三阴乳腺癌与基底细胞样乳腺癌病理形态和生物学特征探讨

江汉大学学报（自然科学版） ›› 2014, Vol. 42 ›› Issue (6): 57-61.

三阴乳腺癌与基底细胞样乳腺癌病理形态和生物学特征探讨

王成鑫，黄萱，封华

江大病理诊断所|江汉大学医学院病理学与病理生理学教研室，湖北武汉 430056

收稿日期:2014-12-26 修回日期:2014-12-26 出版日期:2014-12-25 发布日期:2014-12-26
作者简介:王成鑫（1954—），男，教授，主任医师，硕士生导师，研究方向：肿瘤病理

Investigation of Pathomorphology and Biologic Characteristics ofTriple-Negative Breast Cancer and Basal-Like Breast Cancer

WANG Chengxin，HUANG Xuan，FENG Hua

Jiangda Pathologic Diaglostic Institute； Department of Pathology & Pathophysiology, School of Medicine， Jianghan University,Wuhan 430056, Hubei, China

Received:2014-12-26 Revised:2014-12-26 Online:2014-12-25 Published:2014-12-26

摘要/Abstract

摘要： 目的 探讨三阴乳腺癌（triple-negative breast cancer，TNBC）与基底细胞样乳腺癌（basal-likebreastcancer ，BLBC）及非三阴乳腺癌（nontriple-negativebreastcancer ，NTNBC）的关系及其形态、生物学特征。方法应用免疫组织化学（immunohistochemistry ，IHC ）方法对96例乳腺癌标本进行HER2 、ER、PR蛋白的检查|应用FISH（fluorescentinsituhybridization）方法对3 例HER2 IHC 3 + 及5 例HER2 IHC 2 + 标本进行HER2 基因扩增的检查|对22例TNBC 进行了CK5 / 6 或EGFR 的检查。按照检查结果，将其分为TNBC、NTN ?BC和BLBC，比较三者的病理形态及生物学特征。结果 NTNBC占72. 92%（70/ 96），其组织学Ⅰ、Ⅱ及Ⅲ级的病例分别为28.57%（20/70）、57. 14%（40/ 70）和14. 29%（10/ 70），淋巴结转移率为44.44%（16/36）；TN?BC占乳腺癌的27. 08%（26/ 96），无组织学Ⅰ级病例，组织学Ⅱ及Ⅲ级的病例分别为53. 85% ，（14/ 26）及46. 15% ，（12/ 26）例，淋巴结转移率为61. 11%（11/ 18）|BLBC 占TNBC 的63. 64%（14/ 22），同TNBC 一样，无组织学Ⅰ级病例，Ⅱ、Ⅲ级的病例分别为57. 14%（8 / 14）及42. 86%（6 / 14），淋巴结转移率为55. 56%（5 / 9）。 TN?BC与BLBC 低分化病例的比例以及淋巴结的转移率均高于NTNBC。3 例HER2 IHC 3 + 的病例FISH检查结果同IHC ，5 例HER2 IHC 2 + 标本FISH检查1 例基因扩增，3 例阴性，1 例结果不确定。结论 TNBC 与BLBC 占乳腺癌1 / 4 的比例，组织学多为中、低分化，浸润性生长，易发生淋巴结转移和复发，临床预后较差。虽然BLBC 与TNBC 大部分有重叠，但其具有独自的特异性，应成为独立的组织病理学类型。CK5 / 6 或EGFR 可用作从TNBC 中筛选BLBC 的指标。IHC 2 + 病例要做FISH检查，以正确指导治疗。

关键词: 三阴乳腺癌, 基底细胞样乳腺癌, 病理形态学, 荧光原位杂交

Abstract: Objective To investigate the pathomorphology ，biologic characteristics and the relation?ships of triple-negative breast cancer (TNBC)，non triple-negative breast cancer(NTNBC) and basal like breast cancer（BLBC）. Methods HER2 ，ER，PR，CK5 / 6 or EGFR protein were determined with immunohistochemistry（IHC ）in breast cancer, 3 cases of HER 2 IHC 3 + and 5 cases of HER2 IHC 2 + were analysed for HER2 gene amplification with fluorescent in situ hybridization（FISH）. CK5 / 6 or EGFR were checked in 22cases of TNBC. The cases were divided into the TNBC，NTNBC and BLBC groups according to the examination results.The pathomorphology and biologic characteristics of the three groups were compared. Results Of the 96cases，27. 08% （26/96）were confirmed to be TNBC in which grade Ⅱand Ⅲ caseswere 53. 85%（14/ 26）and 46. 15%（12/26）respectively ，lymph nodes metastasis rate was 61. 11%（11/ 18）；BLBC accounted for63. 64%（14/22）of TNBC ，in which grade Ⅱand Ⅲcases were 57. 14%（8 / 14）and 42. 86%（6 / 14）respectively ，lymph nodes metastasis rate was 55. 56%（5 / 9）；There were no grade Ⅰcases in TNBC andBLBC. 7 2 . 92%（70/ 96）wereconfirmedtobeNTNBCinwhichgradeⅠ，Ⅱand Ⅲcaseswere 28. 57%（20/ 70），57. 14%（40/ 70）and 14. 29%（10/ 70）respectively ，lymph nodes metastasis rate was 44. 44%（16/36）. The percentage of poorly differentiated cases and lymph nodes metastasis rate were higher inthe TNBC and BLBC group than those in NTNBC ，besides there was no gradeⅠcases in TNBC andBLBC group. Of the 5 HER2 IHC 2 + cases，one case there was gene amplification ，one equivocaland threenegativeand of 3 HER2 IHC 3 + cases,theFISH resultwasconsistentwith IHC.Conclusion More than 1 / 4 of breast cancer are TNBC or BLBC in our study.Compared with NTNBC，eventhough TNBC and BLBC share agreat dealof overlap and have a poor differentiation with aggressive behavior and increased local recurrence or distant metastasis，indicating a poor prognosis，theymaybe independent histopathologic entity. CK 5 / 6 or EGFR can be used to differentiate the BLBC fromTNBC.IHC 2 +cases should be examined with FISH in order to avoid misleading treatment.

Key words: triple-negativebreastcancer, basal-likebreastcancer, pathomorphology, FISH

中图分类号:

R 737 . 902

王成鑫，黄萱，封华. 三阴乳腺癌与基底细胞样乳腺癌病理形态和生物学特征探讨[J]. 江汉大学学报（自然科学版）, 2014, 42(6): 57-61.

WANG Chengxin，HUANG Xuan，FENG Hua. Investigation of Pathomorphology and Biologic Characteristics ofTriple-Negative Breast Cancer and Basal-Like Breast Cancer[J]. Journal of Jianghan University(Natural Science Edition), 2014, 42(6): 57-61.