Objective: To investigate the clinicopathological and immunohistochemistrical features of secretory carcinoma of the breast (SCB), as well as its diagnosis and prognosis. Methods: Five cases of SCB were collected and specimens were fully drawn. Microscopic pathology examinations and immunohistochemistry(SP method)were performed. Results: Five cases were all female patients aged from 31 to 54 years old (with an average age of 38 years), and all patients initially presented with the painless breast lump, often near the areola. Macroscopically, all the tumors were relatively circumscribed, with a mean diameter of 2.1 cm(1.2-3.0 cm). Histologically, the tumors revealed different patterns (microcystic, solid, ductal, and so forth) and appeared large amounts of intracellular and extracellular eosinophilic PAS- and AB-PAS- positive secretory materials, as well as the granular eosinophilic cytoplasm. Immunohistochemistrically, the tumor cells were strongly positive for epithelial membrane antigen (EMA) and S-100. Three cases had negative expression for estrogen receptor (ER) and progesterone (PR), and two cases had weakly focal expression. Human epidermal growth factor receptor 2 (HER2) and P53 were negative, while only one case had weakly focal expression. The tumors were positive for CK7, CK5/6, CD10, but they were negative for CEA, smooth muscle actin (SMA) and P63 . The proliferation index of Ki-67 was 5%-8%. There was no patient with metastasis of the tumor in axillary lymph node. Except 1 case lost follow-up, and the rest had no recurrence or distant metastasis. Conclusions: SCB is very rare, with low malignancy, and has better prognosis, but it is usually classified as triple-negative breast cancer because of the immune phenotype. The correct diagnosis of this lesion depends on clinical characteristics, morphology and immunohistochemistry.
目的： 探讨乳腺分泌型癌(SCB)临床病理学特征，免疫组织化学和特殊染色特点，诊断及预后，以提高对本病的认识。 方法： 收集5例乳腺分泌型癌病例，标本均充分取材，完善临床及预后资料，观察临床病理学特点，高碘酸雪夫反应(PAS反应)和奥辛蓝过碘酸雪夫法(AB-PAS法)特殊染色和SP法免疫组织化学检测。 结果： 5例患者均为女性，年龄31～54岁(平均38岁)，临床均以乳腺无痛性肿块为主要症状就诊，肿块多位于乳晕区。病理学大体改变主要为肿瘤质实或硬，边界多较清，直径1.2～3.0 cm，平均2.1 cm。镜下观察肿瘤细胞核异型不明显，主要排列为成微囊状、实体型、腺管状、条索样等结构，肿瘤细胞胞质颗粒状嗜酸性，肿瘤细胞质内及细胞外的腺腔样间隙中有大量均质嗜伊红分泌物，HE染色呈淡红色，PAS和AB-PAS染色均阳性。免疫组织化学染色：EMA、S-100均强阳性，3例ER、PR均呈阴性，2例局灶弱表达，预后相关基因HER2和P53呈阴性，仅1例HER2局灶弱表达，CK7、CK5/6、CD10均阳性，CEA、SMA、P63均呈阴性，Ki-67增殖指数5%～8%。所有患者腋窝淋巴结均无转移。除1例失访外，其余目前均无复发或远处转移。 结论： 乳腺分泌型癌是一种罕见的低度恶性的实体肿瘤，预后较好，但免疫表型将其大多数归入三阴性乳腺癌中，结合临床特征、HE形态、特殊染色及免疫组织化学有助于正确诊断。.
Keywords: AB-PAS; Breast neoplasm; Immunohistochemistry; PAS; Secretory carcinoma.