肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2014年
1期
32-35
,共4页
杨拥军%张秀琳%王作君%谭庆民
楊擁軍%張秀琳%王作君%譚慶民
양옹군%장수림%왕작군%담경민
乳腺肿瘤%叶状肿瘤%病理诊断%免疫组织化学
乳腺腫瘤%葉狀腫瘤%病理診斷%免疫組織化學
유선종류%협상종류%병리진단%면역조직화학
Breast neoplasms%Phyllodes tumor%Morphology%Immunohistochemistry
目的 观察乳腺叶状肿瘤(PT)的病理形态学改变及免疫表型特征,探讨其在PT鉴别诊断及预后评估中的意义.方法 筛选乳腺PT病例48例,同时选取10例乳腺纤维腺瘤(FA)作为对照,对所有病例临床特征、病理形态学改变及随访结果进行回顾性分析,采用一抗CD34、CD10、CD117、p53及Ki-67进行免疫组织化学染色.结果 PT境界清楚,大体及镜下均呈典型的叶状结构,裂隙衬覆腺上皮及肌上皮分化良好,间质富于细胞伴过度生长,根据间质增生程度、细胞异型性、核分裂数及肿瘤边缘生长方式等指标将48例叶状肿瘤分为良性31例,交界性12例,恶性5例.恶性肿瘤中3例可见局灶性肿瘤坏死,1例间质出现脂肪肉瘤成分.免疫组织化学染色显示在良性、交界性及恶性组中CD34的中-强度表达率分别为93.5％、58.3％、0,三组间的差异有统计学意义(P＜0.05);CD10呈灶性表达,阳性率分别为25.8％、83.3％、80.0％,良性PT组与交界和恶性间的差异有统计学意义(P＜0.05);p53在各组间的表达差异均无统计学意义(均P＞0.05),CD117、Ki-67的表达在恶性PT中有较明显增高.随访5～141个月,48例患者经手术治疗后复发病例11例,双肺多发转移致死1例,其余10例经再次手术治疗后无再次复发.结论 病理形态学改变是乳腺PT诊断及分级的主要依据,免疫标志物在肿瘤中的表达对鉴别诊断及预后评估有一定辅助意义.选择合理的术式有助于减少复发和改善预后.
目的 觀察乳腺葉狀腫瘤(PT)的病理形態學改變及免疫錶型特徵,探討其在PT鑒彆診斷及預後評估中的意義.方法 篩選乳腺PT病例48例,同時選取10例乳腺纖維腺瘤(FA)作為對照,對所有病例臨床特徵、病理形態學改變及隨訪結果進行迴顧性分析,採用一抗CD34、CD10、CD117、p53及Ki-67進行免疫組織化學染色.結果 PT境界清楚,大體及鏡下均呈典型的葉狀結構,裂隙襯覆腺上皮及肌上皮分化良好,間質富于細胞伴過度生長,根據間質增生程度、細胞異型性、覈分裂數及腫瘤邊緣生長方式等指標將48例葉狀腫瘤分為良性31例,交界性12例,噁性5例.噁性腫瘤中3例可見跼竈性腫瘤壞死,1例間質齣現脂肪肉瘤成分.免疫組織化學染色顯示在良性、交界性及噁性組中CD34的中-彊度錶達率分彆為93.5％、58.3％、0,三組間的差異有統計學意義(P＜0.05);CD10呈竈性錶達,暘性率分彆為25.8％、83.3％、80.0％,良性PT組與交界和噁性間的差異有統計學意義(P＜0.05);p53在各組間的錶達差異均無統計學意義(均P＞0.05),CD117、Ki-67的錶達在噁性PT中有較明顯增高.隨訪5～141箇月,48例患者經手術治療後複髮病例11例,雙肺多髮轉移緻死1例,其餘10例經再次手術治療後無再次複髮.結論 病理形態學改變是乳腺PT診斷及分級的主要依據,免疫標誌物在腫瘤中的錶達對鑒彆診斷及預後評估有一定輔助意義.選擇閤理的術式有助于減少複髮和改善預後.
목적 관찰유선협상종류(PT)적병리형태학개변급면역표형특정,탐토기재PT감별진단급예후평고중적의의.방법 사선유선PT병례48례,동시선취10례유선섬유선류(FA)작위대조,대소유병례림상특정、병리형태학개변급수방결과진행회고성분석,채용일항CD34、CD10、CD117、p53급Ki-67진행면역조직화학염색.결과 PT경계청초,대체급경하균정전형적협상결구,렬극츤복선상피급기상피분화량호,간질부우세포반과도생장,근거간질증생정도、세포이형성、핵분렬수급종류변연생장방식등지표장48례협상종류분위량성31례,교계성12례,악성5례.악성종류중3례가견국조성종류배사,1례간질출현지방육류성분.면역조직화학염색현시재량성、교계성급악성조중CD34적중-강도표체솔분별위93.5％、58.3％、0,삼조간적차이유통계학의의(P＜0.05);CD10정조성표체,양성솔분별위25.8％、83.3％、80.0％,량성PT조여교계화악성간적차이유통계학의의(P＜0.05);p53재각조간적표체차이균무통계학의의(균P＞0.05),CD117、Ki-67적표체재악성PT중유교명현증고.수방5～141개월,48례환자경수술치료후복발병례11례,쌍폐다발전이치사1례,기여10례경재차수술치료후무재차복발.결론 병리형태학개변시유선PT진단급분급적주요의거,면역표지물재종류중적표체대감별진단급예후평고유일정보조의의.선택합리적술식유조우감소복발화개선예후.
Objective To investigate the morphological and immunophenotypic characteristics of phyllodes tumors (PT) and explore their significance in differential diagnosis and evaluation of prognosis.Methods 48 specimens with PT were observed under light microscope with HE and immunohistochemical staining (EnVision method).The antibodies including CD34,CD10,CD117,p53,and Ki-67 were used.10 cases of fibroadenoma were compared and the clinical data and follow-up results were analyzed retrospectively.Results All of 48 cases with PT presented as well-circumscribed masses with typically leaflike structures composed of double-layered epithelial component arranged in clefts and overgrowing hypercellular mesenchymal component.31 benign,12 borderline,and 5 malignant PT were diagnosed based on stromal overgrowth,cellular pleomorphism,mitosis,margins,and others.Focal necrosis was detected in 3 malignant cases and liposarcoma component existed in 1 case.Immunohistochemical staining showed that the positive rates of CD34 were 93.5 ％,58.3 ％,0 in benign,bordline,and malignant PT respectively,there were significant differences between each groups (P ＜ 0.05).The expression of CD10 were 25.8 ％,83.3 ％,80.0 ％,its expression in benign group was significantly different compared with bordline and malignant PT (P ＜ 0.05).p53 was expressed in three groups with no significant difference (P ＞ 0.05).CD117 and Ki-67 had high expression comparatively in malignant PT.All cases were treated surgically with a local recurrence rate of 22.9 ％.Conclusions Reasonable surgery pattern based on accurate histopathological diagnosis is crucial to reduce the local recurrence rate of PT.Immunohistochemistry examination in PT is helpful to the differential diagnosis and evaluation of prognosis.
