乳腺恶性腺肌上皮瘤1例临床病理分析及文献复习

Malignant Adenomyoepithelioma of the Breast:a Clinicopathological Observation and Review of Litrature

目的探讨乳腺恶性腺肌上皮瘤(malignant adenomyoepithelioma,MAME)的临床病理特征、诊断及鉴别诊断要点。方法对1例乳腺恶性腺肌上皮瘤进行组织学观察及免疫组化分析,并复习文献。结果肿瘤由腺上皮及肌上皮两种成分组成,主要为透明肌上皮细胞成分。肿瘤边缘呈浸润性生长,核分裂多见。免疫组化示肌上皮细胞中P63、CK5/6、SMA、Calponin均呈阳性表达,ER及PR呈阴性,而腺上皮细胞中RE及PR呈阳性表达。结论乳腺恶性腺肌上皮瘤罕见,起源于良性腺肌上皮瘤,腺上皮及肌上皮成分均可恶变,但以肌上皮恶变多见,组织学形态结合免疫组化检测结果是诊断关键,恶性腺肌上皮瘤具较强侵袭性,如出现淋巴结转移及复发则预后不佳。

Objective To investigate the clinicopathological features,diagnostic criteral and differential diagnosis of malignangt adenomyoepithelioma（MAME） of the breast.Methods One case of breast MAME were analyzed by morphological observation and immunohistochemistry,and reviewed relevant literature.Results Histologically,the tumor consisted of adenoepithelial and myoepithelial cells,and clear myoepithelial cells was predominant.The tumor shows invasive border,mitoses are abundant.The immunohistochemical study demonstrated that myoepithelial cells were positive of P63,CK5/6,SMAandCalponin,negative of ER and PR.While adenoepithelial cells positive of ER and PR.Conclusion MAME of the breast are rare,come from benign adenomyoepithelioma,The epithelial or myoepithelila components of benign AME can be transformed into malinancies,but latter is the most.Morphological features combined with immunohistochemistry can assist in the diagonsis of this tumor.Malignant AME are have a stong invasive behavior,the pathient with lymph node metastasis or recurrence may have a poor prognosis.