乳腺错构瘤30例临床病理分析

乳腺错构瘤３０例临床病理分析唐山市妇幼保健院（０６３０００）何春年刘翠英刘继国华北煤炭医学院（０６３０００）王元福乳腺错构瘤（ｂｒｅａｓｔｈａｍａｒｔｏｍａ）是女性乳腺一种良性肿瘤，过去认为很少见。由于对其认识不足，在临床与病理工作中极易被漏误诊。现...     

乳腺错构瘤1例

乳腺错构瘤是一种很少见的乳腺良性肿瘤,且没有明确的起因[1].乳腺X线照相时偶尔发现.根据其主要成份,组织学分型为:腺脂肪瘤、纤维性错构瘤、腺性错构瘤、软骨脂肪瘤和平滑肌错构瘤.     

乳腺错构瘤的病因、病理及诊治

错构瘤(hamartoma)是指正常组织器官组成成分的异常混合,属于肿瘤样畸形,全身多种脏器均可发生。其中乳腺错构瘤(breast hamartoma)是指一种含有不同比例的纤维、脂肪组织、乳腺导管和小叶成分的包裹性肿块。虽然早在1904年Al-berecht就曾对此提出报道,随之Prym在1928年报道3例,称之为假性腺瘤,1958年Puence又称之为腺纤维脂肪瘤性增生,直到1971年Arrigoni等[1]根据Alberecht的诊断标准,提出了乳腺错构瘤这个名称。乳腺错构瘤并不多见,1992年Fisher等[2]报道了35例,分别占同期乳腺活检及乳腺良性肿瘤的0.5%和0.8%。在我国亦多为零星报道,…     

乳腺错构瘤2例

1 病例报告 例1 女,39岁,左乳肿物8个月,伴轻微胀痛入院.查体:左乳外上象限可触及6.0cm×6.0cm×4.0cm囊性肿块,轻微压痛,移动性好,皮肤正常.细针头穿刺检查未见异常.X线钼靶片诊断:乳腺肉瘤.局麻下行乳腺肿物切除,病理诊断:乳腺错构瘤.术后随访5年无复发.     

乳腺肌样错构瘤24例临床病理分析

背景与目的 乳腺肌样错构瘤（MHB）是乳腺错构瘤中极为罕见的亚型,文献中以个案报道为主,目前对其临床与病理学特征认识尚不足,容易漏诊或误诊。为提高对该病的认识,笔者报告1例MHB患者的临床资料,并结合国内学者报告的23例MHB,探讨其组织发生、临床病理特征、临床诊断、治疗及预后。方法 对三峡大学附属仁和医院收治的1例MHB及国内文献报道的23例MHB进行回顾性临床病理分析。结果 患者均为女性,发病年龄19~65岁,平均（37±12.3）岁。24例均为单发性肿瘤,其最大直径范围1.9~10.0 cm,平均（2.9±1.94）cm。笔者报告的1例在全组肿瘤中体积最大（直径10 cm）,其占笔者单位20年来受检的1 849例乳腺病理活检标本的0.05%和893例乳腺良性肿瘤的0.1%。影像学检查显示,所有肿瘤均可显示界限清楚的肿块,但图像不具特征性;B超引导下芯针活检有一定诊断价值。肉眼观察显示,均为界限清楚、可活动的无痛性乳腺包块或结节,类似纤维腺瘤。14例（58.3%）有临床诊断记录,但均被误诊为或考虑为乳腺纤维腺瘤。21例（87.5%）行单纯乳腺肿块切除术,3例（12.5%）行乳腺肿块扩大切除术。组织病理学结果显示,肿瘤均由乳腺导管、腺泡和纤维脂肪组织以不同比例随机混合组成;肿瘤内可见特征性平滑肌组织或肌样细胞,分化良好。免疫表型分析显示,肿瘤内平滑肌成分desmin、α-SMA、vimentin、MSA和h-caldesmon呈弥漫性强阳性。20例（83.3%）术后平均随访（18.6±15.4）个月,1例于术后10个月复发,1例于术后36、41个月2次复发,余无复发。结论 MHB是罕见的良性肿瘤,误诊率高。临床医师需增强对MHB的了解和诊断意识。临床和病理诊断中需与乳腺纤维腺瘤等相关肿瘤和瘤样病变鉴别。MHB可复发,治疗应采用广泛局部切除并确保切缘阴性,术后需定期随访。     

38例乳腺错构瘤的彩色多普勒超声图像分析

目的探讨乳腺错构瘤的彩色多普勒超声图像特征。方法回顾性分析38例乳腺错构瘤患者,探讨其二维、彩色血流及血流频谱表现,并按二维声像图及病理表现将其分为Ⅰ型、Ⅱ型、Ⅲ型。结果38例乳腺错构瘤中24例（63.16%）肿块位于外上象限。在超声检出的36例中,Ⅰ型病例14例,Ⅱ型病例5例,Ⅲ型病例17例。所有病变均具有清楚的边界。在检出病例中,15例瘤体内可检出血流信号,其中14例血流Adler分级为Ⅰ级,1例Adler分级为Ⅱ级;8例可检出动脉血流频谱。结论乳腺错构瘤的超声图像表现具有一定的特征性。     

