CAJ | 학술논문

目的探讨乳腺囊性高分泌性病变的临床病理特点、免疫组织化学表型及鉴别诊断.方法收集2010至2013年6例乳腺囊性高分泌性病变的临床病理及随访资料,进行光镜观察和免疫组织化学染色,并对相关文献进行复习.结果 6例患者均为女性,发病年龄37 ～ 71岁(平均49.3岁).3例为囊性高分泌性增生,3例为囊性高分泌性癌.临床表现为乳腺肿块或因钼靶X线检查发现钙化灶就诊.病变大体呈多个大小不等的囊腔,内含胶冻样物,与周围组织界限不清.镜下见病变广泛,多个囊性扩张的导管内含均质红染分泌物,其中缺乏细胞成分,酷似甲状腺滤泡胶质,1例囊腔内见钙盐沉积.囊腔内衬上皮呈扁平、立方或柱状,单层排列或增生呈簇状、实性或微乳头状,细胞可出现不典型增生及癌变.本组3例囊性高分泌性癌中,2例为浸润性导管癌,1例为导管原位癌.囊性高分泌性病变表达S-100蛋白、CK5/6和CK14.3例囊性高分泌性癌中仅1例雌激素受体(ER)和孕激素受体(PR)阳性,HER2均阴性.淀粉酶消化后过碘酸-雪夫染色和黏液卡红染色显示管腔内分泌物为阳性.随访3 ～18个月不等,1例失访,其余患者均存活.结论多个扩张的囊腔、充满甲状腺胶质样的均质红染分泌物是囊性高分泌性病变的主要组织学特征,病变与周围正常组织界限不清.囊腔内衬上皮可见普通型增生、不典型增生及原位癌,少数病例伴浸润性癌.
목적 탐토유선낭성고분비성병변적림상병리특점、면역조직화학표형급감별진단.방법 수집2010지2013년6례유선낭성고분비성병변적림상병리급수방자료,진행광경관찰화면역조직화학염색,병대상관문헌진행복습.결과 6례환자균위녀성,발병년령37 ～ 71세(평균49.3세).3례위낭성고분비성증생,3례위낭성고분비성암.림상표현위유선종괴혹인목파X선검사발현개화조취진.병변대체정다개대소불등적낭강,내함효동양물,여주위조직계한불청.경하견병변엄범,다개낭성확장적도관내함균질홍염분비물,기중결핍세포성분,혹사갑상선려포효질,1례낭강내견개염침적.낭강내츤상피정편평、립방혹주상,단층배렬혹증생정족상、실성혹미유두상,세포가출현불전형증생급암변.본조3례낭성고분비성암중,2례위침윤성도관암,1례위도관원위암.낭성고분비성병변표체S-100단백、CK5/6화CK14.3례낭성고분비성암중부1례자격소수체(ER)화잉격소수체(PR)양성,HER2균음성.정분매소화후과전산-설부염색화점액잡홍염색현시관강내분비물위양성.수방3 ～18개월불등,1례실방,기여환자균존활.결론 다개확장적낭강、충만갑상선효질양적균질홍염분비물시낭성고분비성병변적주요조직학특정,병변여주위정상조직계한불청.낭강내츤상피가견보통형증생、불전형증생급원위암,소수병례반침윤성암.
Objective To study the clinicopathologic features,immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast.Methods Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed.Results All six patients were female,age ranged from 37 to 71 years (average 49.3 years).Three cases were cystic hypersecretory hyperplasia (CHH),the other three cases were cystic hypersecretory carcinoma (CHC).Clinically the lesions presented as either breast mass or mammographic calcification.Grossly,the cystic hypersecretory lesions were poorly circumscribed,with multiple colloid containing cysts on the cut surface.Microscopically,the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles,and calcification was seen in the cyst in one case.The secretion was D-PAS and mucicarmine positive.The lining epithelium of the cysts was uniformly fiat,cuboid or columnar,and arranged in a monolayer.The cells may be arranged in turfs,solid or micropapillary patterns in CHH.In cases with dysplasia,the epithelium showed cytological and structural atypia,but the usual morphology of atypical dutal hyperplasia such as arcades,rigid bridges or cribriform pattern was less common.The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL,there was immunoreactivity to S-100 protein,CK5/6 and CK14.Of the three CHCs,ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up,and the rest were uneventful at 18 months.Conclusions CHL of the breast is a rare pathological entity.Multiple colloid-filled cysts is a unique histological feature.The epithelium of CHL may show usual hyperplasia,dysplasia or carcinoma.