多形型和旺炽型变型乳腺小叶原位癌 85例来自单一研究中心的伴有和不伴有浸润性癌病例的临床病理研究

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  --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
  乳腺多形型小叶原位癌(pleomorphic lobular carcinoma in situ,PLCIS)和旺炽型小叶原位癌(florid lobular carcinoma in situ,FLCIS)是小叶原位癌(lobular carcinoma in situ,LCIS)的变型,其自然病程和最佳治疗方案还不十分清楚。我们复习了本机构内20多年来所遇见LCIS病例的临床病理特征和处理措施。85例病例(61例PLCIS、24例FLCIS)中,77%伴有浸润性癌(84%为小叶癌、13%为导管/小叶癌、3%为导管癌),只有17%的病例(9例PLCIS、5例FLCIS)仅含有原位癌成分。多数(81%)浸润性癌组织学分级为II级;所有组织学分级为III级/多形型浸润性小叶癌均与PLCIS相关,而所有组织学分级为I级的肿瘤与FLCIS相关。PLCIS相关的浸润性癌较FLCIS相关肿瘤(100%ER+、6%HER2)多见ER-(21%)或HER2+(14%)。有浸润性癌成分的LCIS变型常是单一病灶或局灶性(20/20),而经典型小叶原位癌(classic LCIS,CLCIS)则是多灶性且广泛分布(10/17)。21例行粗针活检的单纯LCIS变型均为放射检查(95%)发现或可触及(5%)肿块。PLCIS(38%)与FLCIS(33%)切除后,诊断级别上调率类似。纯LCIS变型粗针穿刺活检组织常(20%)呈HER2+,与同期CLCIS相比,Ki-67增殖指数较高(P<0.002)。相对于CLCIS,LCIS变型的ER低表达是由于出现ER-的大汗腺性PLCIS。在LCIS变型和升级的浸润性小叶癌中,ER和HER2的表达始终一致,而同期的CLCIS与LCIS变型则不一致(5/14,36%)。纯LCIS变型切除时保证切缘阴性,常应用内分泌治疗(58%),无需进行放射治疗,均可达到无复发。总之,LCIS和FLCIS具有直接的前驱病变特征,进行外科切除是适宜的。
  Am J Surg Pathol 2019;43:399–408
美国外科病理学杂志中文版2019年第四期摘要NO.3
(张帆 翻译/审校)

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