Mucinous Neuroendocrine Carcinoma of the Breast: Report of a Case

本文報告一位75歲女性患者，在她右側乳房長出一個黏液性神經與內分泌癌。腫瘤的乳房攝影皆呈現緻密、分葉狀及邊緣界限明顯。乳房粗針切片診斷爲侵襲性腺管癌。患者接受改良性根除性乳房切除手術。進一步的組織病理檢查發現腫瘤細胞以實體樣的擴張生長且呈小梁狀排列，幾乎全部的腫瘤細胞含有細胞內黏蛋白，而有些腫瘤細胞則散落在大量的胞外黏蛋白中。因此，診斷修正爲黏液性神經內分泌癌。黏液性神經內分泌癌的鑑別診斷包括黏液性腺癌，侵襲性腺管癌，侵襲性小葉癌及轉移性神經內分泌癌。免疫組織化學染色結果顯示多數腫瘤細胞皆有神經及內分泌性蛋白顆粒。在小檢體見到實體樣擴張生長且呈小梁狀排列與產生大量的細胞內和細胞外黏蛋白的腫瘤，有時候會出現診斷上的困難。目前仍無標準的治療方法，但以手術切除腫瘤爲主。根據腫瘤的分化程度，大小和腫瘤分期，手術方式有腫塊切除和前稍淋巴結摘除術加上後續的局部放射線治療，或根除性乳房切除術，術後也許可以給予化學治療或荷爾蒙治療等輔助性的治療。

關鍵字

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並列摘要

We report a case of well-differentiated mucinous neuroendocrine carcinoma in an aged woman who presented with a right breast lump. The mammogram revealed a dense, lobulated mass with a circumscribed margin. The core needle biopsy was initially misdiagnosed as an invasive ductal carcinoma, and modified radical mastectomy was performed later. A detailed histologic examination of the whole specimen revealed a solid and expansile growth pattern of epithelial cells with a trabecular arrangement. Almost all the tumor cells contained intracellular mucin, and some tumor cell clusters floated in a large amount of extracellular mucus. The differential diagnoses of primary neuroendocrine carcinoma of breast include mucinous carcinoma, invasive ductal carcinoma, invasive lobular carcinoma, and metastatic neuroendocrine carcinoma. The immunohistochemical studies demonstrated that the majority of tumor cells were immunoreactive for neuroendocrine markers that included chromogranin A, synaptophysin and neuronspecific enolase. Recognition of the neuroendocrine (NE) carcinoma showing a solid trabecular growth pattern with florid intracellular and extracellular mucin production is occasionally one of the most challenging diagnoses in small biopsy. There is no standard therapy for patients with NE carcinomas, however, surgery is regarded as the treatment of choice. The surgical protocol includes lumpectomy, axillary lymph node dissection and adjuvant radiation therapy or modified radical mastectomy based primarily on the tumor grade, size and stage. The chemotherapeutic agents or hormone therapy may be given accordingly.

並列關鍵字

breast cancer ； mucinous neuroendocrine carcinoma ； chromogranin A

國際替代計量

Mucinous Neuroendocrine Carcinoma of the Breast: Report of a Case

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