乳腺神经内分泌癌三例

例 1　 患者女 ,5 0岁 ,因发现左侧乳房包块 1年入院。查体 :左乳腺外上象限触及 2 5ｃｍ× 3 0ｃｍ× 1 5ｃｍ包块 ,质中 ,边界不清 ,腋窝无肿大淋巴结。术后病理诊断 :左乳腺神经内分泌癌 ,免疫组化染色 (阳性细胞 <2 5 %为 +,2 5 %～5 0 %为 ++,>5 0 %为 +++) :突触素 (Ｓｙｎ) ++,神经元特异性烯醇化酶 (ＮＳＥ) +,嗜铬粒蛋白Ａ(ＣｇＡ) ++。例 2 　 患者女 ,6 0岁 ,因发现左侧乳房包块 5 0ｄ入院。查体 :左乳头内陷 ,左乳腺内下象限触及 3 5ｃｍ× 5 0ｃｍ×0 8ｃｍ包块 ,表面皮肤可见散在的红色小结节 ,边界不清 ,表面不光滑 ,酒窝…     

65例肾错构瘤的诊疗分析

目的：提高肾错构瘤（AML）的诊疗水平。方法：对65例肾错构瘤诊治资料回顾总结分析。结果：65例肾错构瘤全部经手术和病理证实，行肾切除术34例，肾部分切除术15例，肾错构瘤切除术16例。其中双侧肾错构瘤8例，恶变4例。结论：肾错构瘤手术后应长期随访，因紧错构瘤有复发，双侧性及恶变可能，肾错构瘤应早期诊断，尽早手术，保留肾脏。     

肺内错构瘤的诊断与外科治疗

总结肺内错构瘤11例，其发病年龄与肺癌者近似。但临床症状较轻，且无进行性加重。X线表现为弧立圆形或类圆形。有分叶者边界清楚，典型的可见爆米花样钙化。这些可与肺癌进行鉴别。现重点讨论错构瘤临床上虽属良性，但也应尽早手术治疗。原因是①某些病例与肺癌不易鉴别。②种瘤逐渐增大。对周围气管有压迫症状。③早期切除单纯摘除机会多，可保留较多功能肺组织。手术方法以单纯肿瘤摘除和局部切除为主，强调术中进行冰冻病理切片检查，以进行合理切除。     

23例乳腺粘液腺癌临床病理研究

乳腺粘液腺癌较少见,占乳腺癌的1%～6%,其预后明显好于普通类型乳腺癌.本院1985年1月至2000年12月,共诊治乳腺粘液腺癌23例,结合文献,探讨其临床病理特点.报告如下.     

Breast hamartoma: A report of 14 cases of an under-recognized and under-reported entity

ObjectivesMammary hamartoma is a rare benign lesion accounting for approximately 4.8% of all benign breast masses. It is often underdiagnosed and therefore is underreported mostly due to lack of awareness of the characteristic clinical and histological features. Raising awareness of this poorly recognized benign entity is of utmost significance as it clinically mimics other breast tumors including both benign and malignant ones. This study is to report and present our experience of breast hamartomas from Johns Hopkins Aramco Healthcare in the Eastern province of Saudi Arabia from which there have not been previous studies in literature.MethodA retrospective review of our pathology files was done from 1994 to 2014 for cases diagnosed as breast hamartoma during this 20 year period.ResultsA total of 14 cases with diagnosis of breast hamartoma were identified in our institute. Histologically the lesion is mostly sharply demarcated showing a mixture of varying proportions of fibrous, adipose, and glandular tissue. 13 cases were seen in females (93%) and only one rare occurrence in a male patient (7%). The age ranges quite vastly from 18 to 51 years (mean 33 years). Two-third of these lesions were seen involving the right breast (9 cases/64.3%) and only one-third in the left side (5 cases/35.7%). 13 out of 14 patients had a well circumscribed lesion (92.9%) while only 1 case showed irregular borders (7.1%). The size varied from 1.4 to 9.5 cm. Three cases (21.4%) showed evidence of myoid differentiation, a histopathologic variance which is important to identify however has no clinical significance. 3 cases had associated epithelial ductal hyperplasia of the usual type varying from mild (2 cases) to moderate (1 case); with two of these cases exhibiting additional features of fibrocystic mastopathy including adenosis, apocrine metaplasia, and cyst formation. None of our cases showed any malignancy or pseudoangiomatous stroma hyperplasia (PASH).     

