乳腺血管瘤病6例临床病理学分析

Angiomatosis of the breast: a clinicopathological analysis of six cases

目的探讨乳腺血管瘤病的临床病理特征及病理诊断。方法收集解放军总医院第七医学中心病理科及北京中医药大学东直门医院病理科2011年1月至2023年12月诊断的共6例乳腺血管瘤病患者, 分析其临床病理资料并复习相关文献。结果 6例患者均为女性, 年龄范围25~62岁, 平均年龄46岁。临床常表现为可触及的单侧乳腺肿块, 肿瘤最大径7~14 cm, 平均11 cm。组织学上, 6例均表现为血管、淋巴管弥漫性增生, 脉管腔扩张、大小不等、互相吻合、管壁薄, 无/极少见平滑肌, 内皮细胞扁平、无异型性, 病变弥漫性浸润乳腺间质, 但不破坏乳腺终末导管小叶单位。CD31、CD34、第Ⅷ因子相关抗原、Fli-1、D2-40等免疫组织化学染色结果显示血管和/或淋巴管内皮细胞阳性, Ki-67阳性指数均<1%。结论乳腺血管瘤病是一种罕见的良性脉管性病变, 与低级别血管肉瘤的鉴别需要关注病变生长模式、内皮细胞形态和Ki-67阳性指数。

Objective:To investigate the clinicopathological features and differential diagnosis of breast angiomatosis.Methods:Six cases of breast angiomatosis diagnosed at the Department of Pathology,the Seventh Medical Center,People′s Liberation Army General Hospital and the Department of Pathology,Dongzhimen Hospital,Beijing University of Chinese Medicine from January 2011 to December 2023 were evaluated and reviewed.Results:All patients were female with an average age of 46 years at presentation,ranging from 25 to 62 years.The most common clinical presentation was a palpable unilateral breast mass with diameter ranging from 7 to 14 cm,and the average size was 11 cm.Histologically,all cases were composed of variably-sized ectatic,thin-walled blood vessels with minimal to no apparent smooth muscle,lined by flat normochromic endothelium without atypia,and diffusely infiltrating the breast stroma.Where present,the lesional vessels infiltrated between and around terminal duct lobular units but not into individual intralobular stroma.Immunohistochemical staining for CD31,CD34,FactorⅧ,Fli-1 and D2-40 revealed positive expression in vascular and/or lymphatic endothelial cells.Additionally,the Ki-67 proliferation index was found to be less than 1%.Conclusions:Angiomatosis of the breast is a rare benign vascular lesion.Distinguishing it from low-grade angiosarcoma requires careful consideration of the growth pattern,atypical features,and Ki-67 proliferation index.