乳腺原发性局限性淀粉样变临床病理观察

Clinical pathologic features of localized breast amyloidoma

目的探讨乳腺局限性淀粉样变的临床病理特点、诊断及治疗要点。方法复习1例乳腺局限性淀粉样变的临床表现、影像学、组织病理学、免疫组化及组织化学染色,并复习文献。结果患者女性,52岁,美籍非洲人。体检时钼靶发现乳腺肿物,粗针穿刺除外了恶性病变且提示淀粉样物沉积。内科除外系统性淀粉样变后转入外科,局部手术切除。术后病理诊断:乳腺淀粉样变。镜下病变周围间质纤维化,纤维囊性变,导管周慢性炎症细胞浸润,切缘净。刚果红染色在偏振光镜下可见双折光的苹果绿色物质。随访11个月,无复发。结论乳腺局限性淀粉样变非常罕见,明确诊断需结合组织病理学形态、组织化学染色及临床资料;治疗以手术切除为主,预后好。

Objective To analyze the clinicopathologic features, histochemical staining and treatment of localized breast amyloidoma. Methods Clinical, radiological, histopathological features and histochemical staining were analyzed in a case of primary localized breast amyloidoma. Literatures were reviewed. Results Primay localized breast amyloidoma have been reported in case reports. Most of the patients were middle aged female, often secondary to systemic amyloidosis. Coincidence with breast cancer or hematologic malignancy was reported. The case reported here was a 52-year old African- American female. A new questionable area within the left breast was found on her scheduled screening mammogram. She underwent an ultrasound-guided core biopsy. The pathology revealed amyloidosis without malignancy. Ruled out systemic amyloidosis, the patient came to surgery department and underwent lumpectomy of this mass. The final pathology revealed localized breast amyloidoma. Interstitial fibrosis and fibrocystic change as well as periductal chronic inflammation were present. The mayloid material was positive for the special staining of Congo red and showed apple green under polzrization microscope. No recurrence was detected in the 11-month follow-up. Conclusion Localized breast amyloidoma is rare. It is important to combine histopathologic features, special staining and clinical materials. The main treatment is local removal by lumpectomy.