乳腺硬化性腺病伴非典型大汗腺增生的临床病理特征

The clinicpathological feature of atypical apocrine metaplasia in sclerosing adenosis of the breast

目的:探讨乳腺硬化性腺病伴非典型大汗腺增生临床病理特征、诊断及鉴别诊断。方法:收集1例乳腺硬化性腺病伴非典型大汗腺增生的病例的临床与病理资料,分析其临床表现,组织学特征和免疫组化特征,并复习文献。结果:肿物位于左乳3点钟位,直径约1.7 cm,肿物质硬,边界欠清。光镜下可见肿物由多个大小不一类圆型结节构成,结节之间见硬化的纤维性间质,>90%区域由大汗腺化生的细胞构成,排列呈圆形或不规则腺样、实性小巢状,腺腔内有少量粉红染的分泌物。大汗腺化生的细胞形状不规则,有丰富的颗粒状嗜酸性胞浆,小部分细胞胞质淡染透明呈泡沫颗粒状,可有空泡形成;细胞核增大,大小不一,圆形或轻度不规则,核膜增厚,有1至2个大而突出的嗜酸性核仁,部分细胞可见核仁周空晕,核分裂2/50HPF。免疫组化示,CK、EMA、GCDFP-15阳性,Ki67 10%阳性,S-100、ER、PR、HER-2阴性,calponin和P63示增生的腺体周围有肌上皮存在。结论:乳腺硬化性腺病伴非典型大汗腺增生是一种罕见的乳腺病变,组织学形态特征是其主要诊断依据,需要与低级别大汗腺导管原位癌与浸润性大汗癌进行鉴别。

Objective：To investigate the clinicpathological features of atypical apocrine metaplasia in sclerosin adenosis of the breast.Methods： 1 case of atypical apocrine metaplasia in sclerosin adenosis of the breast was investigated, included clinical and pathological data, and analyzed their clinical manifestations, histological and immunohistochemistical features, and reviewed the literature.Results： hTere was a round hard mass located at 3 o’clock in the left breast, diameter about 1.7 cm. Multiple unequal round nodules were shown with sclerosis fibrous stroma. Atypical apocrine metaplasia cells occupied the region of 〉90%, cells arrangemented round or irregular glandular or the small nest, and the pink secretion in glandular cavity. The sharp of atypical apocrine metaplasia cells was irregular, with abundant granular eosinophilic cytoplasm, the nuclei was enlarged, round or 〈br〉 slightly irregular, with thickening nuclear membrance. Most cells had 1 to 2 a large and prominent eosinophilic acid nucleolus. hTe mitosis was rare （2/50HPF）. Atypical apocrine metaplasia cells were positive for CK, EMA, GCDFP-15, Ki67 index was 10%, negative for S-100, ER, PR, and HER2. Calponin and p63 showed myoepithelial cells around the gland.Conclusion： Atypical apocrine metaplasia in sclerosin adenosis is an uncommon breast lesion, identiifed with low-level apocrine ductal carcinoma in situ and invasive apocrine carcinoma by histological and immunohistochemistical characteristics.