乳腺肌纤维母细胞性肿瘤/肿瘤样病变临床病理及影像特征初探

The Clinical,Pathological and Imaging Features of Breast Myofibroblastic Tumors and Tumor-Like Lesions: A Preliminary Study

目的探讨乳腺肌纤维母细胞性肿瘤/肿瘤样病变的病理及影像学特征,提高对该病的认识与术前诊断准确率。方法回顾分析4例经病理证实肌纤维母细胞性肿瘤/肿瘤样病变的临床特征、病理及影像学表现,并结合文献进行讨论。结果 4例均以临床发现乳腺肿块为主要症状。左乳3例,右乳1例。触诊表现为肿块质硬、边界不清、活动欠佳、无压痛,3例肿块与皮肤粘连,3例病变位置较浅(位于腺体边缘),1例位于乳腺深部。X线表现为不规则结节3例,分叶状肿块1例;2例边缘有毛刺,1例边缘清楚,周围腺体受挤压,1例边缘模糊;3例邻近皮肤增厚,1例仅表现为皮下脂肪层密度增高;4例合并异常血管影。病理结果示:结节性筋膜炎1例;肌纤维母细胞瘤2例,其中1例伴感染;肌纤维母细胞瘤样增生伴炎细胞浸润1例。结论乳腺肌纤维母细胞性肿瘤/肿瘤样病变较少见,影像缺乏特异性征象,但综合分析病变发生年龄、部位及多种影像学特征,有助于提高该病诊断的准确性。

Objective To investigate the pathological and imaging characteristics of breast myofibroblastic tumors and tumor-like lesions in order to improve the understanding of the diseases as well as the preoperative diagnostic accuracy.Methods The clinical,pathological and imaging manifestations of four patients with pathologically-proved breast myofibroblastic tumors or tumor-like lesions were retrospectively analyzed,and the relevant literatures were reviewed.Results Clinically,mass or mass-like lesion on mammography was the main presentation in all the 4 cases,the lesions were located at the left breast in 3 cases and at the right breast in one case.Palpation examination revealed that the mass was hard,clearly-bordered with no tenderness.Mass and skin adhesion was seen in 3 cases; the lesion was superficially located（ located at the gland edge） in 3 cases; and the lesion was deep in the breast in one case.Radiological findings included irregular nodules（ n = 3）,lobulated mass（ n = 1）,marginal burr（ n = 2）,sharp border with compressed neighboring gland（ n= 1）,edge blur（ n = 1）,adjacent skin thickening（ n = 3）,increased density of subcutaneous fat layer（ n = 1）,and coexisting abnormal vessel shadow（ n = 4）.Pathological examination showed that nodular fasciitis was found in one,myofibroblastic tumor in 2,of which one had infection,and myofibroblastic tumor-like hyperplasia accompanied by inflammatory cell infiltration in one case.Conclusion Clinically,breast myofibroblastic tumors and tumor-like lesions are rather rare and lack of characteristic signs.Nevertheless,mammography findings combined with patient’s age and lesion’s location can help make a correct diagnosis.