乳腺癌保乳术及放疗后非典型性血管病变的病理特征

Atypical vascular lesions after conservative surgery and radiation of breast cancer:report of a case and review of the literature

目的探讨研究乳腺癌保乳手术后和放疗后所发生的非典型性血管病变(atypical vascular lesions,AVLs)的临床病理学特点及与血管肉瘤的关系。方法对1例AVLs的临床资料、组织学形态和免疫表型进行分析,并复习相关文献。结果患者为57岁女性,因右乳癌接受保乳手术,术后辅助放疗。3年多后于右乳外上瘢痕旁见大小不一的发红皮疹,呈放射状向乳头排列。临床上考虑为右乳癌保乳术后右胸壁复发结节。对皮疹行细针穿刺未见肿瘤细胞。对皮疹的活检显示,病变主要位于真皮浅层,由聚集成簇、相互贯通的薄壁脉管组成,管腔内多无红细胞,内皮细胞也无明显的异型性。局灶区域可见少量脉管向真皮中层内穿插性生长。免疫组化标记显示内皮细胞主要表达CD31,部分表达CD34和D2-40,脉管周无α-SMA阳性的周皮细胞。回顾性复习乳腺癌切片显示为浸润性微乳头状癌。结论AVLs是一种与乳腺保乳癌术后放疗相关的血管增生性病变,是乳腺癌保乳术后放疗性血管肉瘤的前驱性病变。熟悉AVLs的临床病理学特点不仅对病理医师,而且对临床医生也有积极的意义。

Purpose To describe the clinical and pathological features of atypical vascular lesions （AVLs） after conservative surgery and radiation of the breast cancer,and to discuss the association with post-radiation angiosarcoma.Methods The clinical and pathological features in one case of AVLs was evaluated.The literatures were reviewed.Results The patient is a 57-year-old female who underwent a conservative surgery of the right breast because of a carcinoma.She received standard dose of radiation as adjuvant therapy.Three years later,multiple erythematous plaques developed around the former scar,which radiated to the nipple.Clinically,the plaques were considered as relapses of the carcinoma.However,fine needle aspiration gave negative results.Biopsy of one large plague revealed a circumscribed vascular lesion confined to the superficial dermis.It was composed of thin-walled anastomosing lymphatic vessels lined by attenuated endothelial cells.In focal areas,the vessels extended to the mid-dermis.Immunohistochemically,the endothelial cells were positive for CD31,CD34 and D2-40,with absent of α-SMA positive pericytes.Review of the breast tumor sections showed an invasive micropapillary carcinoma.Conclusions AVLs is a rare vascular lesion related with conservative surgery and post-radiation therapy of the breast.AVLs may represent as a precursor of breast angiosarcoma.Being familiar with the clinicopathologic characteristics of AVLs is important not only for the pathologists but also for the clinicians.