乳腺腺病上皮细胞胞质内嗜酸性粗颗粒的形态学观察  

Morphological changes of eosinophilic coarse granules in epithelial cytoplasm of breast adenosis

作　　者：宋沙沙 丁华野 Song Shasha;Ding Huaye(Department of Pathology,Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University,Jinan 250014,China;Department of Pathology,the Seventh Medical Center of People′s Liberation Army General Hospital,Beijing 100700,China)

机构地区：[1]青岛大学附属山东省妇幼保健院病理科,济南250014 [2]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237-242,共6页Chinese Journal of Pathology

摘　　要：目的探讨乳腺腺病上皮细胞胞质内嗜酸性粗颗粒的形态学变化、免疫表型特征及其临床病理意义。方法收集解放军总医院第七医学中心病理科及青岛大学附属山东省妇幼保健院病理科2019年12月至2023年8月本院收治及会诊的乳腺上皮细胞胞质内含有嗜酸性粗颗粒的病例共64例,观察其嗜酸性粗颗粒的分布及形态学特征,部分病例进行溶菌酶、α-抗胰蛋白酶、α-抗胰糜蛋白酶、组织蛋白酶D、上皮细胞膜抗原(EMA)、广谱细胞角蛋白(CKpan)、雌激素受体(ER)、孕激素受体(PR)、雄激素受体(AR)、GCDFP-15、突触素、嗜铬粒素A(CgA)、神经元特异性烯醇化酶(NSE)、CD68、S-100蛋白、抗线粒体、p63、平滑肌肌动蛋白(SMA)免疫组织化学染色、黏液卡红染色及淀粉酶消化前后阿辛蓝-过碘酸雪夫(AB-PAS)染色。结果64例乳腺上皮细胞胞质内嗜酸性粗颗粒均为镜下偶然发现,大部分(43例)位于导管内乳头状瘤周围的腺病内。在HE切片中,胞质内见弥漫性分布的嗜酸性粗颗粒,呈大小不等的圆形,粉红色-鲜红色,具有一定的折光性。根据颗粒的大小,可将其分为小、中和大颗粒3种类型,中-大颗粒在病变中更为突出。免疫组织化学及组织化学染色,嗜酸性粗颗粒溶菌酶、α-抗胰蛋白酶、α-抗胰糜蛋白酶、组织蛋白酶D、EMA及S-100蛋白均呈阳性,ER、PR腺上皮细胞呈非克隆性阳性,淀粉酶消化前后PAS染色均呈阳性;AR、GCDFP-15、突触素、CgA、NSE、CD68及抗线粒体均呈阴性,黏液卡红及AB染色亦均呈阴性。结论64例乳腺腺病上皮细胞胞质内嗜酸性粗颗粒的形态学特征及免疫表型均与酶原颗粒相同,其性质符合酶原颗粒,它们的存在可能是一种非特异性的形态学表现,代表乳腺上皮细胞的一种化生现象。溶菌酶、α-抗胰糜蛋白酶等的阳性表达不能被认为是特定细胞分化的证据,诊断腺泡细胞癌,应结合形态学及�Objective To investigate the morphological changes and immunophenotypic characteristics of eosinophilic coarse granules in the cytoplasm of epithelial cells of breast adenosis,and their clinicopathological significance.Methods A total of 64 cases containing eosinophilic coarse granules in the cytoplasm of breast epithelial cells admitted to the Department of Pathology of the Seventh Medical Center of People′s Liberation Army General Hospital and the Department of Pathology of Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University for admission and consultation from December 2019 to August 2023 were collected.The distribution and morphological characteristics of eosinophilic coarse granules in the epithelial cytoplasm in 64 cases of breast adenosis were observed.Some cases underwent immunohistochemical staining of lysozyme,α-antitrypsin,α-antichymotrypsin,cathepsin D,EMA,panCK,ER,PR,AR,GCDFP-15,Syn,CgA,NSE,CD68,S-100,anti-mitochondrial antibody,p63,and SMA;and some cases were stained with mucicarmine,and AB-PAS histochemical staining before and after amylase digestion.Results The eosinophilic coarse granules in the breast epithelial cytoplasm of 64 cases were seen accidentally,of which most(43 cases)were located in adenosis adjacent to the intraductal papilloma.By HE sections,eosinophilic coarse granules were found with diffuse distribution in the cytoplasm,which were round in varying sizes,pink-bright red,and with a certain degree of refractivity.The size of the coarse granules could be divided into three types:small,medium and large.The medium to large granules were more prominent in the lesions.The eosinophilic coarse granules were all positive for lysozyme,α-antitrypsin,α-antichymotrypsin,cathepsin D,EMA and S-100.ER and PR were all nonclonal positive in glandular epithelial cells.Histochemical stains for PAS were all positive before and after digestion of amylase.AR,GCDFP-15,Syn,CgA,NSE,CD68 and anti-mitochondrial antibodies were all negative;mucicarmine and AB stai

关 键 词：乳腺肿瘤 免疫组织化学 嗜酸性粗颗粒 

分 类 号：R73[医药卫生—肿瘤]