Clinicopathological Analysis Of Breast Carcinoma In Young Patients And Primary Breast Carcinoma With Signet-ring Cell Differentiation

BACKGROUND AND OBJECTIVEAs a highly heterogeneous malignant tumor,breast cancer poses a great threat to women’s physical and mental health.Most of the previous reports in both Chinese and foreign literatures have shown that young patients with breast cancer have relatively strong invasiveness and metastasis,rapid disease progression,earlier lymph node metastasis,higher metastasis rate,and relatively poor prognosis.The clinicopathological features of breast cancer in young patients are a subject worthy of attention.In this study,the clinicopathological features of young breast cancer patients were explored.The understanding of breast cancer in young patients will be professionally improved.And it will lay the foundation for further etiological research and treatment,prevention and other research.METHODSA total of 1156 cases of breast cancer tissue that had been diagnosed during the period from January 1,2016 to December 31,2017 in Shandong Provincial Hospital Affiliated to Shandong University were collected.Through statistical analysis of clinical data of cases,immunohistochemical staining and fluorescence in situ hybridization results,the correlation between the expression of ER,PR,HER2,and Ki-67 immunophenotypes,clinical features,and pathological factors was explored.The cases were divided into young group(<40 years old)and non-youth group(≥40 years old).Through comparative study of the differences between the two groups,the clinical pathological features of young patients(<40 years old)were studied.RESULTS1 There was a significant difference in the lymph node metastasis rate between the two groups.The lymph node metastasis rate in the young group was higher than that in the non-youth group(P<0.05).2 When the Ki-67 index is on the cutoff of 14%,the Ki-67 high expression rate of the youth group is higher than that of the non-youth group.After the x2 test,P<0.05,the difference is statistically significant.When the 20%is the cutoff,the youth group The Ki-67 high expression rate was higher than non-youth group,but the difference was not statistically significant by the x2 test,P>0.05;3There was a significant difference in molecular phenotype between the two groups.The Luminal B type had the largest proportion in the youth group and was higher than the proportion in the non-youth group.The other three types(Luminal A,HER-2 overexpression and basal/triple negative)are lower in the youth group than in the non-youth group(P<0.05).4There was no significant difference in infiltration degree,tumor size,ER,PR,HER2 expression,and histological grade between the two groups.CONCLUSIONSThe lymph node metastasis rate of young breast cancer patients is higher than that of non-youth breast cancer patients,showing poor biological behavior.The role of the 20%cutoff value of the Ki-67 index in predicting the prognosis of young patients with breast cancer is not sure.The distribution of four molecular phenotypes is also different from that of non-younger breast cancer patients,suggesting a prognosis and treatment differences.It is also important that should fully consider the impact of the above factors.BACKGROUND AND OBJECTIVE Primary breast carcinoma with signet-ring cell differentiation is a rare type of breast cancer,with typical morphological characteristics and strong invasiveness,poor prognosis which is needed to be identified with mucinous cancer.Therefore,this part will focus on the study of investigating the clinicopathological features,immunophenotypic characteristics and differential diagnosis of primary breast carcinoma with signet-ring cell differentiation.METHODS Clinical pathological data of 8 surgically treated patients who were pathologically confirmed primary breast carcinoma with signet-ring cell differentiation by Shandong Provincial Hospital Affiliated to Shandong University between May 17,2010 to July 13,2017 were collected.Hematoxylin-eosin(HE)and immunohistochemical staining were performed for pathological morphology observation and immune phenotype analysis,combining with literature review.RESULTS All cases were female with a mean age of 50±13.5 years old and presented with breast lumps.In the microscopic cells,the cytoplasmic vacuoles can be seen and the nucleus is squeezed on one side,which were like signet-rings.3 of 8 cases were confirmed to be simple type of signet ring cell carcinoma.Among them,one case was carcinoma in situ while the other 5cases had also suffered from other types of invasive breast carcinoma.Immunohistochemical staining results confirmed the high expression of CK7 and GCDFP-15 while CK20,CDX2MUC-2 and HepPar-1 were negative.There was no significant difference in the expression of estrogen receptor,progesterone receptor,and HER2.MUC-1 was positive in 8 cases and presented with two types: luminal and cytoplasmic type and circumferential membranous accentuation type.One case of the 2 cases that expressed the latter mode had bone metastasis and liver metastasis after operation and finally passed away,and the other 7 living cases had no progression except 1 cases with recurrence of signet ring cell carcinoma in situ.CONCLUSIONS The characteristics of the morphological and immunohistochemical characteristics of the signet-ring cells are the key points in diagnosis of the breast carcinoma with signet-ring cell differentiation.This type has a strong potential of recufrence and metastasis,which requires the attention of clinicians and pathologists.