 cases,and calponin in 1 case.The diameter of the BLSIBC cases was 1.2-7 cm (averagely 3.9 cm),and in 6 cases,the tumor diameter was 5 cm.Only one case displayed extensive in situ component,9 cases were grade 2,and 9 cases were grade 3.Compared to non basal subtype,there were significantly more high grade cases(P＜0.01).The morphological features of basal-like subtype were summarized as the followings:pushing margin(13 cases),lymphocytic tissue hyperplasia(18 cases),nest or sheet arrangement(18 cases),nucleus grade 3 and scattered giant or bizarre nuclei(17 cases),syncytial growth(7 cases),and comedo-like necrosis(17 cases).The frequency of these features were significantly more common than non basal subtype(P＜0.01).Conclusion The morphologic diagnostic features of BLSIBC are pushing margins,lymphocyte infiltration,comedo-like necrosis,gigantic cell and syncytial growth.