乳腺肌样错构瘤临床病理分析及文献复习

目的探讨乳腺肌样错构瘤(myoid harmatoma,MH)的临床病理特征及生物学行为。方法收集5例MH,进行组织病理学、免疫表型及电镜观察。结果 5例发病年龄29~44岁,平均39岁。肿瘤直径1.4~2.0 cm,平均1.7 cm。镜检:3例边界清楚,2例边界不清。肿瘤均由不同比例的乳腺腺泡、导管,肌样细胞束,纤维间质及脂肪组织组成。肌样细胞束散在灶性分布于纤维脂肪间质之中(4例),或与间质弥漫片状混合(1例)。肌样细胞类似于平滑肌细胞(1例)或肌纤维母细胞(4例)。免疫表型:5例肌样成分均表达desmin,α-SMA,MSA。电镜检查:1例显示肌纤维母细胞分化。5例均行肿块切除术,2例局部复发。结论 MH是乳腺错构瘤的少见亚型,以呈平滑肌或肌纤维母细胞分化的肌样细胞束为典型特征。肌样细胞表达平滑肌标记,而超微结构上可能显示肌纤维母细胞分化。少数MH存在复发潜能;需局部广泛切除,保证切缘阴性。     

乳腺髓系肉瘤与弥漫性大B细胞淋巴瘤临床病理特征的比较

目的探讨乳腺髓系肉瘤的临床病理学特征、诊断及鉴别诊断。方法收集2005年2月至2019年9月北京大学人民医院病理科诊断的10例乳腺髓系肉瘤病历资料, 与同期19例乳腺弥漫性大B细胞淋巴瘤(DLBCL)相对比, 按2008版WHO淋巴造血组织肿瘤分类和2017版分类更新, 应用光镜观察、免疫组织化学染色方法进行临床病理学分析。结果 10例髓系肉瘤患者均为女性, 年龄范围23～47岁, 平均年龄33.8岁。患者均表现为乳腺肿物。6例(6/10)有B症状。4例血清乳酸脱氢酶升高。肿物最大径1.0～5.3 cm,平均2.7 cm。10例均有急性髓性白血病(acute myeloid leukaemia,AML)病史, 1例5年前因葡萄胎化疗后出现AML。其中M0 1例, M2 4例, M4 2例, M5 3例。10例患者均行化疗, 9例行异基因造血干细胞移植, 4个月至2年后出现乳腺肿物。Ann Arbor分期5例为Ⅰ期, 3例为Ⅱ期, 2例为Ⅳ期。病变位于乳腺左侧2例, 右侧3例, 双侧5例。2例除了乳腺病变以外, 还伴有中枢神经系统、眼眶周围侵犯。与DLBCL病例比较, 外周血淋巴细胞百分...     

乳腺纤维瘤病样化生性癌3例临床病理分析

目的 探讨乳腺纤维瘤病样化生性癌(fibromatosis-like metaplastic carcinoma,FLMC)的临床病理学特征.方法 回顾性分析3例FLMC的临床病理学特征及免疫表型、诊断及鉴别诊断、治疗及预后等,并复习相关文献.结果 3例患者均为女性,年龄范围43～58岁,均为无意间发现乳腺肿块就诊.镜...     

乳腺腺样囊性癌临床病理学特征及生物学行为

目的探讨乳腺腺样囊性癌(adenoid cystic carcinoma,ACC)的临床病理学特征、诊断及预后,以提高对该病的认识水平。方法收集3例乳腺ACC,标本均充分取材,完善临床及预后资料,观察临床病理学特点,行PAS、AB-PAS法特殊染色和免疫组化SP法检测。结果 3例患者均为女性,年龄49～65岁,平均56岁,临床以乳腺无痛性肿块或触痛为主要症状就诊,肿块多位于乳晕区。眼观:肿块与周围乳腺组织分界清楚,无包膜,切面呈灰白、淡黄、棕褐或粉红色;直径1.0～3.0 cm,平均2.2 cm。镜检:肿瘤细胞形成许多大小不等的管腔结构,肿瘤细胞较小,胞质少,核深染,核分裂象少见,核仁不明显。间质可见疏松黏液样改变。免疫表型:CD117、CK5/6、CK(34βE12)、SMA、Calponin、p63均强阳性,S-100呈局灶表达,Ⅳ型胶原基膜阳性,ER、PR、HER-2均呈阴性,Ki-67增殖指数5%～8%。AB-PAS和PAS染色均阳性。结论 ACC多见于唾腺,发生于乳腺者罕见,属于低度恶性、生长缓慢的实体肿瘤,预后较好,但免疫表型将其大多数归入三阴型乳腺癌中,常误诊为其他类型的癌,结合临床特征、HE形态、特殊染色及免疫组化有助于正确诊断。     

