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- B1766Rare 乳腺分泌型癌 (cqz 13)
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44 y women with breast mass lesion
F1-2. 40x
F3-7 200x
F8-10 400x
You diagnosis or interpretation
标签：乳腺分泌型癌 s-100
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本帖最后由 于 2009-03-06 01:21:00 编辑
×参考诊断
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本帖最后由 于 2009-03-07 09:08:00 编辑
经常学习，今天也做一点贡献
分泌型癌（secretory carcinoma），简称SC。为少见的低度恶性乳腺癌。瘤细胞常产生丰富的细胞内和细胞外分泌物（乳汁样）。同义词：幼年性乳腺癌。在所有乳腺癌中SC发病率＜0.15%。相当一部分患者年龄＜20岁，男性偶有发病。
临床特点：表现为生长缓慢的可移动肿块，约1/2的病例位于近乳晕区域，特别是男性或儿童患者。
大体检查：SC分界清楚，结节状，切面灰白或黄色至褐色；大小0.5－12cm，较大的肿瘤多发生在老年患者。
组织病理学：
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有三种结构二型细胞: 1. 小囊腔组成的微囊结构,有的合并成大的空腔而与甲状腺滤泡相似. 2. 致密的实性结构. 3. 小管结构,由许多含分泌物的小管腔组成. 免疫表形：SC常表达EMA，α－乳白蛋白、S－100。ER大多阴性。
预后及预测因素： 在儿童和青少年，SC有极好的预后，但在年长的患者中有浸润性行为，儿童少见复发，但淋巴结转移的的危险与青年或年长患者类似。近15%的患者有腋窝淋巴结转移。肿瘤＜2cm未必成进行性。单纯乳腺切除一般可治愈，但也有例外。肿瘤可在20年后复发，故需长期随访。致死性病例少见，从未见于儿童。
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- 有福不在忙
| 以下是引用cici在2009-3-6 20:39:00的发言：
不好意思，三种结构两种细胞中是哪两种细胞呀？ |
I assume that 有福不在忙 mean that
3 patterns: microcystic (honeycombed); more solid; tubular patterns.
2 cell types: Type A and Type B riginal described by Drs.Tavassoli and Norris at AFIP.
There are no a lot of meaning to calssify the cell types. Most of the cases are mixed with different growth pattern and cells. When you meet these kinds of cases, check the books and you will know the diagnosis.
In fact I do not know the patterns and cell types, until I read the book to answer your questions.
It is important for us to know and be familiar with the histologic featurs, but it is not important to remember some numbers.
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Secretory carcinoma of the breast.
Nineteen examples of a very rare type of carcinoma of the breast have been studied. The carcinoma is unusual in that it has exaggerated secretory features previously reported only (with one exception) in juveniles. But not all the patients in our series were juveniles; they ranged in age from 9 to 69 years (median age, 25 years). Six were 30 years of age or older. Eighteen patients were female and 1 was a 9-year-old boy. Treatment varied from local excision of the tumor to radical mastectomy. Four of the 11 patients who had axillary node dissection had metastatic deposits showing the same secretory features as the primary neoplasm. One of these 4 patients, a 25-year-old woman, died within ten months with disseminated tumor. Because this distinctive pattern of carcinoma is not limited to children and adolescents, we propose that it be called "secretory carcinoma." Since, of the 19 patients, 4 (21%) had axillary node metastases and 1 (5%) died with disseminated tumor, an extended simple mastectomy is recommended as the initial treatment for patients more than 20 years of age.
U can find the original paper to read if you are interested to the classification
Cancer. 1980 May 1;45(9):2404-13.
分泌性癌（secretory carcinoma,SC）又称幼年性癌，1966年首次报道，因其发生在儿童故命名为幼年性癌，后来发现SC主要发生在成人，并根据肿瘤细胞内外腔隙内富含AB/PAS（抗淀粉酶）染色阳性的分泌物这一特点命名为分泌性癌。【巨检】：肿块径1.5~3cm，质实，可有假包膜。【镜检】：常为3种组织类型：1、微囊型：有大小不等的小囊泡组成，可融合成大的腔隙（似甲状腺滤泡）。2、实性型：瘤细胞紧密排列成实性。3、小管型：由大量小管组成，内含分泌物。也可呈乳头状、不规则小梁状。细胞温和，核分裂象罕见。二种细胞形态：一种胞浆丰富淡染颗粒状，另一种胞质空泡状。此癌预后好，生长缓慢且无明显症状，容易漏诊。
