乳腺癌放疗后血管肉瘤2例临床病理学特征  

Clinical and pathological features of angiosarcoma after radiotherapy for breast cancer

作　　者：董玮[1] 刘玉花[2] 仉林霞 徐晋峰 郭晓彤 于海 DONG Wei;LIU Yu-hua;ZHANG Lin-xia;XU Jin-feng;GUO Xiao-tong;YU hai(Department of Pathology,Weifang Traditional Hospital,Weifang 261041,China;Operating Room,Weifang Traditional Hospital,Weifang 261041,China)

机构地区：[1]潍坊市中医院病理科,山东潍坊261041 [2]潍坊市中医院手术室,山东潍坊261041

出　　处：《诊断病理学杂志》2020年第1期20-23,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨乳腺癌放疗后发生的血管肉瘤临床病理特点、诊断及鉴别诊断。方法对2例继发于乳腺癌放疗后的血管肉瘤行临床病理学观察和免疫组化分析,并复习文献。结果例1女性,71岁。乳腺癌放疗后8年,局部表面皮肤暗红色。巨检见2处质硬区,质硬区体积为1.5 cm×1.5 cm×1 cm和1 cm×1 cm×0.8 cm;切面均为灰白、黄色,质韧。肿瘤主要位于皮下,累及实质组织。瘤细胞呈短梭形,异型性明显,不规则裂隙状、腺样排列,侵及表皮。免疫组化:CD31、CD34、ERG和Fli-1等阳性。例2女性,69岁。乳腺癌放疗后9年,乳腺内侧和乳晕之间发现直径7 cm大小的瘀斑,其他临床病理特点与例1相似。结论放疗后乳腺血管肉瘤为高度恶性肿瘤,形态欠典型,呈多样性,结合病史及免疫组化可明确诊断。肿瘤分化程度与预后密切相关,其对放、化疗不敏感,预后差。目前手术切除仍是乳腺血管肉瘤的主要治疗手段。Objective To investigate the clinical and pathological features,diagnosis and differential diagnosis of angiosarcoma after radiotherapy for breast cancer.Methods Two cases of angiosarcoma secondary to breast cancer after radiotherapy were analyzed by histomorphology and immunohistochemistry,and the literature was reviewed.Results Case 1,female,71 years old,had been undergoing radiotherapy for breast cancer for 8 years.The skin was dark red on the surface,and there were 2 hard areas in the gross examination.The volume of the hard area was 1.5×1.5×1 cm,and 1×1×0.8 cm,respectively.The tumor was primarily subcutaneous and involved parenchymal tissue.The tumor cells were short spindle shaped with obvious atypia,irregular fissure and adenoid arrangement,invading the epidermis.Immunohistochemically,the tumor cells were positive for CD31,CD34,ERG and Fli-1.Case 2,female,69 years old,had been undergoing radiotherapy for breast cancer for 9 years.A 7 cm sized ecchymosis was found between the medial breast and areola.Other clinicopathological features were similar to those of case 1.Conclusion Breast angiosarcoma is a highly malignant tumor after radiotherapy.The morphology is less typical,diversity,combined with medical history and immunohistochemistry can be used in making the diagnosis.The degree of tumor differentiation is closely related to the prognosis.It is not sensitive to radiotherapy and chemotherapy,and the prognosis is poor.Surgery is still the main treatment method for angiosarcoma of breast.

关 键 词：乳腺癌 放疗后血管肉瘤 病理诊断 

分 类 号：R732.2[医药卫生—肿瘤]