摘要目的 探讨乳腺以微乳头状结构为特点的单纯型黏液癌的临床病理特点.方法 收集26例以微乳头状结构为特点的乳腺单纯型黏液癌患者的临床病理资料,对组织形态、免疫表型及临床情况进行分析.结果 26例患者的发病年龄30～ 77岁,其中资料完整的12例平均年龄54岁,肿物最大径0.8 ～ 9.0 cm,平均3.2 cm,淋巴结转移3例,皮肤浸润2例.组织形态与浸润性微乳头状癌类似,上皮细胞膜抗原细胞外缘阳性,微乳头与间质的空隙内充填数量不等的黏液.不同病例的癌细胞具有不同的核级,19例具有低级别核,2例具有中级别核,5例具有高级别核;22例以大微乳头为主,4例以小微乳头为主.12例周围可见导管内癌;8例出现钙化及沙砾体.免疫表型具有激素受体高表达、HER2阴性的特点;Ki-67阳性指数为1％ ～ 70％;6例伴有神经内分泌分化.结论 乳腺具有微乳头状结构的单纯型黏液癌多发生在较年轻的女性,其侵袭性较普通的单纯型黏液癌可能要强,至少是具有高级别核的病例如此,应该将其从普通型的单纯型黏液癌中区分出来,以免贻误治疗.

abstractsObjective To study the clinicopathologic features of pure mucinous carcinomas of the breast with diffuse micropapillary pattern.Methods Twenty-six cases of micropapillary variant of pure mucinous carcinoma of the breast were retrospectively reviewed by light microscopy,immunohistochemistry and clinical data analyses.Results The age of 26 female patients ranged from 30 to 77 years old,of which 12 cases with clinical details available were mean 54 years old.The tumor diameter ranged from 0.8 to 9.0 cm (mean 3.2 cm).Ipsilateral axillary nodal metastases were identified in 3 cases.Cutaneous involvement was also found in 2 cases.The tumor cells showed the similar architectural arrangement as in invasive micropapillary carcinoma,with peripheral borders of the cell clusters highlighted by epithelial membrane antigcn.Various amount of mucin occupied the retraction spaces around the tumor cells.Compared with conventional pure mucinous careinoma of the breast,mucinous carcinomas with micropapillary pattern showed different nuclear grades (19 cases of grade Ⅰ,2 cases of grade Ⅱ,5 cases of grade Ⅲ).The micropapillary cell clusters varied in size (22 cases of big micropapillary and 4 cases of small).Intraductal carcinoma was observed in 12 cases.Calcification and psammoma bodies were observed in 8 cases.Immunophenotyping,the tumor cells were with higher expression of hormonc rcccptors,but HER2 were negative.Ki-67 positive index was 1％ ～ 70％.Neuroendocrine differentiation was observed in 6 cases.ConcLusions The micropapillary variant of pure mucinous carcinoma of the breast,which mainly occurs in younger women,may carry the similar propensity for angioinvasion and nodal metastasis as infiltrating micropapillary carcinoma at least in cases with high nuclear grade.This morphologic subtype needs to be distinguished from conventional pure mucinous carcinoma of the breast and treated properly.