A systematic review of symptomatic hamartomas of the jejunum and ileum

IntroductionGastrointestinal hamartomas are rarely encountered benign growths made of an abnormal mixture of tissues normally found in the body where the growth occurs. Most hamartomas are asymptomatic and diagnosed incidentally. Evidence regarding symptomatic hamartomas of the jejunum and ileum is limited and restricted to anecdotal case reports. We aim to provide a contemporary overview to clarify various aspects linked to symptomatic hamartomas, helping aide management and clinical decision-making.MethodsThe search terms ‘small bowel’, ‘small intestine’, ‘jejunum’ and ‘ileum’ were combined with ‘hamartoma’. Embase, Medline, PubMed searches and Google Scholar hand-searches were conducted. All English language papers from 1 January 2000 to 1 June 2020 were included.ResultsIn total 39 cases were reviewed: 29 adults and 10 paediatric (0–16 years). Presenting symptoms included abdominal pain (87%), vomiting (56%), gastrointestinal bleeding (20.5%) and weight loss (5%); 36 of 39 cases (92%) presented as emergencies. Diagnostic investigations included: abdominal x-ray (49%), endoscopy (38%), computed tomography (56%), magnetic resonance imaging (5%), contrast study (15%) and video capsule endoscopy (5%). Initial management strategy was either open (30) or laparoscopic (7) surgery or endoscopy (2). All cases required surgery for definitive management. Twenty-five cases recorded hamartoma size, and mean maximum diameter was 3.56cm (1.2–8cm) with stricturing in seven cases. Nine of the 39 cases were associated with hamartomatous syndromes. Two mortalities were recorded.ConclusionsThis is the first published review addressing symptomatic hamartomas of the jejunum and ileum. New data relating to demographic cohort, symptom profile, investigations, management strategies, and morbidity and mortality provide greater insight to those encountering this challenging clinical finding in the future.     

肾错构瘤自发性破裂10例报告

目的：探讨肾错构瘤自发性破裂出血的诊断与治疗。方法：10例肾错构瘤自发性破裂的患者。均行B超检查,9例行CT或MRI检查。结果：8例术前CT或MRI提示为肾错构瘤破裂出血,1例MRI诊断为肾肿瘤破裂出血,1例B超诊断为肾占位病变并肾周血肿。所有患者肿瘤直径均大于6cm,9例行患侧肾切除术。结论：CT和MRI是诊断肾错构瘤破裂出血的较好方法,并能提示病变的性质以及确定出血的范围。对于肿瘤直径大于4cm,且靠近肾包膜生长的肾错构瘤应积极治疗,手术治疗时应尽量保留有功能的肾组织。     

Glycogen-rich clear cell mammary malignant myoepithelioma

Primary clear cell tumors of the breast are uncommon and often present a diagnostic challenge. We describe an extremely rare case of glycogen-rich clear cell malignant myoepithelioma in a 43-year-old woman. Histologically, this tumor is composed of clear cells with abundant cytoplasmic glycogen particles. Immunohistochemically, these tumor cells show co-expression of vimentin, smooth muscle actin, epithelial membrane antigen, S-100 protein, and cytokeratin as evidence of myoepithelial cell tumor. The pathological staging of the patient is IIB (pT3N0M0) and the nuclear grading is 2. The patient demonstrated no evidence of recurrence or metastasis over a period of 42 months. We suggest that glycogen-rich clear cell malignant myoepithelioma be included in the histological differential diagnosis of clear cell tumors of the breast.     

误诊为肾细胞癌的肾错构瘤临床分析(附5例报告)

目的：分析肾错构瘤(Hamartoma of kidney,HK)的影像学误诊原因,探讨如何避免其误诊。方法：回顾性分析35例HK及其5例误诊为肾细胞癌(RCC)的临床表现及影像学特点。结果：影像学误诊为肾癌5例。B超、CT、MRI和选择性肾动脉造影等检查上有相应的表现。结论：只根据影像学所见可发生误诊,应结合临床表现并综合分析各种影像学检查结果,可提高HK的术前诊断率。     

B超引导下 Mammotome旋切系统在乳腺微创外科中的应用研究(附320例报告)

目的探讨B超引导下Mammotome微创手术在乳腺病灶的诊断与治疗价值。方法我科2004年6月～2005年1月对320例患者511个乳腺病灶在B超引导下进行Mammotome微创切除术,并进行回顾性分析及评价其在乳腺微创外科的应用价值。结果术后病理学诊断7个乳腺浸润性导管癌,6个乳腺导管内癌,24个中度～重度不典型增生。474个为病理学诊断良性病变。13个乳腺癌患者及24个中度～重度不典型增生患者均接受后序开放性手术切除,没有发生组织学低估。所有病理诊断良性病变患者术后2个月～8个月均接受B超,均未发现手术残留乳腺病灶。结论应用B超引导下Mammotome旋切系统对3mm～30mm乳腺病灶可进行微创完整切除并能获得明确病理组织学诊断。