摘要
目的观察乳腺导管内乳头状肿瘤（intraductal papillary neoplasms，IDPN）的形态学和免疫表型特征，并探讨其诊断。方法根据WHO分类（2003）和Tavassoli等（1999、2003）有关标准，筛选出乳腺导管内乳头状肿瘤41例，对上述病例进行HE形态观察和免疫组化检测，选用的一抗有CK5、CK34βE12、CK8、CD34、SMA、p63、CD10。结果（1）导管内乳头状瘤19例，镜检为扩张的导管或小管内含纤维-脉管轴心的乳头状病变，由腺（系）上皮和肌上皮覆盖轴心形成双层构型。其中16例伴腺（系）上皮普通性增生，2例〈10％的乳头覆盖上皮呈不典型增生（AH）改变。腺（系）上皮CK5 17例（89．5％）中～强阳性；CK34βE1216例（84．2％）中～强阳性。肌上皮SMA、p63、CD10均阳性。（2）非典犁导管内乳头状瘤4例，3例伴发于囊内乳头状癌，1例作为主要诊断。表现为≥10％而〈90％的乳头覆盖上皮呈AH改变。其AH区域CK5均阴性，3例CK34βE12阴性～弱阳性。（3）导管内乳头状癌21例，其中①2例仅表现为≥90％的乳头区肌上皮层完全缺乏；②1例仪表现为〉90％的乳头覆盖上皮呈低级导管原位癌（DCIS）样改变；③8例兼具上两种特征；④10例乳头覆盖上皮呈中～高级别DCIS样改变。符合②及③者CK5均阴性，CK34βE12 6例（66．7％）阴性～弱阳性；符合④者CK5、CK34βE12 8例（80％）均阴性～弱阳性。结论IDPN是一组良恶性不同的病变，各自的HE形态和免疫表型均有差异，应采用HE形态和免疫组化相结合的综合标准进行诊断。
Purpose To investigate the morphologic and immunophenotypic characteristics of intraductal papillary, neoplasms（1DPN） of the breast and explore the diagnosis criteria. Methods 41 cases of IDPN of the breast were observed with stains of hematoxylin eosin stain and studied by immunohistochemical method. Results （ 1 ） 19 cases of intraductal papilloma were confirmed as principal disease. They were characterized by an papillary, structure composed of fibrovascular stalks coverd by a layer of myoepithelial cells with overlying glandular epithelial cells within a distended duct or ductule. 16 of the 19 cases displayed usual epithelial hyperplasia,and 2 cases displayed less than 10% of the papillary processes with atypical epithelial hyperplasia. Glandular epithelial cells were moderate to strong positive for CK5 in 17 cases （89. 5% ）, and for CK34βE12 in 16 eases（ 84. 2% ）. Myoepithelial cells were positive for SMA, p63, CD10. （2） 4 cases of atypical intraductal papilloma were confirmed. 3 of the 4 cases were confirmed as concomitant disease and I ease was confirmed as prineipal disease. They displayed at least 10% but less than 90% of the papillary processes with atypical epithelial hyperplasia. The epithelial cells with atypical hyperplasia were negative for CK5 in all ,and negative to weakly positive for CK34βE12 in 3 cases. （3） 21 cases of intraductal papillary carcinoma（IDPC） were confirmed. ① Bland IDPC were characterized by 90% or more of the papillary processes were totally devoid of a myoepithelial cell layer in 2 of the 21 cases. ②Low grade IDPC occupied more than 90% of the lesion in 1 case. ③ 8 eases were characterized by both devoid of a myoepithelial cell layer and low grade. ④ 10 cases displayed moderate to high grade IDPC. Immunohistochemically,in the cases of ② and ③, CK5 was negative in all, and CK34βE12 was negative to weakly positive in 6 cases （66. 7% ）. In the cases of ④, CK5 and CK34βE12 were negative to weakly positive in 8 cases （ 80% ）. Con
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2006年第5期520-525,530,共7页
Chinese Journal of Clinical and Experimental Pathology
关键词
乳腺肿瘤/病理学
导管内乳头状肿瘤
免疫组织化学
breast neoplasms/pathology
intraductal papillary neoplasms
morphologic
immunohistochemistry
