上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2013, Vol. 33 ›› Issue (6): 818-.doi: 10.3969/j.issn.1674-8115.2013.06.024

• 论著（临床研究） • 上一篇    下一篇

乳腺包膜内乳头状癌和乳腺导管原位癌的超声图像和病理特征分析

余燕民1，吕 珏2*，汪 成1，徐 明3，包家林1   

  1. 上海市黄浦区中心医院 1.乳腺外科； 2.超声科； 3.病理科， 上海 200002
  • 出版日期:2013-06-28 发布日期:2013-06-28
  • 通讯作者: 包家林, 电子信箱: huangpuruxian@gmail.com。
  • 作者简介:余燕民（1975—）， 女， 主治医师， 硕士; 电子信箱: yuyanmin75@126.com; 吕珏（1971—）， 女， 主治医师， 学士; 电子信箱: lv.jue@hotmail.com。*为共同第一作者。
  • 基金资助:

    上海市医学重点专科建设项目（ZK2012A13）

Ultrasonic imaging and pathological features of encapsulated papillary carcinoma and ductal carcinoma in situ of breast

YU Yan-min1, LV Jue2*, WANG Cheng1, XU Ming3, BAO Jia-lin1   

  1. 1.Department of Breast Surgery； 2.Department of Ultrasound； 3.Department of Pathology， Huangpu Central Hospital of Shanghai, Shanghai 200002， China
  • Online:2013-06-28 Published:2013-06-28
  • Supported by:

    Shanghai Key Medical Specialties Foundation, ZK2012A13

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摘要：

目的 研究乳腺包膜内乳头状癌和乳腺导管原位癌的超声图像和病理特征。方法 回顾性分析7例乳腺包膜内乳头状癌和12例乳腺导管原位癌患者的资料，所有病例术前超声检查结果资料完整。采用HE染色观察肿瘤组织的病理学改变，免疫组织化学法检测雌激素受体（ER）、孕激素受体（PR）以及p53、Ki67、p63、CerbB-2蛋白的表达。结果 超声图像观察显示：乳腺包膜内乳头状癌组织形态不规则，边缘毛糙，内部回声为混合性回声，无回声区中见强回声，呈乳头状突起，后方回声增强，未见钙化灶，可见血流信号；乳腺导管原位癌组织中可见导管扩张或扩张的导管内见低回声，形态不规则，边缘毛糙，后方回声未增强，可见钙化灶和血流信号。HE染色后显微镜下显示：乳腺包膜内乳头状癌组织中可见纤细的纤维血管轴心，衬覆的肿瘤上皮细胞核为低或中等级别，外裹纤维囊；乳腺导管原位癌组织中可见上皮细胞呈肿瘤性增生和异型，其中乳头型乳腺导管原位癌组织中可见纤细的纤维血管轴心，无纤维囊。免疫组织化学检测显示：乳腺包膜内乳头状癌组织的上皮细胞中ER和PR均呈强阳性表达，p53、Ki67和CerbB2均呈阴性或弱阳性表达，乳头内和病变周围肌上皮细胞中p63均呈阴性表达；乳腺导管原位癌的乳头内肌上皮细胞中p63呈阴性表达，而病变周围肌上皮细胞中p63呈阳性表达。结论 超声图像和病理学独特表现为乳腺包膜内乳头状癌和乳腺导管原位癌的诊断提供了帮助。

关键词: 乳腺肿瘤, 乳头状癌, 乳腺导管原位癌, 超声, 病理学

Abstract:

Objective To investigate the ultrasonic imaging and pathological features of encapsulated papillary carcinoma and ductal carcinoma in situ of breast. Methods The clinical data of 7 cases of encapsulated papillary carcinoma and 12 cases of ductal carcinoma in situ were retrospectively analysed, and there were preoperative ultrasonic findings and images for all cases. The pathological features of tumor tissues were observed with HE staining, and the expression of estrogen receptor (ER), progesterone receptor (PR), p53, Ki67, p63 and CerbB-2 protein was detected by immunohistochemical method. Results The ultrasonic findings of encapsulated papillary carcinoma indicated that the masses were in irregular shape with unclear boundaries; internal echo was mixed echo; in case of no echo, high echo was found with papillae, and rear echo was enhanced; calcification was not found; and blood flow signals were visible around the tumor. The ultrasonic findings of ductal carcinoma in situ indicated that there was mammary duct ectasia; low echo was in the mammary duct ectasia, with irregular shape, unclear boundaries and no enhancement in the rear echo; calcification was found; and blood flow signals were visible around the tumor. Light microscopy with HE staining indicated that in encapsulated papillary carcinoma, fine fibrovascular cores were found, and neoplastic epithelial cells were of low or intermediate nuclear grades surrounded by a fibrous capsule. And in ductal carcinoma in situ, there was neoplastic proliferation cytological atypia of epithelial cells, and fibrovascular cores with no fibrous capsule were found in the nipple type ductal carcinoma in situ. Immunohistochemical detection revealed that in encapsulated papillary carcinoma, there was significantly positive expression of ER and PR and negative or weakly positive expression of p53, Ki67 and CerbB-2 in epithelial cells, and p63 was negative in myoepithelial cell layer within the papillae or at the periphery of the lesion. And in ductal carcinoma in situ, p63 was negative in myoepithelial cells within the papillae, but was positive in the cells at the periphery of the lesion. ConclusionThe unique ultrasonic imaging and pathological features are helpful in the diagnosis of encapsulated papillary carcinoma and ductal carcinoma in situ of breast.

Key words: tumor of breast, papillary carcinoma, ductal carcinoma in situ, ultrasonography, pathology