乳腺癌新辅助化疗后的形态学改变与鉴别诊断  

Morphologic changes of breast carcinoma after neoadjuvant therapy and its differential diagnosis

作　　者：郑闪[1] 张柏林[2] 邹霜梅[1] 林冬梅[1] 薛丽燕[1] 罗巍[1] 袁燕玲[1] 刘秀云[1] 吕宁[1] 

机构地区：[1]中国医学科学院肿瘤医院肿瘤研究所病理科,北京100021 [2]中国医学科学院肿瘤医院肿瘤研究所腹部外科,北京100021

出　　处：《诊断病理学杂志》2009年第4期255-257,共3页Chinese Journal of Diagnostic Pathology

基　　金：北京市科技计划课题(D0905001040131);中国医学科学院肿瘤研究所肿瘤医院重点课题(LC2008A18)

摘　　要：目的总结新辅助化疗后乳腺癌组织、癌旁乳腺组织及淋巴结的形态学改变,并提出相关鉴别诊断注意点。方法收集入组新辅助化疗病例119例,治疗前均行核芯针穿刺活检（CNB）。复习新辅助化疗后手术切除标本的病理切片,分别记录癌组织、癌旁乳腺组织及淋巴结的治疗后改变,并根据上述改变提出鉴别诊断的注意点。结果癌组织可出现不同程度的退变及间质纤维化等多种反应,癌细胞的空泡变性、合体癌细胞等需与泡沫细胞、多核巨细胞等鉴别,免疫组化染色（AE1/AE3、CD68等）有助益。癌组织的间质反应可作为新辅助化疗后肿瘤完全消失的组织学线索。淋巴结存在与原发灶相似的治疗后改变,但出现比例较低。癌旁乳腺组织可出现导管上皮增生等改变,需与残存的导管内癌鉴别。结论乳腺癌新辅助化疗后的形态学改变会造成诊断困难,复习治疗前CNB切片、充分及必要的取材、免疫组化染色（AE1/AE3、CD68等）有助于诊断及疗效评价。Objective To investigate the morphologic changes of breast carcinoma, para-cancer and normal tissues after neoadjuvant therapy and to indicate the key points of differential diagnosis. Methods 119 eases of breast carcinoma after neoadjuvant therapy were analyzed. All of them were taken core needle biopsy （CNB） before neoadjuvant therapy. The HE - stained sections after operation were reviewed, and the changes of the cancer, para-cancer and normal tissues were collected. Results The main changes of breast carcinoma after neoadjuvant therapy were cellular degeneration, stromal fibrosis and others. Cell degeneration may be differentiated from foamy histiocyte and multi-nuclear histiocyte. The changes of fibrous hyperplasia and foamy histiocyte and so on were the clues of the existence of breast carcinoma before neoadjuvant therapy. The morphologic changes of lymph node were similar to that of the original site. The atypical hyperplasia of para-cancer were differentiated from ductal carcinoma in situ. Conclusion The morphologic changes of breast carcinoma after neoadjuvant therapy may be one of difficulties in diagnosis. CNB, sufficient examination of specimen and immtmohistochemistry （AE1/AE3, CD68） may help solve this problem.

关 键 词：乳腺癌 新辅助化疗 诊断 核芯针穿刺活检 免疫组化 

分 类 号：R737.9[医药卫生—肿瘤]