乳腺颗粒细胞瘤2例并文献回顾

Granular cell tumor of breast: two case report and literature review

目的 探讨乳腺颗粒细胞瘤的临床病理特征、诊断、鉴别诊断及预后。方法 收集2008年1月—2022年3月陕西省人民医院病理科诊断的2例乳腺颗粒细胞瘤的相关临床病理资料,进行组织学观察、免疫组织化学分析。结果 镜下肿瘤细胞呈条索状或实性巢团状排列,浸润性生长,间质纤维化或玻璃样变;肿瘤细胞呈多角形,胞质富含嗜酸性颗粒,细胞核小,圆形或者卵圆形,核偏位或位于中央,核深染,核仁不明显;细胞膜界限不清,核分裂罕见。免疫组织化学检测显示肿瘤细胞阳性表达Vimentin、S-100、CD68、TFE3、β-catenin,Ki-67指数约3%,不表达CK、Desmin、SMA、CR、ER、PR、Melan-A、HMB-45。PAS染色阳性。结论 乳腺颗粒细胞瘤是一种少见的乳腺肿瘤,预后良好。依据临床表现、冷冻切片及放射影像学易误诊为乳腺癌,术后应长期定时随访,避免复发和恶变。

Objective To investigate the clinicopathological features, differential diagnosis and prognosis of granular cell tumor of the breast(GCTB). Methods The clinicopathological features and immunohistochemical phenotypes of two cases of GCTB were analyzed by light microscopy and immunohistochemistry, and the relevant literature was reviewed. Results Microscopically, the tumor cells are arranged in strips or solid nests, with invasive growth, interstitial fibrosis or hyaline degeneration. The tumor cells are polygonal, the cytoplasm is rich in eosinophilic particles, the nucleus is small, round or oval, the nucleus is biased or located in the center, the nucleus is deeply stained, and the nucleolus is not obvious;the boundaries of cell membrane are unclear, and mitosis could be rarely observed. Immunohistochemical examination showed that tumor cells expressed Vimentin, S-100, CD68, TFE3, β-catenin, Ki-67index was about 3%, but CK, Desmin, SMA, CR, ER, PR, Melan-A, HMB-45 were negative. PAS staining was positive. Conclusion Granular cell tumor of the breast is a rare breast tumor with a good prognosis. It is easy to be misdiagnosed as breast cancer via clinical manifestations, frozen sectioning, and radiological imaging. Long term regular follow-up should be carried out after operation to avoid recurrence and malignant transformation.