乳腺颗粒细胞瘤临床病理学特征及生物学行为

Granular cell tumor of breast: clinicopathological and biological behavior

目的探讨乳腺颗粒细胞瘤(granular cell tumor,GCT)临床病理学特征,免疫组织化学和特殊染色特点、诊断及预后,以提高对本病的认识。方法收集3例乳腺颗粒细胞瘤病例,标本均充分取材,完善临床及预后资料,观察临床病理学特点,高碘酸雪夫反应(PAS反应)特殊染色和SP法免疫组织化学检测。结果 3例均为女性,平均年龄46岁,年龄范围为39~56岁,临床上表现为单个质硬的无痛性或伴压痛肿块,肿块位于乳腺实质内。病理学大体改变主要为肿瘤质实或硬,边界清楚或浸润性,直径1.5~2.0 cm,平均1.7 cm,切面呈灰白至黄色。组织学表现为类圆形或多角形的大细胞,胞质丰富嗜酸性,呈实体巢状、簇状或索状排列,1例边界清,2例呈浸润性生长,细胞核小,位于中心或偏位。胞浆中含丰富溶酶体,胞浆呈粗颗粒状,内见S-100染色阳性的微细颗粒,PAS反应阳性(抗消化酶)。免疫组织化学染色:S-100、CD56、NSE、Vi-mentin均阳性,CK、SMA均呈阴性。所有患者目前均无恶变或转移。结论 GCT可发生于身体的任何部位,但乳腺中不常见,在临床表现、影像学及肉眼观察等方面,均类似于乳腺癌。结合HE形态、免疫组织化学及特殊染色做出正确诊断,术后密切随访。

Objective To investigate the clinicopathological and immunohistochemical features, diagnosis and prognosis of granular cell tumor of breast (GCT) and to improve the awareness of the disease. Methods Three cases of GCT were collected;Specimens were fully drawn, microscopic pathologic examinations and immunohistochemistry (SP method) were performed. Results Three cases were female patients aged from 39 to 56 years old (average 46 years). In clinical, a single indolent or indolent mass with a hard texture was located in the breast parenchyma. In pathological, the lump was mainly solid or hard tumor with clear boundary or infiltration, with a mean diameter of 2.1 (1.2-3.0) cm, and grey to yellow sections. Histologically, large cells were round or polygonal in shape. The cytoplasm was abundant and eosinophilic. The boundary of the tumor was clear in one case, and in the other two cases, the boundary was unclear. The nucleus was small and located in the center or ectopic. The cytoplasm was coarse-grained with s-100 staining positive microparticles and PAS reaction positive (anti-digestive enzymes). Immunohistochemistrically, the tumor cells were strongly positive for S-100, CD56, NSE and Vimentin, and negative for CK and SMA. None of the patients had present malignant transformation or metastasis. Conclusions GCT can occur in any part of the body, but is not common in breast. GCT is similar to breast cancer in clinical manifestations, imaging and macroscopic observation, etc. The correct diagnosis of this lesion depends on HE morphology, immunohistochemistry and special dyeing. The close postoperative follow-up should be performed.