淋巴细胞性乳腺炎临床病理学及发病机制的研究(英文)

Clinicalpathological and pathogenetic study of lymphocytic mastitis

目的探讨一种特殊类型的乳腺疾病──淋巴细胞性乳腺炎的临床病理学特点及发病机制。方法分析了7例淋巴细胞性乳腺炎患者的临床资料，采用常规HE染色观察该病的形态学特点并采用免疫组织化学EnVision法检测浸润于乳腺小叶内的淋巴细胞中CD20和CD45RO的表达，对其进行分类。并按体视学要求对浸润于乳腺小叶内的淋巴细胞进行定量分析。并检测了浸润细胞中CD68和葡萄糖调节蛋白94(grp94)/糖蛋白96(gp96)的表达。结果7例淋巴细胞性乳腺炎有4例是发生于有长期糖尿病病史的妇女，均为胰岛素依赖型糖尿病，1例无糖尿病病史，2例病史不清。组织学上7例均有不同程度的乳腺小叶炎、小叶周围炎及导管周围炎，即数量不等的淋巴细胞浸润于乳腺小叶内、小叶周边及导管周围；基质纤维结缔组织不同程度的增生，伴乳腺小叶萎缩及均匀一致的纤维化。免疫组织化学显示浸润于乳腺小叶内、小叶周边及导管周围的淋巴细胞主要是CD20阳性的B淋巴细胞，同时也有部分CD45RO阳性的T淋巴细胞。对浸润于乳腺小叶内的淋巴细胞进行形态学定量分析的结果表明，浸润的淋巴细胞主要是B淋巴细胞，且差异有显著性(P∨0.01)。部分浸润于乳腺小叶和小叶周围的淋巴细胞表达葡萄糖调节蛋白94(grp 94)/糖蛋白96(gp96)。

Aim To explore clinicalpathological features and the pathogenesis of lymphocytic mastitis, an uncommon breast benign disease. Methods The clinical pathological characteristics of 7 patients with lymphocytic mastitis were studied retrospectively. All cases were evaluated by using paraffin-embedded sections and by immunohistochemical staining with mouse anti-CD20, -CD45RO, and -CD68 antibodies. T and B lymphocytes infiltrated in the lobules of mammary gland were quantitatively analyzed according to stereoscope. The glucose regulation protein 94 (grp 94)/glycoprotein 96(gp 96), a member of heat shock protein family was also investigated in these cases by using immunohistochemical staining. Results It was showed that 4 cases were women suffering from insulin dependent diabetic mellitus (IDDM). One case was a woman without diabetic history. The history of the other two cases was not clear. The histopathological features of all 7 cases were lobulitis, perilobulitis and catheter ductitis with infiltration of lymphocytes accompanied with atrophy of lobule in mammary glands and homologous fibrosis of stroma. The result of immunohistochemical staining showed that most of infiltrated lymphocytes were B lymphocytes, while the small proportion of the cells were T lymphocytes, and the difference was significant(P∨0.01). There was the expression of grp 94 in the cytoplasm of epithelium cells of lobules and ducts in normal mammary glands. A proportion of lymphocytes infiltrated in lobules and perilobules expressed grp 94. Some infiltrated cells expressed CD68. Conclusion A portion of lymphocytic mastitis is related closely to insulin dependent diabetic mellitus. Both humoral immunity and cellular immunity are probably involved in the pathogenesis of lymphocytic mastitis. Because of its unique pathologic and clinical features, lymphocytic mastitis should be defined as an independent mastitis and distinguished from other chronic inflammatory and fibrosing conditions in breast.