乳腺富细胞黏液腺癌的超声表现及病理学诊断对照

Hypercellular variant of mucinous breast cancer: correlation between sonographic features and pathology

目的:探讨乳腺富细胞黏液腺癌的超声表现与病理学诊断的关系。方法:分析11例乳腺富细胞黏液腺癌的超声表现及病理学检查结果,包括细胞内有无黏液、分布形态(多发细小囊泡、较大黏液湖、较大黏液湖伴印戒细胞)及细胞外黏液与细胞面积比值(<30%、30%～90%、>90%),并对照研究超声内部回声与病理学检查结果之间的关系。结果:超声图像上肿块均呈实性团块,5个肿块为高回声,2个为等回声,4个为低回声;8个形态不规则;8个边界模糊;10个见中等或丰富彩色血流信号。8例行超声弹性成像检查,5个弹性超声评分为2～3分。病灶细胞内黏液为多发细小囊泡时,超声均表现为高回声;病灶细胞内黏液为黏液湖或无细胞内黏液时,超声表现为等回声或低回声。超声内部回声与细胞外黏液无明显关系。超声均诊断为BI-RADS 4类。结论:乳腺富细胞黏液腺癌常表现为形态不规则、边界模糊的高回声,血流丰富,弹性评分低。其内部回声与细胞内黏液有关,与细胞外黏液无明显关系。超声有助于乳腺富细胞黏液腺癌的术前良恶性诊断。

Objective:To investigate the correlation between ultrasonic features and pathologic findings of hypercellular variant of mucinous breast cancer(MBC).Methods:The sonographic features of 11 cases with hypercellular variant of MBC were analyzed.The microscopic slides were evaluated to estimate the presence of intracellular mucin,the shape of intracellular mucin(small globules,large lake,large lake with signet ring cell)and the proportion of volume of extracellular mucin to area of tumor cell(<30%,30%-90%,>90%).The sonographic echo pattern of tumors was compared with pathologic findings.Results:Ultrasound showed a solid mass in all 11 cases,which was hyperechoic(5/11),isoechoic(2/11)or hypoechoic(4/11).Eight masses had irregular shape.Eight masses had indistinct margins.Ten masses were hypervascular or isovascular.Elastography was performed in eight patients,and five masses had a elasticity score of 2 or 3.The lesions with many small intracellular mucin globules were presented as hyperechoic,while the lesions with large lake of intracellular mucin or with no intracellular mucin were isoechoic or hypoechoic.There was no correlation between sonographic echo pattern and extracellular mucin.All lesions were classified as BI-RADS category 4.Conclusion:The common sonographic features of hypercellular variant of MBC are irregular,indistinct and hyperechoic mass with hypervascularity and low elasticity score.The sonographic echo pattern is correlated with intracellular mucin,but not with extracellular mucin.Ultrasound is useful in the prediction of malignancy or benignancy of hypercellular variant of MBC.