乳腺颗粒细胞瘤临床病理观察并文献复习

Granular cell tumor of the breast:clinicopathological case study and literature review

目的探讨乳腺颗粒细胞瘤(granular cell tumor of the breast,GCTB)的临床病理学特征、诊断、鉴别诊断、治疗与预后。方法应用光学显微镜及免疫组织化学方法分析1例GCTB病例的临床病理特点及免疫表型,并复习相关文献。结果患者女性,31岁,无明显诱因出现左乳无痛性肿块10天。术中快速冰冻切片镜下见瘤细胞体积大,成巢状或条索状排列,其间有纤维脂肪组织分隔,似浸润性生长,与乳腺癌极为相似,但胞质内可见丰富的嗜酸性颗粒,罕见核分裂象和核异型性,快速冰冻切片诊断为左乳良性病变。冰冻后石蜡切片镜下见瘤细胞间边界不清,呈实性巢片状排列,瘤细胞呈圆形、椭圆形或多边形,胞核小,圆形或卵圆形,核仁明显,胞质粗颗粒状、嗜酸性,未见明显核分裂象及核异型性。免疫组织化学显示肿瘤细胞S-100阳性,CD68阳性,广谱细胞角蛋白(Pan Cytokeratin,PCK)阴性,Ki-67增殖指数约3%。结合组织学特征及免疫组织化学诊断为乳腺颗粒细胞瘤。结论乳腺颗粒细胞瘤是一种罕见的软组织肿瘤,虽然极少数具有恶性倾向,但是从临床特征、影像学检查上都极易误诊为乳腺癌,加大了诊断难度。依据临床病理组织学特点及免疫组织化学可准确诊断。

Objective To investigate the clinicopathological characteristics,diagnosis,differential diagnosis,treatment and prognosis of granular cell tumor of the breast(GCTB).Methods The clinicopathological characteristics and immunophenotype of a GCTB case were analyzed using optical microscope and immunohistochemical methods.The relevant literature was reviewed.Results A31years old female patient complained of a painless mass in her left breast with no obvious cause for10days.Fast intraoperative frozen section showed that the tumor was composed of nests and cords of large polygonal cells separated by fibrous adipose tissues which appeared grossly a malignant lesion.However,the granular eosinophilic cytoplasm with rare mitotic figure or nuclear atypia suggested benign breast disease.The paraffin sections showed that tumor cells were arranged in nests with infiltrating boundaries.The tumor cells were round,oval or polygonal with granular eosinophilic cytoplasm,small nuclei and clear nucleolus.Rare mitotic figures and nuclear atypia were observed.Immunohistochemistry revealed tumor cells were positive for S-100protein and CD68,negative for PCK.Ki-67proliferative index was3%.Based on histological features and immunohistochemistry,the case was diagnosed with granulosa cell tumor of the breast.Conclusion GCTB is a rare soft tissue tumor with low tendency toward malignancy.It can easily be misdiagnosed as breast cancer based on clinical features and imaging examination.The accurate diagnosis relies on clinicopathology characteristics and immunohistochemistry.