青春期男性乳腺小管癌临床病理观察

Clinicopathological features of tublar carcinoma of the breast in adolescent male

目的 探讨青春期男性乳腺小管癌的临床与病理形态学特点、诊断与鉴别诊断、预后观察及合理的治疗方法.方法 应用光镜观察、免疫组化染色方法结合临床资料对1例青春期男性乳腺小管癌进行临床病理分析,并复习相关文献.结果 患者青春期男性,发现右乳肿物1年余.细针穿刺考虑为导管内乳头状肿瘤,增生活跃.手术切除标本为灰白色肿物,3 cm×2 cm×1.5 cm大小,质脆,并见直径0.2～0.6 cm的囊腔数个,内可见细乳头状物.镜下肿瘤由开放的单层小管上皮细胞组成,浸润性分布于增生的纤维间质中,细胞异型性不明显,核分裂罕见.在其周伴随微乳头型及筛状型导管内癌结构.免疫组化显示小管外周肿瘤细胞肌上皮标记阴性.术后随访5年,患者一般情况良好.结论 发生于青春期的男性乳腺小管癌罕见.需与微腺型腺病、放射状瘢痕、男性乳腺发育等良性病变及具有小管结构的乳腺浸润性导管癌等鉴别.免疫组化有助于鉴别.

Purpose To investigate the clinicopathological features, diagnosis and differential diagnosis of tubular carcinoma of male breast in adolescence. Methods Morphological observation and immunohistochemistry were applied in one case of tubular carcinoma of the breast in an adolescent male, and the literatures were also reviewed. Results The tumor with a clear capsule was 3 × 2× 1.5 cm in size. Grossly, the tumor revealed gray red and greyish white on cutting surface, with cystic and solid appearance. The size of cysts was 0. 2 - 0. 6 cm in diameter. The cyst had thin papillary projects. The tumor cells arranged in tubules, infiltrating haphazardly in the cellular desmoplastic stroma. The neoplastic tubules were lined by a single layer of epithelial cells with insignificant atypia or rare mitoses. The tumors were often associated with lobular neoplasm, columnar cell lesion, ductal atypical hyperplasia or carcinoma in situ. Pathological result was pure tubular carcinoma of the breast. Immunostaining displayed that myoepithelial cells were absent or incomplete. The patient was alive for 5 years after operation. Conclusions Tubular carcinoma of the breast is seldomly seen in adolescent male. It is easily confused with microglandular adenosis, radial sclerosing lesions, gynecomastia or low grade invasive ductal carcinoma. Immunohistochemistry is useful for the differential diagnosis.