中文摘要：

目的研究乳腺浸润性微乳头状癌（IMPC）的病理学特征与淋巴结转移的关系。方法观察51例乳腺IMPC的主要病理学特征及淋巴结转移情况，采用免疫组织化学方法（LSAB法）检测IMPC中血管内皮生长因子（VEGF）-C和VEGF受体（R）-3的表达并计数淋巴管密度，分析其与淋巴结转移的关系。结果（1）乳腺IMPC病理组织学分级Ⅱ、Ⅲ级组的淋巴结转移数平均12．5个，明显高于Ⅰ级组的4．0个；（2）问质淋巴细胞浸润（＋）和（＋＋）组的淋巴结转移率（27／28，96．4％）明显高于（-）和（±）组（14／23，60．9％），且其淋巴结转移数平均14．4个，也明显高于（-）和（±）组的4．6个；（3）IMPC肿瘤细胞的VEGF—C表达在病理组织学分级Ⅱ、Ⅲ级组显著高于Ⅰ级组（P=0．03），VEGF—C的表达与淋巴结转移呈正相关（P=0．006）；淋巴管密度与VEGF．C表达（P=0．009）、淋巴结转移（P=0．007）呈正相关；（4）肿瘤组织中IMPC成分的多少与淋巴结转移无显著性关系，淋巴结转移灶为纯IMPC或以IMPC成分为主；（5）28例伴有导管原位癌的IMPC中，14例为微乳头状型导管原位癌（14／28，50％）。结论乳腺IMPC的病理组织学分级、淋巴管密度及问质淋巴细胞浸润可能是影响IMPC淋巴结转移的关键性因素。VEGF—C和VEGFR．3表达增高是促使IMPC发生淋巴结转移的重要原因。微乳头状型导管原位癌可能是IMPC的早期阶段。

英文摘要：

Objective To investigate the relationship between lymph node metastasis and pathologic features of invasive micropapillary carcinoma （IMPC） of the breast. Methods Histopathologic features and status of lymph node metastasis of fifty-one cases of IMPC were studied by microscopic examination, immunohistocbemical staining （VEGF-C and VEGFR-3 ） and analysis of lymphatic vessel density. Results （ 1 ） The numberof positive lymph nodes in histologic grade Ⅱ/Ⅲ IMPCs was significantly higher （ mean 12.5） than that in histologic grade I tumors （mean 4.0）. （2） The incidence of nodal metastases in IMPCs with lymphocyte infiltration （ ＋ ）/（ ＋ ＋ ） was significantly higher （27/28,96.4%） than that in tumors with no or minimal lymphocyte infiltration （ - ）/（ ± ） （ 14/25, 60.9% ）, and the number of positive nodes was also higher （ mean 14.4 ） in tumors with lymphocyte infiltration compared with those without （mean 4. 6）. （3） In IMPCs with histologic grade Ⅱ/Ⅲ, the expression of VEGF-C was significantly higher than that of histologic grade Ⅰ tumors （ P = 0. 03 ）. VEGF-C expression was in positive correlation with lymph node metastasis （ P = 0. 006 ） and lymphatic vessel density （ P = 0. 009 ）. Lymph node metastasis was also correlated with lymphatic vessel density （ P = 0. 007）. （4） The percentage of IMPC component in the tumor did not correlate with nodal metastasis. The metastatic foci in lymph node were all IMPC or mainly IMPC. （5） Fourteen of twenty-eight cases （ 14/28,50% ） of IMPC containing ductal carcinoma in-situ （DCIS） were DCIS of micropapillary type. Conclusious The histologic grade, lymphatic vessel density and lymphocyte infiltration are key histological features that are correlated with lymph node metastasis of IMPC. The expression of VEGF-C and VEGFR-3 may play an important role in the development of lymph node metastasis of IMPC. Micropapillary type DCIS may be the early stage of IMPC.