乳腺囊性病变的临床病理分析

Clincopathological analysis of the breast cystic lesions

目的探讨乳腺囊性病变与囊性增生症的关系及其临床意义。方法收集近3年来诊治的乳腺囊性病变32例的临床资料，分析其临床、影像及病理学特点。并另选10例乳腺癌旁2cm内的病变做对照分析。部分病例行免疫组化检测Calponin、P63、actin、34βE12、S-100了解肌上皮表达情况。结果32例中乳腺囊性增生症16例、导管扩张症5例、乳汁潴留囊肿4例、粘液囊肿样病变1例、单纯囊肿6例。16例“乳腺囊性增生症”均为良性上皮增生，包括硬化性腺病2例、盲管性腺病1例、腺肌上皮腺病3例、导管内乳头状肿瘤10例（中央型6例，外周型乳头状瘤4例）；其中非典型乳头状瘤3例，其肌上皮标记相对减弱或消失。癌旁组织见囊性增生症1例，导管内乳头状瘤病5例。结论囊性病变是增生症的继发改变，囊性增生症的癌变风险在于部分病例的不典型性增生，尤其是非典型性乳头状增生。故临床病理宜区分非典型性与普通型增生，不宜用囊性增生症术语并视之为癌前病变。

Objective To implore the clinical significance and relationship between breast cystic lesion and cystic hyperpalsia. Methods The data of 32 cases of breast cystic lesion diagnosed and treated in the latest 3 years were collected, and their clinical features, image characteristics, pathological structures were analyzed. Some cases were detected with C alponin, P63, actin, 3415E12 and S - 100 by immunohistochemical test. Results 16 cases were the breast cystic hyperplasia, 5 cases were mammary ductectasia, 4 cases were galactocele, only one case was mucocele - like lesions and 6 cases were single cyst. The 16 cases with cystic hyperplasia were all benign epithelial proliferation. Including 2 cases with sclerosing adenosis, one case with blunt ductal adenosis, 3 cases were adenomyoepithelial adenosis, 10 cases were intraductal papilloma, 6 cases were central type,4 cases were peripheral type;and there were 3 cases of atypical papilloma,the myoepithelial markers expressed weaken relatively or negative. 1 case of cystic hyperplasia and 5 cases of papilloma were found in para- carcinoma areas. Conclusion The cystic lesions are the secondary change of hyperplasia and the canceration risk of cystic hyperplasia is ascribed to atypical proliferations in partly cases,especially in atypical papillary hyperplasia. So the clinical and pathological diagnosis should be with the term of atypical proliferation and conventional hyperplasia, and the term of cystic hyperplasia would not be suitable.