乳腺导管内乳头状病变64例临床病理分析  

Clinicopathologic features of intraductal papillary lesions of the breast

作　　者：朱丽娜 王晓晶 史雪鸿 孙春杰 

机构地区：[1]通州区妇幼保健院病理科,北京101100

出　　处：《诊断病理学杂志》2016年第4期267-271,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨乳腺导管内乳头状病变的临床病理特征及其鉴别诊断。方法对64例乳腺导管内乳头状病变进行HE染色和CK5/6、p63、CK8、ER免疫组化染色观察。结果导管内乳头状瘤(IP)51例,伴不典型导管增生(ADH)或导管原位癌(DCIS)6例,导管内乳头状癌(IPC)4例,实性乳头状癌3例。32例伴普通型导管增生的IP其增生上皮CK5/6呈镶嵌状(+),CK8呈分散或簇状(+),其中21例ER呈不均匀(+);纤维血管轴心肌上皮呈p63和CK5/6(+)。导管内乳头状瘤伴ADH、IP伴DCIS、IPC和SPC的增生上皮CK5/6(-),CK8片状(+),ER均匀强(+);纤维血管轴心肌上皮呈p63和CK5/6(-)或(+)。结论乳腺导管内乳头状病变是一组良、恶性混合存在的病变,应通过特定的组织形态、增生上皮CK5/6、CK8和ER的表达情况以及肌上皮的位置进行鉴别。Objective To elucidate the clinicopathologic features and differential diagnosis of intraductal papillary lesions of the breast. Methods Total 64 cases of intraductal papillary lesions of the breast were observed by histopathologic morphology and analyzed by immunohistochemical staining. Results A total of 51 cases of intraductal papilloma（ IP）were diagnosed. 32 cases had usual ductal hyperplasia（ UDH）,13 had large sweat gland metaplasia,2 had necrosis,10 had interstitial fibrosis,and 2 had myoepithelial hyperplasia. 6 cases of IP with atypical ductal hyperplasia（ ADH） or ductal carcinoma in situ（ DCIS） were confirmed. 5 of the 6 cases exhibited areas of epithelial proliferation that fulfilled the combined architectural and cytological criteria for the diagnosis of low grade DCIS. The atypia within 1 case was intermediate nuclear grade. Myoepithelial cells were present or absent in fibrovascular cores of ADH or DCIS in 6 cases. 4cases of intraductal papillary carcinoma（ IPC） were identified. The papillae of 1 case were covered by a population of columnar epithelial cells,no myoepithelial cells were present. 3 cases displayed the combined architectural and cytological criteria similar to low grade DCIS,myoepithelial cells were present or absent in fibrovascular cores. 3 cases of solid papillary carcinoma（ SPC） were verified. The nuclei of the neoplastic epithelial cells were low grade in 1 cases and were intermediate grade in 2 cases. Immunohistochemical results showed that hyperplasia epithelium of 32 cases of IP with UDH were mosaicly positive for CK5 /6 and were dispersedly or clusteredly positive for CK8,hyperplasia epithelium that 21 of 32cases were stained by ER were unevenly positive; myoepithelial cells were positive for p63 and CK5 /6 in fibrovascular cores. But hyperplasia epithelium of IP with ADH or DCIS,IPC and SPC were negative for CK5 /6,were diffusedly strongly positive for CK8 and were evenly strongly positive for ER; myoepithelial cells were negative or positive for p63 an

关 键 词：导管内乳头状病变 实性乳头状癌 CK5/6 肌上皮 鉴别诊断 

分 类 号：R655.8[医药卫生—外科学]