乳腺原发性鳞状细胞癌的临床、病理及超声特征

Clinical, histopathological and ultrasonographic features of primary squamous cell carcinoma of the breast

目的总结乳腺原发性鳞状细胞癌临床超声及病理特征。方法对7例1995年1月至2014年12月北京协和医院临床收治并经超声及手术病理检查证实为乳腺原发性鳞状细胞癌患者的临床、病理及超声声像图特征进行总结分析。结果7例乳腺原发性鳞状细胞癌患者8个乳腺原发灶中单发6例，多发1例；大小7．0～60．0mm，平均大小（34．0±19．6）mm；其中6个呈实性低回声，2个呈囊实性混合回声；8个原发灶形态均不规则、边界模糊；2个出现点状及条状钙化。彩色多普勒血流成像示7个原发灶血流丰富（Ⅱ或Ⅲ级），1个原发灶未见血流（0级）。术后病理大体标本示8个乳腺肿物中实性6个，颜色灰白，质中，边界不清；2个肿物内部分呈囊腔样。1例70岁老年患者乳腺癌根治术后胸壁多次复发，超声显示胸壁复发灶呈厚壁无回声；2个胸壁复发灶大体标本示肿物均呈囊腔，囊壁厚，镜检示纤维脂肪及骨胳肌组织内见鳞状细胞癌浸润。结论乳腺原发性鳞状细胞癌病灶较大，超声显示肿瘤内部较多囊性成分和丰富血流，对诊断乳腺原发性鳞状细胞癌有帮助。

Objective To observe the ultrasonographic features of primary squamous cell carcinoma of the breast and its clinical and histopathological characteristics. Methods The ultrasonographic features, clinical and histopathological characteristics of 7 middle-aged women （median age 61 years old） with primary squamous cell carcinoma of the breast confirmed histopathologically from January 1995 to December 2014 in Peking Union Medical College Hospital were retrospectively reviewed. Results There were 8 lesions in seven cases. Six cases were single lesion and 1 case with multiple lesions, the diameters of the lesions were 7.0-60.0 mm [mean （34.0± 19.6） mm]. On grayscale ultrasound, 6 lesions with solid compoments were hypoechoic, 2 lesions with solid and cystic compoments were complex echogenic, the lesions all had irregular shape and indistinct margin, 2 lesions had calcifications. On color Doppler flow imaging, 7 lesions had rich blood flow signals （Ⅱ or Ⅲ） and 1 lesion had no blood flow signal. On gross histopathological examination, 6 masses were solid, pale-white colored, medium texture and the boundary was not clear. Two masses had cystic cavity. One old patient who was 70 years old had several times chest wall recurrence after mastectomy. On ultrasonography, the lesion showed an anechoic cyst with thick wall. Two chest wall recurrence lesions were cystic with thick wall. Microscopic examination showed squamous cell carcinoma infiltrating into the fiber adipose and skeletal muscle tissue. Conclusions Primary squamous cell carcinoma of the breast is more common in large tumor size. Ultrasound can show the more cystic components of the tumor and abundant vascularity, which is helpful for diagnosis.