“癌肉瘤”样恶性叶状肿瘤诊断陷阱分析  

Diagnostic pitfall of “carcinosarcomatoid”malignant phyllode tumor

作　　者：牛海艳[1] 王敏健[1] 郑少江[1] 马志健[2] 

机构地区：[1]海南医学院病理教研室暨附属医院病理科,海口571199 [2]海南医学院教务处,海口571199

出　　处：《诊断病理学杂志》2016年第8期605-608,共4页Chinese Journal of Diagnostic Pathology

基　　金：海南省自然科学基金(812194)

摘　　要：目的分析"癌肉瘤"样恶性叶状肿瘤(CMPT)的诊断陷阱并文献复习。方法对1例CMPT的临床特点、HE染色和免疫组化特点并结合文献进行分析。结果 CMPT形态学上具有间质细胞双向分化的特征并缺乏叶状结构;肿瘤组织中上皮样间质细胞高表达CD34,梭形间质细胞低表达或不表达;由于形态上具有典型上皮样区域,且肿瘤细胞疏松区常见炎细胞浸润,在细针穿刺、冷冻及常规病理时,需排除炎症性病变和浸润性癌;其与乳腺导管周间质肿瘤在形态和免疫组化上部分重叠。结论 CMPT可能是一种与恶性叶状肿瘤和导管周上皮样间质肿瘤相关的特殊而罕见的乳腺恶性纤维上皮性肿瘤,或是导管周间质肿瘤向恶性叶状肿瘤转化的中间过程。Objective To analyse the diagnostic pitfall of ＂carcinosarcomatoid＂ malignant phyllode tumor （CMPT） with review of literatures. Methods According to one case of CMPT, the clinical-pathological feature was studied by means of gross observation, HE staining and immunohistochemical staining with review of the relevant literature. Results Morphologically, CMPT stromal cells surrounding the open small duct exhibited biphasic differentiation： spindle cells and epithelialoid cell with a few scattered inflammatory cells without leaf-like architecture. Positive expression of CD34 was observed in the epithelialoid stromal cells and the negative expression was observed in the spindle stromal cells. So before the diagnosis by fine needle aspiration, frozen and parrafin section, inflammatory and carcinomatic lesion should be excluded. Morphological changes may overlap between the CMPT and periductal stromal tumor （PDST）. Conclusion CMPT might be a special and rare malignant fiber epithelial tumor associated with MPT and PDST. Possibly it is a intermediate step that PDST will proceed into malignant phyllode tumor.

关 键 词：乳腺 叶状肿瘤 管周间质肿瘤 管周间质肉瘤 

分 类 号：R737.9[医药卫生—肿瘤]