乳腺纤维瘤病样化生性癌临床病理观察  

Fibromatosis-like metaplasia carcinoma of the breast: a clinicopathological analysis.

作　　者：吴晓辉[1] 王莉芬[2] 张莉[2] 冯晓海[2] 

机构地区：[1]大连医科大学附属第二医院钻石湾分院病理科,辽宁大连116031 [2]大连医科大学附属二院病理科,辽宁大连116027

出　　处：《诊断病理学杂志》2013年第11期698-701,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨乳腺纤维瘤病样化生性癌的病理组织学特征、诊断与鉴别诊断。方法对1例乳腺纤维瘤病样化生性癌进行病理形态学及免疫组化分析,并复习相关文献。结果患者女性,67岁。左乳内上象限可触及肿物,直径约1.8 cm。镜检:肿瘤大部分区域(>95%)由羽毛状或束状交错排列的梭形细胞组成,夹杂少量残存管状腺体及鳞状上皮细胞巢,肿瘤细胞形态温和或具有轻-中度不典型性,间质纤维组织增生伴胶原化。肿瘤组织界限不清,形成指状突起浸润邻近乳腺及纤维、脂肪组织。免疫组化肿瘤细胞具有双相性表达特征,34βE12、AE1/AE3、CK7和vimentin均(+),并具有肌上皮细胞分化特征p63和CD10(+)、SMA灶状(+)及基底样亚型乳腺癌特征ER、PR和HER-2均(-),CK5/6和EGFR均(+)。结论纤维瘤病样化生性癌是乳腺化生性癌的一种罕见亚型,因其形态温和、异型不明显而易被误诊,诊断需依赖免疫组化标记并与乳腺其他梭形细胞病变相鉴别。Objective To discuss the histopathological features, diagnosis and differential diagnosis of fibmmatosis-like metaplasia carcinoma of the breast. Methods One case of fibromatosis-like metaplasia carcinoma of the breast was studied by light microscopy and immunohistochemical technique. Results A 67-year-old woman presented with a 1.8 ×1.8 cm mass in the upper and inner quadrant of left breast. HistologicaUy, the tumor was predominately （ 〉 95% ） comprised with bland cells with mild atypia, admixing limited loci of residual glandular or squamous element. The spindle cells arranged in wary, intersecting fascicles, embedding in a abundant collagenous stroma and showing an infiltrative growth pattern with finger-like extensions into the adjacent mammary structures and fatty tissue. Both spindle and epithelial polygonal cell expressed epithelial markers, i. e. 34βE12, AE1/AE3 and CK7, and a mesenchymal marker vimentin. The myoepithelial marker, i.e. SMA, P63 and CD10, simultaneously showed positive expression. The tumor also presented a typical immunoprofile of basal-like carcinomas that were identified by the negative to ER, PR and cerbB-2 and positive to CK5/6 and EGFR. Conclusion Fibromatosis-like metaplasia carcinoma is a uncommon form of metaplastic carcinoma of the breast and easy to be misdiagnosed as its bland morphology. The diagnosis mainly relies on immunohistochemical findings and should be differentiated from other spindle cell lesions of the breast.

关 键 词：乳腺肿瘤 化生性癌 纤维瘤病 

分 类 号：R737.9[医药卫生—肿瘤]