乳腺良性硬化性病变基础上发生的低级别腺鳞癌临床病理学分析  

Low-grade adenosquamous carcinoma of the breast arising from benign sclerosing lesions:a clinicopathological analysis

作　　者：安然 李红霞[1] 朱红艳 丁华野 An Ran;Li Hongxia;Zhu Hongyan;Ding Huaye(Department of Pathology,the Seventh Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心病理科,北京100700

出　　处：《中华病理学杂志》2025年第3期230-236,共7页Chinese Journal of Pathology

摘　　要：目的探讨乳腺良性硬化性病变基础上发生的低级别腺鳞癌的临床病理学特征、免疫组织化学特点及诊断与鉴别诊断。方法回顾性分析解放军总医院第七医学中心病理科2010年1月至2023年12月诊断的12例乳腺良性硬化性病变基础上发生的低级别腺鳞癌,收集临床资料,进行常规组织学和免疫组织化学的观察,并结合相关文献进行讨论。结果12例患者均为女性,年龄21~60岁(平均42岁),其中5例伴有复杂硬化性病变,5例伴有硬化性腺病,伴硬化性导管内乳头状瘤及导管腺瘤的各1例。镜下均可见上述良性硬化性病变,亦见有浸润性多结节状纤维性病灶,其内有不规则小腺管、巢状-条索状实性细胞团、簇状及单个细胞,上皮成分有不同程度的鳞化,周围可见纤维瘤病样或促纤维结缔组织增生样改变,病变可累及神经、浸润周围正常小叶间和脂肪组织,常有灶状淋巴细胞浸润。免疫组织化学染色显示,12例不规则的小腺管、巢状/条索状实性细胞团、簇状及单个细胞细胞角蛋白(CK)5/6呈弥漫强阳性,p63呈多种形式阳性表达,雌激素受体、孕激素受体及HER2呈阴性,CK8/18(或CK7)呈不同程度阳性,甚至为阴性;其他肌上皮标志物(如平滑肌肌动蛋白、Calponin、SMMHC等)的表达有很大不确定性,常为阴性,Ki-67呈低增殖活性。结合形态学改变及免疫组织化学染色结果,12例均诊断在乳腺良性硬化性病变基础上发生的低级别腺鳞癌。结论乳腺低级别腺鳞癌少见,可与某些乳腺良性硬化性病变相伴发,容易漏诊及误诊,明确诊断主要依据小腺管的汗管样特征及其浸润生长的模式,并结合免疫组织化学表型特点。Objective To investigate the clinicopathological features,immunohistochemical characteristics,and differential diagnosis of low-grade adenosquamous carcinoma of the breast arising from benign sclerosing lesions.Methods Twelve cases of low-grade adenosquamous carcinoma arising from benign sclerosing lesions of the breast were collected,which were diagnosed from January 2010 to December 2023 at the Seventh Medical Center of the Chinese People′s Liberation Army General Hospital.Their clinical manifestations,histopathological morphology,and immunohistochemical characteristics were analyzed and related literatures were reviewed.Results All the 12 patients were females with a median age of 42 years(21-60 years).Five of the 12 cases had coexisting complex sclerosing lesions,5 with sclerosing adenosis,1 with sclerosing intraductal papilloma,and 1 with ductal adenoma.Microscopically,low-grade adenosquamous carcinoma grew infiltratively in multinodular and sclerosing lesions.The carcinomatous component was characterized by small irregular glandular structures,tubular formations,solid nests,clusters,or a single tumor cell.The epithelium showed varying degrees of squamous differentiation.The carcinoma was surrounded by fibroadenomatoid and desmoplastic lesions.The invasive neoplastic component typically infiltrated normal breast structures,and might infiltrate nerves and adipose tissue.There were lymphocytic aggregates commonly seen at the periphery.By immunohistochemistry,the tumor cells of all 12 cases showed diffuse and strong immunopositivity for CK5/6;negative expression of ER,PR and HER2;and variable expression of myoepithelial markers such as SMA,calponin,SMMHC and others.There was varied staining pattern of tumor cells for p63.CK8/18(or CK7)was variably positive or negative.The proliferative index measured by Ki-67 was low.Conclusions Low-grade adenosquamous carcinoma of the breast is a rare variant,which is found to coexist with other benign sclerosing lesions and can be easily missed and/or misdiagnosed.Their inv

关 键 词：乳腺肿瘤 诊断 鉴别 低级别腺鳞癌 

分 类 号：R73[医药卫生—肿瘤]