Zhou Ruo-ji, Hu Chun-yan, Yu Lin, Bi Rui, Yang Wen-tao
Department of Pathology, Cancer Center, Fudan University, Shanghai 200032, China.
Zhonghua Bing Li Xue Za Zhi. 2012 Dec;41(12):803-7. doi: 10.3760/cma.j.issn.0529-5807.2012.12.003.
To investigate the clinicopathologic and immunohistochemical features as well as the differential diagnoses of the solid variant of mammary adenoid cystic carcinoma with basaloid features.
Clinical and pathological data were collected in four cases of the solid variant of mammary adenoid cystic carcinoma with basaloid features, and microscopic pathological examination and immunohistochemistry EnVision method were performed. The relevant literature was also reviewed.
The four patients were female, with age ranged from 46 - 65 years old (average 56 years) and the maximum tumor diameter ranged from 1.5 to 2.5 cm. Microscopically, the tumors exhibited a predominantly solid architecture with a myxoid or hyalinized stroma. The tumor cells showed moderate to marked nuclear atypia, and a basaloid appearance with scanty cytoplasm and inconspicuous nucleoli, and ≥ 5 mitotic figures per 10 high power fields. Glandular space embedded within tumor islands could be noticed. These spaces were genuine glandular structures and the cells lining these true glandular lumens had more abundant and eosinophilic cytoplasm. Pseudoglandular spaces of cribriform pattern or variable shape were also occasionally seen, and these cysts contained homogenous eosinophilic material. Focal necrosis was found. All cases were negative for ER, PR and HER2. Immunohistochemical staining for CK5/6, CK7 and CK14 was positive in the genuine glandular structures. All cases were positive for CD10, but also positive with varying intensity from weak to strong for vimentin and CD117. Staining for Ki-67 in three patients showed 10% - 50% positive.
The solid variant of mammary adenoid cystic carcinoma with basaloid features is a histologically distinctive and also a rare subset of the mammary adenoid cystic carcinoma. Awareness of its pathological features can help with the diagnosis as well as differential diagnosis. More cases are still needed for accurately assessing the prognosis of this particular tumor.
探讨具有基底样特征的乳腺腺样囊性癌实性变体的临床病理及免疫组化特征以及鉴别诊断。
收集4例具有基底样特征的乳腺腺样囊性癌实性变体的临床及病理资料，进行显微镜病理检查及免疫组化EnVision法检测，并复习相关文献。
4例患者均为女性，年龄46 - 65岁（平均56岁），肿瘤最大直径1.5至2.5 cm。镜下，肿瘤主要呈实性结构，伴有黏液样或玻璃样变性的间质。肿瘤细胞显示中度至明显的核异型性，呈基底样外观，胞质稀少，核仁不明显，每10个高倍视野有≥5个核分裂象。可见肿瘤岛内包埋的腺腔。这些腔隙为真正的腺管结构，内衬这些真正腺腔的细胞胞质更丰富且呈嗜酸性。偶尔也可见筛状或形状各异的假腺腔，这些囊肿内含有均匀的嗜酸性物质。发现局灶性坏死。所有病例雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）均为阴性。CK5/6、CK7和CK14免疫组化染色在真正的腺管结构中呈阳性。所有病例CD10均为阳性，但波形蛋白和CD117也呈不同强度阳性，从弱阳性到强阳性。3例患者的Ki-67染色显示10% - 50%阳性。
具有基底样特征的乳腺腺样囊性癌实性变体在组织学上具有独特性，也是乳腺腺样囊性癌中罕见的亚型。认识其病理特征有助于诊断及鉴别诊断。仍需要更多病例来准确评估这种特殊肿瘤的预后。