乳腺结节性筋膜炎4例临床病理观察并文献复习

目的探讨乳腺结节性筋膜炎的临床病理学特征、诊断及鉴别诊断。方法采用HE染色和免疫组化En Vision法检测4例乳腺结节性筋膜炎,并进行临床病理回顾性分析。结果患者均为女性,中位年龄50.5岁,病程短,无局部外伤史,肿块平均直径1.2 cm,3例位于乳腺实质,1例紧邻皮肤。4例病变均见不同程度梭形细胞增生和红细胞外渗及不等量淋巴细胞浸润,其中3例边界不清,浸润周围乳腺及脂肪组织。3例行术中冷冻,2例与常规诊断完全符合。免疫表型:梭形细胞表达vimentin、CD10和SMA,不表达CK(AE1/AE3)、CK5/6、CK14、CAM5.2、ER和PR。随访6~93个月,4例经手术局部切除后,均未复发。结论乳腺结节性筋膜炎临床较少见,术中冷冻诊断有一定的难度,易与乳腺纤维瘤病、叶状肿瘤及低级别纤维瘤病样梭形细胞癌等良、恶性肿瘤混淆,免疫组化标记vimentin和SMA对诊断及鉴别诊断乳腺结节性筋膜炎有帮助。     

副乳腺及其肿瘤200例临床病理分析

目的 探讨副乳腺及其肿瘤的临床病理学特点和诊断要点。方法 对200例副乳腺及其肿瘤的临床病理学资料进行分析。结果 187例副乳腺中女性185例，男性仅2例。症状期1个月～32年。副乳腺纤维腺瘤发生率是同期副乳腺患者的4．8％，副乳腺癌发生率是同期乳腺癌患者的0．7％。结论 副乳腺及其肿瘤的组织类型与原发于正常部位同类型乳腺肿瘤一样，在诊断副乳腺及其肿瘤时必须证实与正常部位乳腺无关。副乳腺癌早期诊断困难，且淋巴和血供丰富，易早期转移，患者预后差。     

血清HCG在乳腺良恶性肿瘤鉴别诊断中的价值

本文对绒毛膜促性腺激素(HCG)在乳腺良恶性肿瘤患者血清中含量作一评价,旨在探讨HCG在其鉴别诊断中的价值。现报道如下。1　对象和方法1 1　对象1 1 1　正常对照组　31例女性患者,年龄(2 1～6 5 )岁,均为本院健康体检合格者。1 1 2　乳癌组　4 0例女性,年龄(31～5 9)岁,均为本院住院患者,均由病理学确诊,血清CA1 53 值为(87 9±36 4 )KU/L。1 1 3　乳腺纤维腺瘤组　36例女性,年龄(2 3～38)岁,均为本院门诊或住院患者,均由病理学确诊,血CA1 53 值为(1 2 9±3 6 )KU/L ,并排除妊娠。1 2　方法1 2 1　病人肘静脉采血2ml,分…     

