乳腺导管内乳头状瘤伴非典型增生的临床病理特征及预后分析

Clinical and pathological characteristics of intraductal papilloma with atypical hyperplasia and analysis of prognosis

目的探讨乳腺导管内乳头状瘤伴导管上皮非典型增生及导管原位癌的病理组织学特征、免疫组化表达以及临床相关特点。方法回顾性分析2017年2月—2023年11月本院收治的30例乳腺导管内乳头状瘤伴导管上皮非典型增生及导管原位癌患者的临床资料,结合其组织学形态及免疫组化结果分析临床、病理特点。结果患者平均发病年龄(46.3±11.7)岁。临床特征表现为乳头溢液、肿物以及导管扩张,超声检查结果显示BI-RADS分类2例2类,11例3类,15例4a类,2例4b类,导管内乳头状瘤伴导管上皮非典型增生28例,伴有导管原位癌2例;光镜下显示伴导管上皮非典型增生以及原位癌区域的腺上皮细胞较一致,细胞轻度异型性,其内可见纤细的纤维血管轴心,周围导管上皮伴随良性增生性病变;中位随访26个月结果显示原发部位均无新发病灶。免疫组化ER高表达(3+,60%~90%)11例,7例中-高表达PR(2+、3+,50%~90%),4例Ki-67阳性指数为10%,26例小于5%,CK5/6观察区均阴性,肌上皮标志物均显示未被非典型增生及导管原位癌累及区域及导管周围阳性;统计学结果显示导管内乳头状瘤伴有导管上皮非典型增生与低级别导管原位癌两组之间年龄、是否伴有乳头溢液、超声分类以及细胞增殖指数(Ki-67)之间无明显差异。结论伴有导管上皮非典型增生或导管原位癌的导管内乳头状瘤于影像学检查及临床诊断定性较为困难,同时,此类疾病在病理形态学表现同样较为复杂,为诊断难点,因此严格把握病理形态学诊断标准及免疫组化进行精准诊断,正确认识该类疾病,防止漏诊及误诊的发生,以利于更好地指导临床地实际工作。

Objective To explore the histopathological characteristics,immunohistochemical expression,and clinical related features of intraductal papilloma with atypical ductal epithelial hyperplasia and ductal carcinoma in situ in the breast.Methods To explore the histopathological characteristics,immunohistochemical expression,and clinical related features of intraductal papilloma with atypical ductal epithelial hyperplasia and ductal carcinoma in situ in the breast.Results The average age of onset in patients was(46.3±11.7)years.Clinical features included nipple discharge,mass,and ductal dilation.Ultrasound examination results showed BI-RADS classification with 2 cases of category 2,11 cases of category 3,15 cases of category 4a,and 2 cases of category 4b.Intraductal papilloma with atypical ductal epithelial hyperplasia was found in 28 cases,and ductal carcinoma in situ was found in 2 cases;under the light microscope,the glandular epithelial cells in areas with atypical hyperplasia and ductal carcinoma in situ showed consistency,with mild cellular atypia,and fine fibrous vascular cores were visible inside,with surrounding ductal epithelium accompanied by benign proliferative lesions;the median follow-up of 26 months showed no new lesions at the primary site.Immunohistochemical results:high expression of ER(3+,60%-90%)was observed in 11 cases,and moderate to high expression of PR(2+,3+,50%-90%)was observed in 7 cases.The Ki-67 positive index was 10%in 4 cases and less than 5%in 26 cases.CK5/6 observation areas were all negative,and myoepithelial markers showed positivity in areas not involved by atypical hyperplasia or ductal carcinoma in situ and around the ducts.Statistical results showed no significant differences in age,presence of nipple discharge,ultrasound classification,and cell proliferation index(Ki-67)between the groups with intraductal papilloma accompanied by atypical ductal epithelial hyperplasia and low-grade ductal carcinoma in situ.Conclusions Intraductal papilloma with atypical ductal epithelial hyperplasia or ductal carcinoma in situ is challenging to diagnose qualitatively through imaging and clinical examination.These diseases have complex pathological and morphological manifestations,posing a diagnostic challenge.Therefore,strict adherence to pathological and morphological diagnostic criteria and immunohistochemistry is essential for accurate diagnosis,proper understanding of these diseases,and prevention of missed and misdiagnoses,which will better guide clinical practice.