乳腺大汗腺癌临床和病理学特征研究

目的：探讨乳腺大汗腺癌（AC）的临床和病理学特征。方法：筛选出的8例乳腺大汗腺癌进行临床病理分析，采用过碘酸雪夫（PAS）、阿辛蓝（AB）染色及免疫组织化学A-P法检测GCDFP-15、Mucin-1、Ki-67、雄激素受体（Androgen receptor，AR）、雌激素受体（estrogen receptor，ER）、C-erbB-2。结果：8例均发生于中老年女性，因发现乳房包块就诊。组织学8例均为高级核，其中大汗腺导管原位癌（ADCIS）1例， ADCIS伴浸润性大汗腺癌（IAC）5例，IAC伴非大汗腺型DCIS灶2例。镜下主要有2种形态：A型，胞质嗜伊红染的粗颗粒状；B型，胞质淡染，呈细粉尘颗粒状，如毛玻璃样。8例AC的PAS染色阳性，AB染色在ADCIS阴性，在IAC可有50%细胞阳性，并同时表达GCDPF-15，AR，Mucin-1及Ki-67；除1例外，ER均不表达。结论：乳腺大汗腺癌的临床表现和大体形态与非乳腺大汗腺癌相似，多发生于单侧并且多数伴有同侧腋窝淋巴结转移，预后较好。其诊断主要依靠病理：（1）特征性的AC型细胞；（2）GCDPF-15阳性率高；（3） AR阳性率高，ER阳性率低。

Clinic and Pathological Study of Apocrine Carcinoma of Breast

To investigate the clinicopathological features and the immunohistochemica phenotype of apocrine carcinoma（AC）of breast. Method：The clinical and pathologic features of 8 cases with AC in breast were investigated. Periodic-acid-Schiff（PAS）,alcian-blue staining were performed. The immunohistochemical study was performed by a panel of antibodies including gross cystic disease fluid protein 15（GCDFP-15）,Mucin-1,AR,ER, c-erb-2 and Ki-67. Result：All 8 cases occurred in middle to old age female patients,complaining of mass in breast. Histologically,8 cases of apocrine carcinomas with high nuclear grade were confirmed,including 1 ADCIS,5ADCIS with IAC and 2 IAC. Two types of AC cells were noted according to the morphologic of cytoplasm：A type,neoplastic cells with copious,granular eosinophilic cytoplasm;B type,carcinoma cells with finely granular pale cytoplasm,like frosting glass. AC cells of 8 cases showed positivity for PAS,AB was negative in ADCIS and 50%positivity in IAC. 8 cases expressed GCDFP-15,AR,Mucin-1,Ki-67,all but 1 case was negative for ER. Conclusions：The clinic features of AC is similar to non-AC,frequency in unilateral and lymph node metastases in ipsilateral armpit,same prognosis with other types of breast carcinoma. Diagnosis of AC mainly depend on pathology：（1）Morphologicly,cells possessed of apocrine carcinoma features. （2）The positivity rate of GCDFP-15 is high.（3）The positivity rate of AR is high but low incident rate of positive ER.