1 福建医科大学附属协和医院病理科，福州 350001
|| 福建省自然科学基金卫生联合项目 (2016J01556); 福建省卫生与计划生育委员会医学创新项目 (2016-CX-23)
目的：探讨乳腺原位癌伴微小浸润(breast carcinoma in situ with microinvasion，BCIS-Mi)的临床病理特征。方法：回顾性收集121例乳腺BCIS-Mi患者的临床资料，分析肿瘤大小、组织学级别、粉刺样坏死、肿瘤浸润淋巴细胞(tumour-infiltrating lymphocytes，TILs)、浸润灶数量、浸润灶类型、淋巴结转移情况等指标之间的关系。结果：121例乳腺BCIS-Mi患者均为女性，86.0%(104/121)的患者为高级别导管原位癌，其中1例为大汗腺型原位癌，7例伴有乳头Paget病，2例伴有小叶原位癌；14.0%(17/121)为中级别原位癌，其中1例为原位实性乳头状癌，1例伴小叶原位癌。54.5%患者可见粉刺样坏死，63.6%的患者具有多个浸润灶，43.0%的患者原位癌导管周围见TILs，26.4%的患者浸润灶富于TILs(浸润灶中淋巴细胞/间质>30%)。121例BCIS-Mi中仅6.6%出现淋巴结转移，主要集中在多个浸润灶且浸润灶中TILs少的患者。结论：乳腺高核级别的BCIS易发生微浸润，肿物>3.5 cm者易出现多个浸润灶。微小浸润灶数量多、间质TILs少是BCIS-Mi发生淋巴结转移的危险因素。
Analysis of the clinicopathological features of 121 cases of breast carcinoma in situ with minimal invasion
This work was supported by the Joint Health Project of Fujian Natural Science Foundation (2016j01556) and Medical Innovation Project of Fujian Health and Family Planning Commission (2016-cx-23), China.
Objective: To investigate the clinicopathological features of breast carcinoma in situ with microinvasion. Methods: The clinical data of 121 cases of breast carcinoma in situ with microinvasion(BCIS-Mi) were retrospectively collected, and the relationships among tumor size, histological grade, acne necrosis, tumor infiltrating lymphocytes, number of infiltrating lesions, type of infiltrating lesions and lymph node metastasis were analyzed. Results: All 121 cases of BCIS-Mi were female. 86.0% (104/121)of the cases had high-grade carcinoma in situ (1 case was apocrine adenocarcinoma in situ, 7 cases with Paget’s disease and 2 cases with lobular carcinoma in situ) and 14.0% (17/121) were middle-grade carcinoma in situ (one case was solid papillary carcinoma in situ and one case with lobular carcinoma in situ). 54.5% of cases showed acne necrosis, 63.6% had multiple infiltrating foci, 43% had TILs around the duct of carcinoma in situ, and 26.4% had rich TILs (lymphocyte/stroma >30%). The infiltrating foci were classified into 3 types according to size and morphology. Only 6.6% of 121 BCIS-Mi patients had lymph node metastasis, which was mainly concentrated in multiple invasive lesions with less TILs. Conclusion: Micro-infiltration is easy to occur in BCIS with high nuclear grade of breast, and multiple infiltration foci are easy to occur in case with mass >3.5 cm. The number of infiltrating foci and the number of TILs in stroma are risk factors for lymph node metastasis in BCIS-Mi.
microinvasive breast cancer; multifocal infiltration; tumor infiltrating lymphocytes