摘要
目的探讨伴有上皮成分恶变的乳腺叶状肿瘤(PTs)临床病理学特征,提高对该病的诊治水平。方法报道5例伴有上皮成分恶变的乳腺PTs,采用SMA、vimentin、CD34、bcl-2、Ki-67、ER、PR、CK5、p63、E-cadherin和p120等抗体进行免疫组化染色,并复习文献。结果 5例伴上皮成分恶变的PTs均为女性,年龄26~58岁(中位年龄53岁),均以原有肿物短期内迅速增大而手术治疗。镜下表现为纤维上皮性肿瘤,上皮成分恶变为低级别导管原位癌(DCIS)3例,低级别导管原位癌及小叶原位癌(DCIS和LCIS)1例,小叶原位癌及浸润性小叶癌(LCIS和ILC)1例;间质成分为良性PTs 2例,交界性PTs 3例。免疫组化示恶变的上皮成分弥漫ER、PR(+),DCIS显示Ecadherin、p120膜(+),CK5(-);LCIS显示p120浆(+),E-cadherin(-)。PTs间质成分SMA和CD34均(+),2例bcl-2(+)。随访4~72个月,均未见复发及转移。结论伴上皮成分恶变的乳腺PTs罕见,癌的免疫组化表达与普通型乳腺癌一样,但PTs内癌的预后稍好,目前尚无标准治疗方案。
Objective To investigate the clinicopathological features of the carcinoma arising in phyllode tumors of the breast. Methods Morphological observation and immunohistochemistry using Envision method were performed on 5 cases of carcinoma arising in phyllodes tumors of the breast from January 2000 to may 2017. Results All 5 patients were female,aged 26 ~ 58 years（median age 53）,and all the masses increased rapidly in short time. 2 cases arose from benign phyllode tumors including DCIS,LCIS and ILC; 3 DCIS arose from borderline phyllode tumors. Immunohistochemistry showed all malignant epithelial components were diffusely positive for ER and PR,and DCIS was positive for p120 and Ecadherin,LCIS was positive for p120 and negative for E-cadherin; mesenchymal component all expressed CD34 and 2 cases were also Bcl-2 positive. All patients were alive without recurrence and metastasis followed by 4 ~ 72 months.Conclusion Carcinoma arising from phyllode tumors of the breast is rare and characterized by in situ and invasive carcinoma in a background of phyllode tumor of the breast. The immunohistochemical features of malignant epithelial component are similar to ordinary breast cancer,but with better prognosis. Because of its rarity,there is no standardized treatment prescription for this disease.
作者
崔力方
张继新
昌红
赵宏禹
李曌
曲从玲
钟定荣
CUI Li-fang;ZHANG Ji-xin;CHANG Hong;ZHAO Hong-yu;LI Zhao;Qu Li-ling;ZHONG Ding-rong(Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100028, China;Department of Pathology, Peking University First Hospital, Beijin9 100034, China;Department of Pathology, Peking Union Medical Hospital, Chinese Academy of Medical Science, Beijing 100730, China)
出处
《诊断病理学杂志》
2018年第1期12-16,共5页
Chinese Journal of Diagnostic Pathology
关键词
乳腺癌
叶状肿瘤
恶变
Breast cancer
Phyllode tumor
Malignant transformation
