乳腺黏液囊腫樣病變——組織病理學及針吸細胞學改變

Mucocele-like lesion of the breast--histiopathology and aspiration cytology changes

目的:分析乳腺黏液囊腫樣病變(Mucocele-like lesion,MLL)的組織病理學及細針吸取(FNA)細胞學特點,尋求在手術前根據FNA細胞學鑑別MLL與乳腺黏液癌。方法:重祈評估7例MLL(良性5例,惡性2例)的組織病理學及FNA細胞學材料,並以同期14例黏液癌作對照,比較兩病在組織學及FNA細胞學上的差異。結果:所有MLL均有乳腺結節,病人年輕(平均年齡34.8),組織學上良性MLL的特徴是形成黏液性囊腫,應腫壁由良性的上皮披覆(惡性MLL囊壁上皮部分呈導管内癌改變);漏出間質的黏液内通常無腫瘤細胞,黏液癌不形成黏液性囊腫,間質的黏液池中有較多的腫瘤細胞。在FNA細胞學上,所有MLL病例針吸時均可吸出黏稠的黏液樣物質,塗片背景均可見豐富的黏液。MLL與典型的黏液癌的最大區別是吸出物中腫瘤細胞稀少,細胞黏合性好,基本上無游離的上皮細胞,細胞呈單層排列而無異型性,結論:可按FNA細胞學改體將MLL與黏液癌區別。黏液癌可直接手術治療,但MLL應行切除活檢,從組織病理學進一步區別良性與惡性MLL。

Objective:To elucidate the histopathology and fine needle aspiration cytology(FNAC)featuers of mucocele-iike lesion(MLL)of the breast,and to establish the criteria in separating MLL from mucinous carcinoma on the basis of pre-operative FNAC.Methods:Seven cases of MLL(five benign and two malignant)were reviewed.The histology and FNAC features were compared with 14 cases of mucinous carcinoma examined during the same period.Results:All cases of MLL presented with breast lumps(One case was detected by doctor after abnormal mammogram).The patients are much younger(mean age 34.8 for MLL and 67.9 for mucinous carcinoma).Histologically,MLL are characterized by mucinous cysts which may rupture and discharge the contents into the surrounding tissue.The lining epithelium is bland and epithelial cells are rare in the mucin pool.Malignant MLL shows associated in-situ carcinoma.In contrast,mucinous carcinoma is formed by large mucin pools devoid of lining epithelium and contain numerous tumor cells in the mucin pools.In all cases,grossly visible jelly-like mucus were obtained from FNA.Cytologically,all smears showed abundant mucus in the background.The most important features distinguishing benign MLL from mucinous carcinoma were:scant cellularity;rare intact single tumor cell and tumor cells arranged in cohesive monolayered clusters lacking significant nuclear atypia.Conclusion:Mucinours lesions of the breast can be divided into MLL and mucinous carcinoma based on the FNAC changes.Operative therapy can be performed for defirdte cases of mucinous carcinoma without further biopsy.However,excisional biopsy is advised in MLL for further separation into benign and malignant categories.