胰腺实性—假乳头状肿瘤8例临床病理学分析

目的探讨胰腺实性-假乳头状肿瘤(solid-pseudopapillary tumor of pancreas,SPTP)的临床病理学特点、诊断和鉴别诊断、治疗及其预后。方法对8例SPTP患者的临床、病理学特点及免疫组化结果进行研究,并复习相关文献。结果 8例均为女性,年龄19～38岁,平均28岁。肿块直径3～15 cm。镜下肿瘤由乳头区和囊实区混合组成,瘤细胞围绕纤维血管轴心形成特征性假乳头结构。免疫表型:CK(3/8)、vimentin(8/8)、NSE(8/8)、CD56(8/8)、ER(0/8)、PR(5/8)、α-AT(8/8)、CgA(1/8)、Syn(8/8)、E-cadherin(0/8)、β-连环蛋白(8/8)和cyclinD1的核阳性率均大于40%。随访6例患者17～131个月,均无肿瘤复发及转移,并存活至今。结论 SPTP是一种好发于年轻女性,具有低度恶性潜能的少见胰腺肿瘤,其病理形态特征和免疫组化标记对SPTP的诊断和鉴别诊断具有重要价值。     

巨乳症的临床与病理学观察

目的 研究巨乳症的临床与病理学特点。方法 采用免疫组化S-P法测定10例巨乳症组织中雌激素受体(ER)、孕激素受体(PR)的表达。结果 巨乳症乳腺组织光镜下以l司质纤维组织、脂肪组织及血管增生为主，ER( )或ER和PR( )为75％。结论 巨乳症的发生与乳腺对雌激素的敏感性增强有关。     

乳腺癌和癌旁乳腺组织中Notch1基因mRNA及蛋白的表达

目的 检测Notch1基因mRNA及Notch1蛋白在人乳腺癌和癌旁乳腺组织中的表达,分析其临床病理学意义.方法 应用逆转录聚合酶链反应(RT-PCR)方法榆测60例乳腺浸润性导管癌和60例癌旁乳腺组织中Notch1基因mRNA,应用免疫组织化学SP法检测60例乳腺浸润性导管癌、30例导管原位癌及60例癌旁乳腺组织Notch1蛋白的表达,分析Notch1表达水平与乳腺癌临床病理特征的相关性.结果 Notch1基因mRNA在人乳腺浸润性导管癌及癌旁乳腺组织中均有表达.Notch1蛋白在癌旁乳腺组织和导管原位癌中的阳性牢分别为55%(33/60)、70%(21/30),二者差异无统计学意义(P>0.05),在乳腺浸润性导管癌中的阳性率为90%(54/60),明显高于癌旁乳腺组织和导管原位癌的阳性率(P<0.05).乳腺浸润性导管癌Notch1蛋白的高表达与肿瘤的淋巴结转移(P=0.006)、病理学分级(P=0.001)和TNM分期(P=0.022)均呈显著正相关.结论 乳腺浸润性导管癌存在Notch1蛋白的高表达.Notch1蛋白高表达与乳腺癌的恶变演进有关.Notch1基因的表达可能影响乳腺癌的发生、发展.     

Lobular carcinoma in a mammary hamartoma.

Mammary hamartomas are uncommon breast lesions, sometimes presenting as mammographic abnormalities which require pathological clarification. Previous cases have all been benign. A unique case of mammary hamartoma containing atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and foci of microinvasive lobular carcinoma is presented. The need for adequately sampling macroscopically innocuous breast lesions is emphasised.     

Mammary hamartoma--a case report

Mammary hamartoma is a rare lesion commonly associated with Cowden syndrome. It presents clinically as a fibroadenoma. The nonspecific cytological findings makes the pre-operative diagnosis of this lesion difficult. Though hamartomas of the breast are predominantly benign, co-existent malignancies within them have been reported. These lesions also have a tendency to recur; hence a correct diagnosis and extensive sampling of hamartoma is essential. We report a case of mammary hamartoma with a brief review of literature.     

Ductal carcinoma in situ arising in mammary hamartoma

Hamartoma of the breast is an uncommon lesion. Although it can possess characteristic radiological features, the pathological appearance is not distinctive. Hamartoma is generally considered benign, but four cases have been reported with ductal and lobular carcinoma arising in hamartomas. This report describes further cases of hamartoma from which ductal carcinoma in situ arose, with one showing early invasion. In both cases, the tumours were within the hamartomas and were adequately excised during lumpectomies of the hamartomas, and the patients were well afterwards. This report emphasises the importance of adequate sampling of mammary hamartoma.     

Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review

OBJECTIVES:

Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review.

METHOD:

We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013.

RESULTS:

In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty''s Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%).

CONCLUSION:

Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates.     

超声引导下麦默通旋切术在BI-RADS3级临床触诊阴性乳腺病灶中的临床应用价值

目的探讨B超引导下麦默通旋切术在BI-RADS 3级临床触诊阴性乳腺病灶中的临床应用价值。方法175例临床触诊阴性的乳腺肿瘤患者,BI-RADS分级为3级的肿块共425个,分析其手术时间、术后并发症、术后复发、≥35岁及<35岁不同年龄段的病理结果、恶性率等。结果425个临床触诊阴性病灶均被完全切除,平均手术时间小于15 min。术后病理结果显示,良性病灶共405个(95.29%),恶性病灶共6个(1.41%),癌前病变共14个(3.29%);术后出现瘀斑4例(2.29%),局部血肿2例(1.14%);术后随访1年,其中3人局部复发(1.71%)。≥35岁患者103例,其中乳腺癌有5例(4.84%),不典型增生有4例(3.88%),良性乳腺疾病患者有94例(91.3%);<35岁患者72例,其中乳腺癌为0(0%),不典型增生有2例(2.78%),良性乳腺疾病患者有70例(97.2%)。结论超声引导下麦默通旋切术可对BI-RADS 3级临床触诊阴性的乳腺病灶进行早期诊治,且美观、微创、安全,值得推广应用;≥35岁患者推荐微创手术活检以早期诊断及降低乳腺癌漏诊率。     

远离乳晕的乳腺纤维瘤手术切口的改进

目的了解远离乳晕的乳腺纤维瘤用乳晕边缘切口的可行性。方法收治约220例肿物距乳晕边缘大于3 cm的乳腺纤维瘤手术病人,分为实验组（120例）和对照组（100例）。实验组采用乳晕边缘切口,对照组采用传统开放手术切口。观察两组病人术后疤痕大小、能否哺乳、血肿有无、拆线时间长短、手术时间长短作为检测指标。结果所有切口均甲级愈合,术后6～7 d拆线。对照组传统切口疤痕宽0.2 cm及以下（小于等于0.2 cm）的有20例（20%）,实验组乳晕边缘切口疤痕宽0.2 cm及以下的有90例（75%）,两组之间差异有统计学意义（P〈0.01）。两组的不能哺乳发生率、血肿、拆线时间相似,实验组手术时间较对照组延长。结论乳晕边缘切口应用于远离乳晕的乳腺纤维瘤手术中是安全可行的,能取得治疗及美容双重效果。     

Androgen receptors are frequently expressed in mammary and extramammary Paget's disease.

Mammary Paget's disease and extramammary Paget's disease are rare intraepithelial neoplasms. Mammary Paget's disease is almost exclusively associated with underlying invasive breast carcinoma or high-grade ductal carcinoma in situ (DCIS G3). Extramammary Paget's disease arises in areas rich in apocrine glands and is suspected to have apocrine gland origin. The aim of the study was to investigate the presence of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR) and Her2/neu in a large number of cases. We investigated 58 cases of mammary and 23 cases of extramammary Paget's disease. Formalin-fixed and paraffin-embedded tissues were analyzed using antibodies against AR, PR, ER and Her2/neu according to standardized procedures. In mammary Paget's disease, positive immunoreactions for Her2/neu, AR and ER were observed in 56 of 58 (97%), 51 of 58 (88%), and respectively in six of 58 (10%) cases. All cases of mammary Paget's disease were negative for PR and showed a coexpression of Her2/neu and AR in 51 out of 58 cases (88%). In extramammary Paget's disease, positive immunoreactions for AR, Her2/neu and ER were observed in 18 of 23 (78%), 12 of 23 (52%), and respectively in 1 of 23 (4%) cases. All cases of extramammary Paget's disease were negative for PR and showed a coexpression of AR and Her2/neu in 12 out of 23 cases (52%). In contrast to ER and PR, AR and Her2/neu are commonly expressed in mammary and extramammary Paget's disease. The knowledge about frequent expression of AR in Paget's disease could lead to the development of a new adjuvant therapy, particularly in patients with recurrent disease.     

