乳腺颗粒细胞瘤6例临床病理学分析及文献复习

Granular cell tumor of the breast: a clinicopathological analysis of 6 cases with review of literature

目的探讨乳腺颗粒细胞瘤(granular cell tumor,GCT)的临床表现、病理学和免疫组化特征以及诊断及鉴别诊断。方法对6例乳腺GCT的临床资料、组织学形态及免疫组化结果进行回顾性分析,并结合文献总结乳腺GCT的临床表现、病理形态学特点、免疫表型、诊断及鉴别诊断。结果 6例乳腺GCT中,男1例,女5例,年龄范围为21~60岁(平均44.3岁),诊断为良性乳腺GCT 5例,诊断为非典型性乳腺GCT1例。临床上,6例均表现为乳腺实质内的单发、质地稍硬韧、边界模糊欠清晰的类圆形肿块;肿块最大径1.5~4.5 cm(平均2.5 cm)。镜下由纤维组织分割的成巢或成片的瘤细胞组成,呈浸润性生长,瘤细胞呈圆形或多边形,细胞界限不清,胞质丰富、嗜酸性、颗粒状,胞核一般较小、呈圆形或卵圆形,可见核仁,无核分裂像。免疫组化Vimentin、S-100、NSE、CD68、α-Inhibin阳性表达,AE1/AE3、ER、PR、Her-2、SMA等阴性表达。结论乳腺GCT是一种少见的乳腺肿瘤,大部分为良性,临床、细胞学及术中快速冰冻检查均易误诊为恶性肿瘤,需结合HE形态学及免疫组化明确诊断。应提高对该疾病的认识,加强术前多学科谨慎评估,正确选择手术方式,术后密切随访。

Objective To investigate the clinicopathological features,immunohistochemical characteristics,diagnosis and differential diagnosis of granular cell tumor(GCT)of the breast.Methods The clinical and pathological profiles of 6 cases with GCT of the breast were retrospectively analyzed.The clinical manifestation,morphological features,immune phenotype,diagnosis and differential diagnosis of breast GCT were summarized in combination with the review of literature.Results One patient was male and five were female.Their age ranged from 21 to 60 years(mean=44.3 years).The study included 5 cases of benign granular cell tumor(BGCT)and 1 atypical granular cell tumor(AGCT).The tumors typically presented as a solitary oval nodule with unclear border in the breast parenchyma.The tumor size ranged from 1.5 to 4.5 cm(mean size=2.5 cm).Microscopically,the tumors were composed of nests or sheets of round to polygonal cells with abundant eosinophilic granular cytoplasm by an infiltrating growth pattern.The nuclei were small,round to oval,with visible nucleoli,and mitosis being absent.Immunohistochemical study demonstrated that tumor cells were possitive for Vimentin,S-100,NSE,CD68 andα-Inhibin,but negative for AE1/AE3,ER,PR,Her-2 and SMA.Conclusion GCT of the breast is a rare tumor,most of which is benign tumor that may be misdiagnosed as malignancy(such as apocrine carcinoma,acidophilic cell carcinoma and invasive lobular carcinoma etc.)by clinicians,in frozen sections or in cytological tests.HE morphology and immunohistochemistry are applied to make definitive diagnosis of the breast GCT.In order to select the right surgical method,the awareness of this disease should be strengthened and the multidisciplinary preoperative assessment as well as the close postoperative follow-up should be performed.