乳腺假血管瘤样间质增生的临床影像、病理学分析

Analysis of the imaging findings and clinical pathology of pseudoangiomatous stromal hyperplasia

目的 探讨分析乳腺假血管瘤样间质增生(pseudoangiomatous stromal hyperplasia,PASH)的临床影像、病理学特征。方法 回顾性分析2017年10月至2022年2月在浙江省中医药大学附属第一医院经病理诊断为乳腺PASH且有完整的临床及影像、病理学资料的患者,观察肿块的影像病理学表现、治疗及预后情况。结果 24例PASH患者中,20例为绝经前状态,21例伴乳房胀痛和(或)触及乳房肿块;超声检查检出1例PASH,钼靶检查无PASH检出,磁共振检查检出1例PASH;1例(2个肿块)病理检查为结节性PASH;7例(8个肿块)行免疫组化染色,其中7个肿块造血祖细胞抗原CD34(hematopoietic progenitor cell antigen,CD34)阳性、细胞核增殖相关抗原(cell proliferation-associated nuclear antigen,Ki-67)弱阳性,6个平滑肌肌动蛋白标志物(smooth muscle actin,SMA)及结蛋白desmin阳性,雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、血小板-内皮细胞黏附分子-1(platelet endothelial cell adhesion molecule-1,PECAM-1/CD31)表达或不表达。治疗及预后:22例患者行手术切除,2例行穿刺活检,1例术后考虑复发或病灶残留,所有病例随访均未见恶性转变。结论 PASH好发于绝经前女性,临床症状及体征无特异性;影像学检查检出率低,病理检查有特异性,为诊断的金标准;一般通过手术切除,预后较好。

Objective To analyze the imaging findings and clinical pathology of pseudoangiomatous stromal hyperplasia(PASH). Methods The patient with breast PASH diagnosed by pathology and with complete clinical imaging and pathological data from October 2017 to February 2022 in the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine were retrospectively analyzed, and the imaging pathological manifestations, treat well and prognosis of the masses were observed. Results In 24 patients, 20 were of premenopausal status and 21 were with palpable masses and(or) tender breast pain. Ultrasound examination reported 1 case of PASH, molybdenum target didn’t report any case of PASH and MRI reported 1 case of PASH.1 patient(2 masses) was reported as nodular PASH.7 patients(8 masses) were receipted immunohistochemical test.7 masses expressed CD34, Ki-67 and 6 masses expressed SMA and desmin.22 patients receipted surgical treatments and 2 patients receipted needle biopsy.1 patient was considered by recurrence or residual lesions but no malignant transition was found at the follow-up visit. Conclusion The PASH is more common in premenopausal women with less specific of the symptoms and signs. Pathological examination is the gold standard for diagnosis. PASH could be removed by surgery with favorable prognosis.