Nasal seromucinous hamartoma (microglandular adenosis of the nose): a morphological and molecular study of five cases

Five cases of nasal seromucinous hamartoma were studied and their clinical, morphological, immunohistochemical and molecular data are reported. The patients, three females and two males, ranged in age from 49 to 66 years (mean 56 year, SD ± 7.91). All lesions were located in the nasal cavity. In four cases where follow-up was obtained, no recurrence was evident. In all cases, numerous small seromucinous tubules, embedded in a cellular stroma, were present in the lamina propria. Tubules were lined by one layer of cuboidal cells which displayed luminal phenotype positive for lysozyme and EMA in four, and S100 protein in all cases. Collagen IV and laminin positive basal lamina outlined the tubules which lacked basal cells. Stromal spindle cells present among tubules were immunoreactive for calponin in all cases and for alpha-smooth muscle actin in four cases. DNA mutation analysis of mitochondrial D-loop region was performed by direct sequencing in order to verify the mutation rate of these lesions. The tubules of the five seromucinous hamartomas showed a higher mutation rate especially in heteroplasmy (0.52% homoplasmy, 2.02% heteroplasmy) in comparison to normal seromucinous glands which exhibited a lower mutation frequency (0.83%). This is considered a sign of a low cellular proliferation rate consistent with a benign process. It is concluded that nasal seromucinous hamartomas are benign glandular proliferations that may resemble microglandular adenosis of the breast. Their distinction from benign and malignant mimics is discussed.     

Breast hamartomas: clinicopathological and immunohistochemical studies of 24 cases

AIMS: The aim of our study was to investigate the clinical, pathological and immunohistochemical features of breast hamartomas, in order to obtain a detailed profile of this somewhat uncommon lesion. METHODS AND RESULTS: This study presents a clinical, pathological and immunohistochemical analysis of 24 breast hamartomas. Four cases of fibrocystic breast changes were used as a control group. The immunohistochemical panel induced oestrogen (ER) and progesterone (PR) receptors, c-erbB-2 protein, p53, Ki67, CK-MNF116, and vimentin. The patients ranged in age from 30 to 78 years (mean 48 years). All patients presented with a palpable unilateral mass. Three patients showed two hamartomas in the same breast. Tumours ranged from 20 to 50 mm in diameter. Typical macroscopic and microscopic features were noted. Immunohistochemical studies showed ER and PR receptor positivity in epithelial cells as well as in the stromal cells in all 24 cases. No c-erbB-2 protein over-expression was noted. p53 expression was not observed. Ki67 showed 2-3% positivity in epithelial cells and not in stromal cells in most cases. CONCLUSIONS: There was no association with side, ethnic origin or dietary habits. The immunohistochemistry of hamartomas is generally similar to normal breast or fibrocystic breast tissue. Ki67 together with receptor positivity may reflect some proliferative activity and explain observed faster growth of hamartoma during pregnancy and lactation.     

Mammary hamartoma—a review of 35 cases

Mammary hamartomas are macroscopically well-delineated tumours composed of a variable mixture of epithelial elements, fat and fibrous tissue. Such lesions are an under-recognized entity and, as they can be visualized by mammography, may be seen more frequently with the advent of the UK National Breast Screening Programme. The clinical and pathological features of 35 cases of mammary hamartoma seen at the Imperial Cancer Research Fund Clinical Oncology Unit at Guy's Hospital between 1979 and 1990 have been reviewed. Hormone receptor analysis on nine cases gave high progesterone with low oestrogen levels, probably reflecting their premenopausal status. Immunohistochemistry showed that the positive receptor staining was confined to the epithelial elements. In 25 cases pseudo-angiomatous hyperplasia was evident in the stroma of the lesion. The importance of distinguishing the inter-anastomosing stromal spaces seen in the latter condition from low-grade angiosarcoma is emphasized; the relationship between pseudo-angiomatous hyperplasia and mammary hamartoma is discussed; and the possibility that the former represents a permanently dilated form of the lymphatic labyrinth suggested.