CAJ | 학술논문

目的探讨乳腺癌肉瘤的临床病理组织学特征,免疫表型与组织学起源关系.方法对3例乳腺癌肉瘤的临床病理学资料进行回顾性分析,免疫组织化学标记并复习相关文献进行讨论.结果 3例病例均发生在中老年妇女,年龄36～91岁不等,病程10天～20年,单侧乳房外上象限多见,可伴有皮肤溃烂及同侧腋窝淋巴结肿大.B超检查常提示肿块回声分布不均,边界欠清,不规整,血流丰富.X线钼靶检查BI-RADS级别高.肉眼肿块边界欠清,切面灰白,质中偏硬.镜下改变:肿瘤细胞由类圆形上皮样和梭形细胞构成,伴有鳞状上皮、平滑肌、软骨和骨组织分化.上皮样细胞呈巢团实性,伴有粉刺样坏死,形似浸润性导管癌结构.梭形细胞弥漫排列,异型性大,形似肉瘤样结构.免疫组化结果:3例中,2例癌成分均表达CK、E-cad、CK(H)和EMA,肉瘤成分表达Vimentin、SMA、S-100和EMA; 1例癌和肉瘤成分均表达CK和Vimentin,肉瘤成分表达CD34.结论乳腺癌肉瘤是一种既可表达上皮性抗体,也可表达非上皮性抗体的上皮/间叶混合性化生性癌.肿瘤的发生与导管上皮有关,部分病变可能与肌上皮化生有关.免疫组化相关抗体检测,可提示肿瘤成分的来源.
목적 탐토유선암육류적림상병리조직학특정,면역표형여조직학기원관계.방법 대3례유선암육류적림상병이학자료진행회고성분석,면역조직화학표기병복습상관문헌진행토론.결과 3례병례균발생재중노년부녀,년령36～91세불등,병정10천～20년,단측유방외상상한다견,가반유피부궤란급동측액와림파결종대.B초검사상제시종괴회성분포불균,변계흠청,불규정,혈류봉부.X선목파검사BI-RADS급별고.육안종괴변계흠청,절면회백,질중편경.경하개변:종류세포유류원형상피양화사형세포구성,반유린상상피、평활기、연골화골조직분화.상피양세포정소단실성,반유분자양배사,형사침윤성도관암결구.사형세포미만배렬,이형성대,형사육류양결구.면역조화결과:3례중,2례암성분균표체CK、E-cad、CK(H)화EMA,육류성분표체Vimentin、SMA、S-100화EMA; 1례암화육류성분균표체CK화Vimentin,육류성분표체CD34.결론 유선암육류시일충기가표체상피성항체,야가표체비상피성항체적상피/간협혼합성화생성암.종류적발생여도관상피유관,부분병변가능여기상피화생유관.면역조화상관항체검측,가제시종류성분적래원.
Objective To investigate the clinical and pathological breast sarcoma histological features,immune phenotype relationship with histological origin.Methods Three cases of breast sarcoma clinical and pathological data were retrospectively analyzed by immunohistochemical markers and review of the literature discussion.Results Three cases occurred in middle-aged women,aged 36-91 years with a duration of 10 days to 20 years,unilateral upper outer quadrant of the breast more common,can be accompanied by skin ulceration and ipsilateral axillary lymph nodes.B-ultrasound often prompted mass echo uneven distribution of boundary less clear,not structured,rich blood flow.X-ray mammography BI-RADS high level.Macroscopic tumor boundary less clear,cut gray matter in more rigid.Microscopic changes:the tumor cells from oval epithelioid and spindle cells,accompanied by squamous epithelium,smooth muscle,cartilage and bone tissue differentiation.Epithelial cells showed solid nests regiment,accompanied comedo necrosis,the shape of the structure of invasive ductal carcinoma.Spindle cells arranged in diffuse,atypia,the shape of sarcoma-like structure.Immunohistochemical results:among 3 cases,2 cases of cancer ingredients were expressed with CK,E-cad,CK(H) and EMA,sarcoma component expressed Vimentin,SMA,S-100 and EMA; 1 cancerous and sarcomatous components were expressed CK and Vimentin,sarcoma component expressed CD34.Conclusion Breast sarcoma is not only an expression of epithelial antibodies but also an expressed nonepithelial antibodies epithelial/mesenchymal mixed metaplastic carcinoma.The occurrence of ductal epithelial tumor related,some lesions may be related with muscle metaplasia.Immunohistochemical detection of relevant antibodies,may indicate the source of tumor components.