Solid Papillary Carcinoma Clinicopathological Features And Immunophenotypic Study Of The Characteristics Of The Breast

The pathological diagnosis of papillary tumors has been one of the difficulties of breast pathology, Its definition, classification and diagnostic criteria for benign and malignant lesions of the inconsistency, as well as the mutual understanding of misdiagnosis led to its complexity.1995, Maluf, etc. A new papillary tumor types:solid papillary carcinoma. Solid papillary carcinoma has four distinct pathological features:intraductal tumor, physical nature of the nipple, often associated with mucus secretion and neuroendocrine differentiation.So far, apart from a very small number of early and normal breast tissue are reported in the literature of neuroendocrine cells, normal breast tissue of the neuro-endocrine function has not yet been recognized.Solid papillary carcinoma in 2003, WHO on "breast and female reproductive system tumors pathology and genetics"category called "intraductal papillary carcinoma of the entity change-type"The current solid papillary carcinoma of the relevant research are fewer and their immune phenotype, biological behavior and molecular genetics has yet to be fully aware of. More importantly, solid papillary carcinoma in benign and very difficult to determine the nature of evil, resulting in the clinical treatment of patients varies. In addition, breast pathology in the emergence of some new immunohistochemical markers, they are solid papillary carcinoma in the expression and diagnostic value has not been retrieved relevant reports.The topic of the 73 cases of solid papillary carcinoma of breast clinical pathological analysis and immunohistochemical staining, transmission electron microscopy, fluorescence in situ hybridization, a better understanding of mammary gland solid papillary carcinoma clinical and pathological features of the immunephenotype of features to aid diagnosis, and through follow-up in-depth understanding of solid papillary breast cancer biological behavior and prognosis.The results are as follow:1. Predilection of this disease in older women, average age of onset 64.7 years. The most common clinical symptoms of cancer of breast lumps and nipple discharge. Axillary lymph node dissection in 43 cases of metastasis,31 were detected.2. Microscopic examination:All specimens are seeing solid papillary lesions,43 patients had invasive carcinoma, including 25 cases of neuroendocrine carcinoma and concurrent mucinous carcinoma,18 cases occurred only neuroendocrine carcinoma,6 cases of micro-invasive carcinoma,2 of them concurrent mucinous carcinoma and neuroendocrine carcinoma,4 cases of neuroendocrine tumors only appeared. Can frequently be accompanied by the classic peripheral intraductal papilloma.Tumor cells were polygonal, oval or spindle-shaped, showing signet-ring-like. Abundant cytoplasm and showed eosinophilic or finely granular. Shaped nuclei with mild or moderate,51 cases of mitotic figures<5/10 HPF.3. Immunohistochemistry:tumor cells cytokeratin (CK34βE12, CK5/6) was negative.Smooth muscle actin, P63 in the epithelium of the nipple-axis myocardial positive rates were 91.8%, 67.1% in the muscle around the duct epithelium positive rates were 91.8%,73.9.Chromogranin A, and synaptophysin, and neuron-specific enolase positive rates were 89.0%,86.3%, 95.9%.The average Ki-67 positive index was 10.2%.73 routine estrogen receptor, progesterone receptor stained positive for the majority of tumors, Her-2 most of the negative.4. fluorescence in situ hybridization:Immunohistochemistry for the three cases the results of Her-2 was weakly positive expression(+)cases and further fluorescence in situ hybridization(FISH) test,the results were negative; to three cases the results of immunohistochemical staining expression of Her-2 positive(++)cases and further fluorescence in situ hybridization (FISH) test, and the results were positive.5.TEM observation:three neuroendocrine markers were positive breast solid papillary carcinoma(Solid Papillary Carcinoma,SPC)can be seen within the cytoplasm of tumor cells of two differentforms of sporadic high electron density of the neurosecretory granules6.Follow:The patients,68 cases (93%) received follow-up data, follow-up time of 12 to 63months (average 28 months). The results showed that:66 patients were disease-free survival, no tumor recurrence or metastasis. One cases of patients with left breast after modified radical mastectomy 25 months was diagnosed with breast cancer right lobe of liver metastasis.Bank survival after resection of metastases present. Another simple one cases of patients with left breast 36 months after resection of bone scan showed "the first lumbar vertebra 4,5 cancer metastasis occurs"currently receiving radiation treatment and "band tumor" survival so far. 7. The patients in groups according to age of onset, Ki-67 positive expression rates in the> 50-year-old age group (positive expression rate of 23.1%) lower than the< 50-year-old age group (positive expression rate was 25.0%). Grouped according to tumor size, diameter>2 cm when the Ki-67 positive rate (25.0%) higer than the diameter of<2 cm when the Ki-67 Positive rate(22.6%), but the difference were not statistically significant.Grouped according to whether the axillary lymph node metastases, associated with axillary lymph node metastases when the Ki-67 positive rate (41.9%) was significantly higher than that associated with axillary lymph node metastases when the Ki-67 positive rate (9.5%), and the difference was statistical significance.The conclusions are as follow:1. Solid papillary carcinoma of the breast is a low-grade intraductal carcinoma.2. Solid papillary carcinoma occur in the older women, and has a unique morphology, immunophenotypic features, as a special kind of solid papillary carcinoma caused by the type of attention.3.Some solid papillary carcinoma with mucinous breast cancer and related neuroendocrine cancers.4. Despite the solid papillary carcinoma of breast (Solid papillary carcinoma, SPC) in the cell and tissue morphology of the great features, but its diagnosis still rely on immunohistochemistry and (or) co-determine the ultrastructural features. When most cells have shown that chromogranin A (Chromogranin A, CgA) and synaptophysin (Synaptophysin, Syn), neuron-specific enolase (Neuron-Specific Enolase, NSE)-positive, you can make a clear diagnosis, this electron microscopy does not necessarily need to confirm.5. According to immunohistochemistry, fluorescence in situ hybridization, as well as follow-up data showed solid papillary carcinoma of breast has a good prognosis and biological behavior.6. Mammary solid papillary carcinoma(Solid papillary carcinoma, SPC) prognosis of patients weth axillary lymph node metastasis, and age of onset and the tumor size and axillary lymph node metastases, when associated with worse prognosis.