乳头浸润性汗管瘤样腺瘤临床病理观察

Invasive syringomatous adenoma of nipple:a clinicopathological observation

目的探讨乳头浸润性汗管瘤样腺瘤的形态学特点、诊断及鉴别诊断。方法报告2例乳头浸润性汗管瘤样腺瘤临床病理资料,通过HE及其免疫组化染色观察其特征,结合相关文献进行回顾性分析。结果肿瘤在乳头表皮下的间质纤维组织内及平滑肌束间/内浸润性生长,局部呈结节状浸润小叶间和小叶内;呈不规则的小管状结构,某些小管呈特征性"逗点状"和"蝌蚪状";小管及实性细胞团均可见有鳞状细胞化生,腔内充满角化物质;间质纤维胶原化,局部特别是角化囊肿周围有多少不等的慢性炎细胞浸润,亦见有多核巨细胞;肿瘤细胞分化良好,温和一致,核淡染无异型性,可见小核仁,无核分裂象,亦无坏死。免疫组化:34βE12、CK5/6、CK14和EMA小管腔缘均为(+);例1PR(+)细胞>80%,ER为(-),Ki-67指数<3%,特别是外层细胞p63(+),CK7/8(-);例2 PR和ER均为(-),小管内衬细胞CK7/8(+)。2例CK18、SMA、CD10、calponin、CEA、c-erbB-2、p53和GCDFP-15均(-)。结论乳头浸润性汗管瘤样腺瘤是一种少见的乳腺良性肿瘤,认识其临床及病理形态特点,并与乳腺恶性肿瘤鉴别,以免误诊。

Objective To investigate the clinicopathologic features, diagnosis, differential diagnosis, characteristics of immunohistochemistry in invasive syringomatous adenoma of the nipple. Methods One case of syringomatous adenoma of the nipple was studied and discussed through review of the literature. Results The tumor was located in the nipple and showed invasive growth of the tumor in interstitial fibers and smooth muscle. The tumor was composed of ducts and tubules scattered in a fibrous stroma; characteristic comma-or tadpole-shaped ducts were seen. A few areas showed squamotts cell metaplasia. Some duets were slightly dilated and contained eosinophilie secretions; The stroma was fibrotts with infiltration of lymphocytes and muhinuclear giant cells. There were no areas of celluar atypia or necrosis. staining showed positivity for 34βE12, CK5/6, CK14, EMA, p63 and PR, but ER and CK7/8 were negative in case 1; however PR and ER were both negative, and CK7/8 was positive in case 2, CK7/8, CK18, SMA, CD10, calponin, CEA, C-erbB-2, p53 and GCDFP-15 were also negative.Conclusion Syringomatotts adenoma of the nipple is a rare benign tumor, and the clinical and histological diagnosis may be difficult sometimes. Recognizafion of the clinical and pathologic feattrres of this tumor is helpful in the differentiation from breast malignant tumors.