乳腺粘液囊肿样病变组织病理学及针吸细胞学改变

Mucocele like lesion of the breast histopathology and fine needle aspiration cytology changes

目的 分析乳腺粘液囊肿样病变（Ｍｕｃｏｃｅｌｅｌｉｋｅｌｅｓｉｏｎ， ＭＬＬ） 的组织病理学及细针吸取（针吸） 细胞学特点， 寻求在手术前根据针吸细胞学鉴别ＭＬＬ与乳腺粘液腺癌的依据。方法 重新评估７ 例ＭＬＬ（ 良性５ 例，恶性２ 例）的组织病理学及针吸细胞学材料，并以同期１４ 例粘液腺癌作对照，比较两种病变在组织学及针吸细胞学上的差异。结果 所有ＭＬＬ均有乳腺结节，病人年轻（ 平均年龄３４ ．８ 岁，而粘液癌为６７．９ 岁） 。良性ＭＬＬ的组织学特征是形成粘液性囊肿，囊肿壁由良性的上皮披覆（恶性ＭＬＬ囊壁上皮部分呈导管内癌改变） ；漏出间质的粘液内通常无肿瘤细胞。粘液腺癌不形成粘液性囊肿，间质的粘液池中有较多的肿瘤细胞。在针吸细胞学上，所有ＭＬＬ病例针吸时均可吸出粘稠的粘液样物质，涂片背景均可见丰富的粘液。ＭＬＬ与典型的粘液腺癌的最大区别是吸出物中肿瘤细胞稀少，细胞粘合性好，基本上无游离的上皮细胞，细胞呈单层排列而无异型性。结论 可按针吸细胞学改变将ＭＬＬ与粘液腺癌区别。粘液腺癌可直接手术治疗， 但ＭＬＬ应先行活检，从病理学上区别良、恶性ＭＬＬ。

Objective To elucidate the histopathology and fine needle aspiration cytology (FNAC) features of mucocele like lesion (MLL) of the breast, and to establish the criteria in separating MLL from mucinous carcinoma on the basis of pre operative FNAC. Methods Seven cases of MLL (5 benign and 2 malignant) were reviewed. The histology and FNAC features were compared with 14 cases of mucinous carcinoma examined in the same period. Results All cases of MLL presented with breast lumps (1 case was detected by doctor after abnormal mammogram) and MLL patients are much younger (mean age 34.8 years for MLL and 67.9 years for mucinous carcinoma). Histologically, MLL are characterized by mucinous cysts which may rupture and discharge their contents into the surrounding tissue. The lining epithelium is bland and epithelial cells are rare in the mucin pool. Malignant MLL shows associated in situ carcinoma. In contrast, mucinous carcinoma is formed by large mucin pools devoid of lining epithelium and contains mumerous tumor cells in the mucin pools. In all cases, grossly visible jelly like mucous was obtained from FNA. Cytologically, all smears showed abundant mucous in the background. The most important fratures distinguishing benign MLL from mucinous carcinoma were scant cellularity, rare intact single tumor cell and tumor cells arranged in cohesive monolayered clusters lacking significant nuclear atypia. Conclusion Mucinous lesions of the breast can be divided into MLL and mucinous carcinoma based on the FNAC changes. Operative therapy can be performed for definite cases of mucinous carcinoma without further biopsy. However, excisional biopsy is advised in MLL for further separation into benign and malignant categories.