The Correlation Between Pathological And Clinical Features Of Solid Papillary Carcinoma Of Breast

Background:Breast cancer is the most common malignant tumor among women in the world.The increasing incidence of breast cancer endangers women's health.It urges breast researchers to explore its pathogenesis,clinical characteristics,prognostic factors and more precise treatment methods.The prognosis of breast cancer is different,which depends on a variety of pathological types.Solid papillary carcinoma(SPC)of the breast is a special subtype of papillary carcinoma of the breast.The incidence of SPC is about 1% in that of breast cancers.It is characterized by solid nodular or expansive growth,often accompanied by mucus secretion and neuroendocrine differentiation.It can be divided into SPC in situ and SPC associated with invasive carcinoma.At present,there are few studies between SPC in situ and SPC associated with invasive carcinoma.There are still controversies on its immunophenotype and biological behavior.It is difficult to make a correct diagnose and classify SPC,and there is no consensus on its clinical treatment.Objective:To compare the difference of clinical features and immunohistochemical indexes between in situ SPC group and SPC with infiltration group,and to explore the independent factors for judging whether SPC is invasive or not.Methods:Cases with pathological diagnosis of SPC from the first,second and third hospitals of Jilin University from December 2011 to February 2019 with complete clinical data and pathological specimens were collected.According to the morphological criteria of SPC described in WHO classification of breast neoplasms in 2012,SPC was confirmed by two senior pathologists,including invasive cancers with ductal carcinoma in situ and mucinous,neuroendocrine and cribriform carcinomas.78 cases were finally obtained.SPC was divided into two groups according to whether there was invasive or not,i.e.SPC in situ group(47 cases)and SPC with invasive group(31 cases).The differences of age of onset,initial symptoms,size of tumors,number of lymph node metastases and immunohistochemical indexes were analyzed and compared.Results:1.78 patients with SPC were female.The onset age was 26-95 years(average age 61 years).47 patients with SPC in situ,the average aged was 61.16 years compared to the onset average age of SPC with invasive group was 60.79 years old.Although the average age of onset in SPC group was older than that in SPC with invasive group,there was no significant difference between the two groups(P=0.341).2.Painless breast mass or hemorrhagic nipple discharge were the main symptoms of the patients.Among 47 cases of SPC in situ,The clinical manifastations were palpable breast mass(42.6%)and hemorrhagic discharge(57.4%).Among 31 cases of SPC with invasive,the clinical manifastations were palpable breast mass(77.4%)and(22.6%)hemorrhagic discharge.The incidence of painless breast mass in SPC with invasive group was significantly higher than that in the in situ SPC group.There was significant different between two groups(P=0.002).3.According to the results of immunohistochemistry,the expression of estrogen receptor was high in both groups.Ki67 was negative in 29 cases(29/47,61.7%)and positive in 18 cases(18/47,38.3%)in SPC group,negative in 16 cases(16/31,51.6%)in SPC group and positive in 14 cases(15/31,48.4%)in Ki67 group.The positive expression rate of Ki67 in SPC group was slightly higher than that in SPC group,but there was no significant difference between the two groups.(P=0.377).4.For myoepithelial markers such as CK5/6,CK14,P63,myoepithelial markers were found in the periphery of the duct lumen and the axes of the fibers and vessels.One of the markers was positive which indicate myoepithelium expression.The myoepithelium expression was 68.1% in SPC compared to 38.7% myoepithelium expression in SPC with invasive group.There was significant different between twe groups(P=0.01).5.The expression rates of neuroendocrine markers Syn and CgA.One of them was positive for neuroendocrine expression.In situ SPC group,37 cases(37/47,78.7%)were positive compared to 28 cases(28/31,90.3%)were positive in SPC with invasive.The neuroendocrine positive rate in SPC with invasive group was higher than that in SPC,but there was no significant difference between the two groups(P=0.394).Conclusion:1.SPC is predilection in elderly women.The average age of onset in SPC with invasive group is slightly younger than that in SPC in situ.2.Hemorrhagic nipple discharge is an important clinical feature of SPC.There is no significant difference in the initial clinical symptoms between SPC group and SPC group with invasive.3.The expression of estrogen receptor was high in all SPC patients.The expression of Ki67 was mostly negative in SPC group and positive in SPC group with invasive.4.The myoepithelium expression rate of SPC in situ was higher than that of SPC with invasive,which indicates myoepithelium could be used as an independent factor for judging whether there is invasive or not.5.Neuroendocrine differentiation is a significant pathological feature of SPC.But it could not be a independent factor for invasiveness.6.Breast conserving surgery is the best treatment for SPC in situ,but radiotherapy has no definite effect on its prognosis,suggesting that local mass resection may be used as the treatment of SPC in situ.