乳腺胶原小体病的临床病理学观察

Clinicopathologic features of collagenous spherulosis of the breast

目的 探讨乳腺胶原小体病的病理形态学特征、免疫表型、诊断及鉴别诊断.方法 对33例胶原小体病进行病理形态学观察,应用免疫组织化学EnVision法及特殊染色对病变进行观察,并结合相关文献进行分析.结果 乳腺胶原小体病是由腺上皮及肌上皮增生形成的良性病变,上皮及肌上皮细胞通常排列呈筛网状,筛孔内为无细胞,呈圆形、卵圆形或放射状、星状的嗜酸性小体.平滑肌肌动蛋白、calponin、p63等免疫组织化学染色显示球形小体周围增生的肌上皮,E-cadherin染色显示病变中增生的导管上皮.嗜酸性小体Ⅳ型胶原、过碘酸-雪夫染色及网织纤维染色阳性.胶原小体病常与硬化性腺病等疾病伴发.结论 乳腺胶原小体病是一种伴随性病变,其病理形态学具有特殊的表现,易与乳腺腺样囊性癌、筛状导管原位癌等恶性病变相混淆,应注意加以鉴别.

Objective To investigate the morphological features,immunohistochemical phenotype,diagnosis and differential diagnosis of collagenous spherulosis of the breast.Methods Clinicopathologic observation,immunohistochemistry using EnVision method and histochemical staining were applied in 33 cases of collagenous spherulosis of the breast.Results Collagenous spherulosis of the breast was a benign lesion,consisting of proliferative myoepithelial and ductal epithelial cells.These cells were arranged in a cribriform pattern with esinophilic,round,oval or star-shaped fibrillary spherules in the lumen.SMA,calponin and p63 by immunohistochemistry identified the proliferative myoepithelium,while E-cadherin identified the proliferative ductal epithelial cells.The esinophilic spherules were stained with collagen type Ⅳ,AB-PAS and reticulin.Collagenous spherulosis was often found in sclerosing adenosis.Conclusions Collagenous spherulosis of the breast is often associated with other diseases.It has special morphological presentation and is easily confused with malignant tumors such as adenoid cystic carcinoma or cribriform carcinoma in situ,and needs to be differentiated from these disease entities.