双侧乳腺孤立性粒细胞肉瘤1例报告并文献复习

Isolated granulocytic sarcoma of bilateral breast:A case report with literature review

目的:讨论乳腺孤立性粒细胞肉瘤的临床及病理特征。方法:回顾性分析被确诊为双侧乳腺孤立性粒细胞肉瘤患者的临床资料、组织形态学、骨髓常规及免疫表型特征,并复习相关文献。结果:1例在发病前无白血病病史的62岁女性患者体检发现双侧乳腺无痛性肿块。组织病理学可见肿瘤细胞呈列兵样排列或弥漫性分布,肿瘤细胞形态及大小一致,呈圆形或卵圆形,细胞质少,细胞核呈圆形或卵圆形,核分裂象及核仁易见,可见未成熟嗜酸性粒细胞散在分布。免疫组化提示MPO、CD 45、CD34、CD68、CD117和CD43呈阳性,CD20、CD3、CD30、CD10和CKpan呈阴性。结论:双侧乳腺孤立性粒细胞肉瘤罕见。由于缺乏特异性临床特征,通常被误诊为淋巴瘤或其它良性肿瘤。肿瘤局部切除、系统化疗及放疗是其主要治疗手段。

Objective:To discuss the clinical and pathological characteristics of isolated granulocytic sarcoma.Methods:The clinical data,histomorphology,bone marrow morphology and immune phenotype of one patient diagnosed as isolated granulocytic sarcoma of bilateral breast were retrospectively analyzed,and previous literature that described the clinical and pathological characteristics,treatments and prognosis of the granulocytic sarcoma of the breast were reviewed.Results:A 62-year-old female patient had a main physical sign of painless mass in both breasts without any prior history of leukemia.The medium-sized round or oval cells were monotonous and arranged in single-file or diffuse pattern.The cytoplasm was scanty and immature eosinophilic myelocytes were scattered.The nuclei were round or oval with obvious mitoses and distinct nucleoli.Immunohistochemically,the tumor cells were positive for MPO,CD45,CD34,CD68,CD117 and CD43,but not CD20,CD3,CD30,CD10 and CKpan.Conclusion:Isolated granulocytic sarcoma of bilateral breast is extremely rare and may be misdiagnosed as lymphoma or other benign tumors because of the absence of specific clinical features.Diagnosis is made by its histopathological and immunohistochemical characteristics.Lumpectomy,systemic chemotherapy and radiotherapy are used in the treatment of isolated granulocytic sarcoma of breast.