乳腺叶状肿瘤的形态学和免疫组织化学研究

目的观察乳腺叶状肿瘤（phyllodes tumours,PTs）的形态学和免疫组织化学特征,并探讨其诊断标准。方法对21例PTs进行组织学观察和免疫组化SP法检测,并选取5例乳腺纤维腺瘤和5例乳腺腺病标本作为对照组。使用一抗包括CK-pan、EMA、SMA、p53、S-100蛋白、CD117、CD34、CD99、bc l-2、ER、PR、K i-67、CD10。结果21例PTs大体上均表现为界限清楚的肿块,且呈分叶状。肿瘤由具有双层排列的上皮成分以及过度生长的间质成分组成。根据间质的过度生长程度、细胞的异型程度、核分裂数、肿瘤边缘情况、有无异源性成分以及肿瘤性坏死等继发性改变将其分为良性、交界性和恶性3个级别。间质细胞免疫组化表达情况：CKpan：0/21、EMA：0/21、SMA：17/21、CD117：6/21、CD34：18/21、S-100蛋白：2/21、CD99：13/21、CD10：8/21、PR：5/21、ER：4/21、p53：18/21、K i-67：3%~10%、bc l-2：15/21。结论PTs的诊断主要依据组织学观察,免疫组化CD117、CD34、CD99、CD10、bc l-2的检测可以起到一定的辅助作用。

Phyllodes tumor of breast: A morphological and immunohistochemical study

Purpose To investigate the morphological and immunohistochemical characteristics of phyllodes tumor(PTs) of the breast and to explore the diagnosis criteria.Methods Twenty-one specimens with PTs of the breast were observed under light microscope with stains of hematoxylin eosin and immunohistochemical staining(SP method).5 cases of fibroadenoma and 5 cases of adenosis were compared with PTs.The first antibodies included CKpan,EMA,SMA,p53,S-100 protein,CD117,CD34,CD99,bcl-2,ER,PR,Ki-67 and CD10.Results All of 21 cases with PTs presented the well-circumscribed masses.The tumors were composed of a double-layered epithelial component arranged in clefts and an overgrowing hypercellular mesenchymal component typically organized in leaf-like structures.PTs were divided into benign,borderline and malignant groups based on stromal overgrowth,cellular pleomorphism,mitosis,margins, heterologeous stromal differentiation,necrosis and others.The stromal component was diffusely positive for SMA(17/21),CD117(6/21),CD34(18/21),S-100 protein(2/21),CD99(13/21),CD10(8/21),PR(5/21),ER(4/21),p53(18/21),Ki-67(3%~10%) and bcl-2(15/21),and the others were negative.Conclusions The diagnosis of PTs depends mainly on the histological features of the tumor.The expression of CD117,CD34,CD99,CD10,and bcl-2 in PTs is helpful to the diagnosis.