乳腺双相型化生性癌伴癌周导管内乳头状瘤一例报告

A case report of metaplastic breast cancer with intraductal papilloma in breast

目的初步探讨乳腺双相型化生性癌伴癌周导管内乳头状瘤的影像学、免疫组化表型、鉴别诊断。方法回顾性收集本院收治的1例经病理证实的乳腺双相型化生性癌伴癌周导管内乳头状瘤患者的病理结果与影像学资料,并复习相关文献。结果患者右乳无痛、质韧肿物,组织形态学显示肿瘤为囊性,灶状囊内见灰白色凸起,凸起区域细胞呈片状、巢状排列,细胞上皮样,部分梭形,细胞核明显异型,核分裂象易见,并见大量坏死,囊壁纤维化明显伴出血、灶状钙化及含铁血黄素沉积;肿瘤周围乳腺组织部分区域呈纤维腺瘤样增生,灶状见导管内乳头状瘤。结论乳腺化生性癌发病机制目前不明确,病理学表现复杂,影像学表现无突出特征,易误诊,免疫组化对鉴别诊断有帮助。本例患者为双相型乳腺化生性癌,且Her-2表达阳性,国内外仅见散在报道。

Objective To investigate the imaging,immunohistochemical phenotype and differential diagnosis of metaplastic breast carcinoma with periaductal papilloma.Methods We retrospectively collected the pathological results and imaging data of a patient with metaplastic breast carcinoma with intraductal papilloma in our hospital,and reviewed relevant literature.Results The patient had a painless,tough mass in her right breast.Histomorphology showed cystic tumor with a grayish-white bulge in the focal sac.Cells in the raised area were arranged in sheet and nest shape,with epithelial like and partially spindle shaped cells.The cells had obvious nuclear atypia,and mitotic images and massive necrosis were easily visible.The cystic wall is fibrotic with bleeding,focal calcification and hemosiderin deposition.Some areas of the breast tissue surrounding the tumor showed fibroadenomatous hyperplasia,and the focus showed intraductal papilloma.Conclusion The pathogenesis of metaplastic breast carcinoma with intraductal papilloma in breast is currently unclear,and its pathological manifestations are complex.The imaging findings do not have prominent features and are prone to misdiagnosis,making immunohistochemistry helpful for differential diagnosis.In this case,the patient had biphasic metaplastic breast carcinoma with positive Her-2 expression,with only sporadic reports found domestically and internationally.