Department of Pathology, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan.
Breast. 2012 Oct;21(5):652-6. doi: 10.1016/j.breast.2012.01.016. Epub 2012 Mar 6.
Bloody nipple discharge (BND) is an important clinical symptom in breast disorders, especially cancers. However, the association between this symptom and breast neuroendocrine carcinomas (NECs) has not been sufficiently investigated or well understood.
We clinicopathologically studied 89 cases using biopsy and/or resection in 144 patients who came to the hospital for a thorough examination of symptomatic BND.
Of these 89 cases examined histologically, 24 (27%) were neuroendocrine carcinomas (NECs) in which >50% of cells immuno-expressed chromogranin A and/or synaptophysin. Moreover, NECs made up 44% (24/55) of the mammary cancers found because of the BND. The frequency of diagnosing malignancy preoperatively in 24 NECs was 4% by nipple discharge cytology, 40% by fine needle aspiration cytology, 62% by core needle biopsy and 67% by mammotome biopsy. There were neither postoperative recurrences nor metastases in the NEC cases during a mean follow-up of 83.7 months. The 24 NECs were subclassified into neuroendocrine ductal carcinoma in situ (NE-DCIS) (9 cases) and microinvasive (7 cases) and invasive (8 cases) NECs with extensive NE-DCIS components. Most NECs had early-stage and low-grade pathological parameters: pTis or pT1 (96%), pN0 (96%), low nuclear grade (83%), absence of necrosis (88%), immuno-positivity of estrogen and progesterone receptors (100%) and absence of HER2 protein overexpression (100%).
NECs predominantly with NE-DCIS lesions, often under-diagnosed preoperatively, accounted for an important share of breast conditions associated with BND. It is, therefore, worth keeping this type of breast cancer in mind when performing medical examinations on patients with BND.
血性乳头溢液（BND）是乳腺疾病的重要临床症状，尤其是癌症。然而，这种症状与乳腺神经内分泌癌（NEC）之间的关系尚未得到充分的研究或很好的理解。
我们对 144 例因 BND 症状进行全面检查而就诊的患者进行了活检和/或切除术，对 89 例患者进行了临床病理研究。
在 89 例组织学检查的病例中，24 例（27%）为神经内分泌癌（NEC），其中>50%的细胞免疫表达嗜铬粒蛋白 A 和/或突触素。此外，NEC 占因 BND 而发现的乳腺肿瘤的 44%（24/55）。在 24 例 NEC 中，术前通过乳头溢液细胞学检查诊断恶性肿瘤的频率为 4%，通过细针抽吸细胞学检查为 40%，通过核心针活检为 62%，通过 Mammotome 活检为 67%。在平均 83.7 个月的随访中，NEC 病例均无术后复发或转移。24 例 NEC 分为神经内分泌导管原位癌（NE-DCIS）（9 例）、微浸润（7 例）和浸润（8 例）NEC，伴有广泛的 NE-DCIS 成分。大多数 NEC 具有早期和低级别病理参数：pTis 或 pT1（96%）、pN0（96%）、低核级（83%）、无坏死（88%）、雌激素和孕激素受体免疫阳性（100%）和 HER2 蛋白过表达缺失（100%）。
NEC 主要为伴有 NE-DCIS 病变的肿瘤，术前常被漏诊，占与 BND 相关的乳腺疾病的重要部分。因此，在对 BND 患者进行体格检查时，值得考虑这种类型的乳腺癌。
