乳腺纤维瘤病临床病理学观察

Pathological observation on fibromatosis of breast

目的:探讨乳腺纤维瘤病的临床病理学特点、免疫表型和鉴别诊断。方法:对1例乳腺纤维瘤病进行组织学和免疫组化观察并复习文献。结果:巨检肿瘤呈结节状,边界欠清,质韧,切面实性,灰白色。镜检肿瘤由梭形细胞和胶原纤维组成,呈束状、条带状交错排列,向周围乳腺组织指突样扩展,并浸润到脂肪组织。局部有淋巴细胞浸润,以边缘区多见。瘤细胞vimentin和SMA阳性,Actin和desmin少数细胞阳性,ER、PR、AE1/AE3、EMA、CK5/6、CD34和S-100蛋白均阴性。Ki-67阳性细胞<5%。结论:乳腺纤维瘤病为少见的乳腺良性肿瘤,由增生的纤维母细胞、肌纤维母细胞和胶原纤维共同组成,临床、钼靶和B超检查很难与癌区别,主要依靠组织病理学诊断,形态上应注意与梭形细胞癌、肌上皮癌、肌纤维母细胞瘤、纤维肉瘤、结节性筋膜炎和乳腺反应性梭形细胞结节等病变进行鉴别。

Objective ：Tn observe the clinicopathological features, immunohistochemical type and differential diagnosis of fibromatosis of breast. Methods： One case of mammary fibronmtosis was studied with histopathology, immunohistochemistry examination and involved literatures review. Results： Grossly, the mass was nodulated and indistinct margin, with a firmly and white-grey cut surface. Microscopy revealed that the neoplasm was composed of spindle cell and collagen fibers, arrayed bunchy and striation,extended to lobule-tube structure of periphery mammary as finger,and infiltrated into fat. Lymphocytic infiltration was seen in the lesions and most prominent at the margins. Immunohistochemical findings showed that the tumor cells were positive for vimentin and SMA, partly positive for actin and desmin, but negative for ER, PR, AEI/AE3, CK5/ 6,EMA,CD34 mad S-100 protein,though Ki-67 〈5%. Conclusion： Fibromatosis is a rare benign soft tumor of the breast, consisting of prolifera-ting fibroblast cells, myofibroblast cells and collagen fibers. It is usually indistinguishable from carcinoma in physical examination, mammography and uhrasound. The diagnosis mainly relies on hitopathological sections. Morphologically, it should be differentiated from other spindle cell lesions in the breast, such as fibromatosis-like spindle cell carcinoma, myoepithelial carcinoma, myofibroblastoma, fibrosarcoma, nodular fasciitis and reactive spindle cell nodules.