乳腺黏液癌的影像学特征与病理对照研究

The imaging characteristics and pathology of mucinous breast carcinoma

目的探讨乳腺黏液癌X线、CT、超声表现及其病理学基础。方法回顾性分析本院2010年1月—2013年1月同时具有手术病理和影像资料的33例乳腺黏液癌患者,分析临床影像学表现和病理学结果及其相关性。结果 33例乳腺黏液癌患者中,单纯型17例、混合型16例。单纯型黏液癌组13例X线表现为局限性边界清楚的结节,其余4例呈边界不清的不规则致密影(P<0.01)。所有混合型均为边界不清或毛刺状肿块(P<0.01),且簇状、沙砾样钙化多见。单纯型黏液癌组8例(80%)CT上呈边界清楚的局限性结节且无明显强化,所有混合型黏液癌均为边界不清弥漫性病灶且多为不均匀明显强化。单纯型黏液癌组多数(76%)为弱回声;而所有混合型黏液癌为不均匀低回声,边界不清,形态不规则。单纯型黏液癌淋巴结转移率(11.8%)较混合型黏液癌(50%)低(P<0.05)。结论单纯型与混合型乳腺黏液癌相比,淋巴结转移少,分期低。单纯型和混合型黏液癌因病理学基础不同而影像学特征不同,前者最常见为边界清楚的肿块,而边缘不规则实性占位多为混合型黏液癌的特点。

Objective To investigate the mammographic, computed tomographic and ultrasonographic appearance of mucinous breast carcinoma with histologic features in different types, and to determine the differential characteristics and patho- logic basis. Methods Thirty-three patients with mucinous breast carcinoma diagnosed from January 2010 to January 2013 were enrolled. Their clinical presentation, imaging findings and microscopic slides were retrospectively reviewed. The correlation between clinicopathological findings and images was investigated. R.esults The histopathologic review confirmed 17 pure tumors and 16 mixed tumors. The lymph node metastasis rate of the pure type was lower than mixed type （P〈0.05）. Thirteen cases （76%） with pure type had a well-defined, solitary and mass lesion on mammogram. The circumscribed and lobulated margins of the masses were well correlated with pure type （P〈0.01）. However, the remaining 4 cases demonstrated irregular dense shadow. All mixed tumors showed mass lesions with poorly defined or spiculated margins （P〈0.01） , and clustered, psammomatous microcalcifications were more common. CT revealed circumscribed mass with no enhancement in 8 pure tumors but significantly enhanced lesions with obscure margin in all mixed tumors. Sonographically, most pure tumors （76%） were shown with isoechogenic echo texture relative to that of subcutaneous fat, while all mixed tumors were heterogeneously hypoechogenic. Conclusion In contrast with mixed tumors, pure tumors have less frequent axillary node involvement and lower stage. The most distinctive mammographic feature of pure mucinous breast carcinoma is a well-defined mass, while irregular solid mass characterizes the mixed type.