关于乳腺普通性增生、不典型增生和原位癌相互关系及鉴别诊断的探讨  

Usual hyperplasia, atypical hyperplasia and carcinoma-in-situ of breast: a morphologic study

作　　者：阚秀[1] 沈丹华[1] 史斌[1] 何京生[2] 

机构地区：[1]北京大学人民医院病理科,100044 [2]北京市肿瘤医院病理科

出　　处：《中华病理学杂志》2004年第4期312-315,共4页Chinese Journal of Pathology

摘　　要：目的 探讨各种类型乳腺增生症的发病特点、形态学分类、不典型增生与乳腺癌的关系以及不典型增生与乳腺原位癌的鉴别诊断标准。方法 (1)观察本院300例乳腺良性增生性病变的临床发病特点及其病理形态改变。(2)观察86例大切片乳腺癌旁不典型增生病灶与癌灶的关系。结果 乳腺增生症中,纤维腺瘤为主型好发于21-30岁年龄组,而不典型增生病变则多见于40-60岁组。其中囊肿病仅占6.0％,而纤维腺瘤变达25.4％;癌旁组织中不典型增生发生率为65.1％,其中以导管原位癌发生率最高,达74.9％。结论 研究证实了1997年(舟山)“乳腺增生症的组织学分类”(推荐方案)的可行性。乳腺不典型增生与乳腺癌的发生密切相关。乳腺增生症可归纳为普通性增生和不典型增生。不典型增生的特殊增生细胞具有特别的诊断价值。重度不典型增生与原位癌的鉴别诊断有一定困难,但大部分可分。Objective To study the morphologic classification of mammary ductal hyperplasia, and its criteria and the significance in distinguishing atypical hyperplasia from carcinoma-in-situ. Methods The clinicopathologic features of 300 cases of hyperplasia of breast were reviewed. Whole-organ H&E sections were also available in 86 cases of breast carcinoma. The occurrence of atypical hyperplasia in adjacent breast tissue was assessed. Results Fibroadenomatoid changes were typically observed in the 21-30 age groups and atypical hyperplasia occurred more frequently in 40 - 60 age groups. Amongst the hyperplastic cases, cystic diseases of the breast were noted in only 6% . In contrast, fibroadenomatoid changes were more common (25.4%) . Atypical ductal hyperplasia occurred in adjacent breast tissue of 65. 1% of the carcinoma cases. The incidence was higher ( 74. 9% ) if the main lesion was ductal carcinoma-in-situ. Conclusions There is a close association between atypical hyperplasia and breast carcinoma. It is prudent to distinguish between usual and atypical hyperplasia. Morphologic differentiation between atypical ductal hyperplasia and ductal carcinoma-in-situ may sometimes be difficult.

关 键 词：乳腺普通性增生 乳腺不典型增生 乳腺原位癌 相互关系 鉴别诊断 

分 类 号：R737.9[医药卫生—肿瘤]