论文部分内容阅读
目的对乳腺神经内分泌型导管内癌(E-DCIS)的临床病理特点、预后和鉴别诊断进行探讨。方法用光镜、免疫组织化学 EnVision 法行嗜铬素 A、突触素和神经元特异性烯醇化酶(NSE)染色和消化 PAS、消化阿辛蓝和嗜银染色,对18例具有 E-DCIS 特征的乳腺癌进行观察。结果具有E-DCIS 特征的乳腺癌具有以下特点:(1)好发于老年女性,平均年龄71岁。最常见的临床症状为乳腺肿块或乳头溢液。(2)E-DCIS 呈导管内肿瘤细胞的膨胀性生长,在肿瘤周边常可见导管内乳头状瘤。(3)肿瘤细胞呈多边形,卵圆形或梭形,胞质丰富,嗜酸性或细颗粒状。细胞核往往只有轻～中度异型,消化 PAS 或 AB 染色显示细胞内或细胞外存在黏液,有些肿瘤细胞呈印戒细胞样。(4)>50%的肿瘤细胞表达嗜铬素 A、突触素和 NSE 中的至少两种,部分病例 CD56和 CD57染色阳性。(5)E-DCIS 中常可见到肿瘤细胞向邻近导管的派杰样扩散,且在膨胀性生长的导管内不存在肌上皮成分。这两点有助于 E-DCIS 与导管上皮增生的鉴别。结论 E-DCIS 是一种低度恶性的乳腺导管内癌,有其独特的组织形态、免疫组织化学特征,应作为一种独立的导管内癌类型加以认识。
Objective To investigate the clinicopathological features, prognosis and differential diagnosis of intracranial endocrine ductal carcinoma (E-DCIS). Methods Enzyme immunohistochemistry was used to stain and digest PAS with chromogranin A, synaptophysin and neuron-specific enolase (NSE). Alcian blue and argyrophilic silver staining were performed on 18 patients with E- DCIS features of breast cancer were observed. Results E-DCIS features of breast cancer has the following characteristics: (1) occurs in older women, with an average age of 71 years. The most common clinical symptoms are breast lumps or nipple discharges. (2) E-DCIS was intumescent intratumoral expansion of tumor cells, often visible in the periphery of the tumor of intraductal papilloma. (3) tumor cells were polygonal, oval or fusiform, rich cytoplasm, eosinophilic or fine granular. The nucleus often only mild to moderately shaped, digestive PAS or AB staining showed intracellular or extracellular mucus, some tumor cells were signet ring-like. (4)> 50% of tumor cells express at least two of chromogranin A, synaptophysin and NSE, and some cases are positive for CD56 and CD57 staining. (5) Pegasi-like proliferation of tumor cells to nearby catheters can often be seen in E-DCIS, and there is no myoepithelial component in the expansive duct. These two points contribute to the identification of E-DCIS and ductal epithelial hyperplasia. Conclusion E-DCIS is a low-grade intraductal carcinoma with its unique histological and immunohistochemical characteristics, which should be recognized as an independent type of intraductal carcinoma.