乳腺幼年性纤维腺瘤临床病理分析

Clinicopathological Analysis of Juvenile Fibroadenoma of Breast

目的:探讨乳腺幼年性纤维腺瘤(juvenile fibroadenoma,JF)的临床病理特点。方法:回顾性分析北京市顺义区妇幼保健院2020年8月-2021年7月确诊为乳腺JF的5例病例的临床资料。5例患者中肿瘤最小者行麦默通微创旋切术,其余4例经粗针穿刺明确诊断后,均进行了完整的肿瘤切除术。所有患者均经过彩色多普勒超声检查,所有标本均进行巨检,光镜下观察所有标本组织病理学特征,采用EnVison两步法对1例幼年性巨大纤维腺瘤(juvenile giant fibroadenoma,JGF)标本进行免疫组织化学检测。分析超声检查、巨检、组织病理学特征及免疫组织化学结果。结果:超声检查显示患者大部分表现为边界较清的低回声结节,结节内部及周边可见较丰富的血流信号。巨检显示完整的肿物切除标本均为边界清晰的结节,表面似有包膜、完整,2例单发型JF结节大小分别为1.4 cm×1 cm×1 cm,3 cm×2 cm×2 cm。1例单发型JF结节大小为5.3 cm×4.5×3.5 cm。1例JGF多发型结节大小分别为2.5 cm×2.1 cm×1.7 cm,13 cm×9.5 cm×6.5 cm。组织病理学特征显示3例管周型,2例混合型,3例JF腺体与间质分布较均匀,2例JGF部分区域腺体与间质比例失调,伴有良性叶状肿瘤结构,部分区域腺体与间质分布较均匀。免疫组织化学检测结果显示1例JGF标本肿瘤中腺上皮细胞ER、PR、CK5/6、P63均阳性,间质细胞CD34阳性,Ki-67<5%,Bcl-2弱阳性,CD10局灶阳性,CD117阴性,p53野生型。结论:JF是一类较为罕见的乳腺良性纤维腺瘤,超声检查、明确的穿刺病理诊断可以帮助临床制定更合理的手术治疗方案,避免过度治疗。

Objective:To explore the clinicopathological characteristics of juvenile fibroadenoma(JF)of breast.Method:The clinical data of 5 cases of breast JF diagnosed in Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital from August 2020 to July 2021 were analyzed retrospectively.Among the 5 patients with the smallest tumor,Mammotome minimally invasive rotary resection was performed,and the other 4 patients underwent complete tumor resection after clear diagnosis by coarse needle puncture.All patients were examined by color Doppler ultrasound,and all specimens were macroscopically examined.The histopathological characteristics of all specimens were observed under light microscope.Immunohistochemical detection was performed on one juvenile giant fibroadenoma(JGF)specimen by EnVison two-step method.The results of ultrasonography,macroscopical examination,Histopathological characteristics and immunohistochemical detection were analyzed.Result:Ultrasound examination showed that most of the patients showed hypoechoic nodules with clear boundary,and abundant blood flow signals could be seen inside and around the nodules.Macroscopical examination showed that the complete tumor resection specimens were well-defined nodules,and the surface seemed to have a complete capsule.The size of nodules in 2 cases of JF with single type were 1.4 cm×1 cm×1 cm and 3 cm×2 cm×2 cm respectively.The size of nodule in 1 case of JF with single type was 5.3 cm×4.5×3.5 cm.The sizes of multiple nodules of JGF were 2.5 cm×2.1 cm×1.7 cm and 13 cm×9.5 cm×6.5 cm respectively.The histopathological characteristics showed that 3 cases of peritubular type,2 cases of mixed type,in 3 cases of JF,the distribution of glands and stroma was relatively uniform,in 2 cases of JGF,the proportion of glands and stroma in some areas was unbalanced,accompanied by benign phyllodes tumor structure,and the distribution of glands and stroma in some areas was relatively uniform.Immunohistochemical results showed that the glandular epithelial cells ER,PR,CK5/6 and p63 were positive in 1 case JGF specimen tumor,the stromal cells CD34 was positive,and Ki-67<5%,Bcl-2 was weakly positive,CD10 was focal positive,CD117 was negative and p53 was wild-type.Conclusion:JF is a kind of relatively rare benign fibroadenoma of the breast.Ultrasound examination and clear puncture pathological diagnosis can help the clinical to make a more reasonable surgical treatment plan and avoid excessive treatment.