乳腺乳头腺瘤7例临床病理分析及文献复习

Nipple adenoma:Report of 7 cases with review of literatures

目的:探讨乳腺乳头腺瘤的临床病理特征、诊断及鉴别诊断的要点。方法:收集中日友好医院近10年确诊的乳头腺瘤7例,调阅病理切片,收集相关临床和病理资料,并查阅文献总结其临床病理学特征、诊断及鉴别诊断的要点。结果:7例患者均为女性,发病年龄34~51岁,中位年龄37岁。其中4例发生于右乳,3例发生于左乳,病变均在乳头。4例有乳头表面的改变,例如糜烂、湿疹、破溃等,1例有乳头溢液。镜下观察肿瘤边界相对清晰。4例导管上皮以旺炽型增生为主,增生的上皮伴有轻度不典型增生,核分裂像少见,实性细胞巢中央偶有腺样的分化,局灶可见少许坏死,部分周边的肌上皮增生伴有鳞化。3例呈腺病样改变,部分腺上皮呈乳头状增生,中央区域呈硬化性腺病样改变。免疫组化染色显示增生的导管上皮CK5/6阳性,雌激素受体(ER)、孕激素受体(PR)呈强弱不等的阳性,上皮巢周围肌上皮标记物P63、Calponin阳性。结论:乳头腺瘤是少见的乳腺良性肿瘤,其生长方式不同,伴有上皮旺炽型增生或出现假浸润等复杂形态时,极易与导管内癌、浸润性癌相互混淆,导致误诊。

Objective:To investigate the clinicopathological features,diagnosis and differential diagnosis of nipple adenoma of the breast.Methods:The clinical data,histopathologic observation and immunohistochemical staining were studied in 7 cases of nipple adenoma of the breast,combined with a review of the related literatures.Results:All the 7 patients were female,with ages ranging from 34 to 51 years of onset,with a median age of 37 years.Four of them occurred in right breasts and three in left,all located at the nipples.Four cases had nipple surface changes,such as erosion,eczema,ulceration,etc,and 1 patient had nipple discharge.Microscopically,the tumor was relatively well defined,ductal epithelium was markedly hyperplastic and showing adenoid and papillomatous growth patterns.In 4 cases,the ductal epithelium showed an active hyperplasia with mild atypical hyperplasia,rare mitosis,solid cells with occasional adenoid differentiation in the central nests,and some peripheral myoepithelial hyperplasia with squamous metaplasia.Three cases showed adenoid-like changes,with papillary hyperplasia in some glandular epithelium and sclerosing adenosis in the central region.Immunohistochemistry showed that proliferative ductal epithelium patchily positive for CK5/6,ER and PR were positive with different strength,and P63 and calponin were positive for myoepithelial around the epithelial nests.Conclusion:Papillary adenoma is a rare benign breast tumor.Due to its different growth patterns,especially when accompanied by epithelial hyperplasia or pseudoinvasion,it is difficult to differentiate from ductal carcinoma in situ and invasive ductal carcinoma.The treatment method of it is complete resection of the lesion,generally no recurrence after surgical excision.