乳腺纤维瘤病样化生性癌临床病理分析

Clinicopathological analysis of fibromatosis-like metaplastic carcinoma of the breast

目的探讨乳腺纤维瘤病样化生性癌的临床病理学特点及免疫组化特征。方法收集并分析1例纤维瘤病样化生性癌病例的临床特征及病理资料,进行HE染色和免疫组化标记,并复习文献。结果组织学乳腺纤维瘤病样化生性癌大部分区域为温和的梭形细胞,仅于靠近导管区域细胞密集,并伴轻-中度异型,可见假血管瘤样、黏液样间质,并见胶原化,肿瘤周边可见乳腺增生性病变;免疫组化标记,梭形细胞既表达上皮标记CK(AE1/AE3)、CKH(34βE12)和CK7,,也表达肌上皮的相关标记CK5/6、p63、CD10,而ER、PR、HER-2、SMA、desmin、CD34、CD117和S-100均阴性。随访13个月,尚未发现复发或转移。结论乳腺纤维瘤病样化生性癌是乳腺化生性癌的一种亚型,诊断时需结合组织学特点及免疫标记表达情况,注意与乳腺相关的梭形细胞病变相鉴别。

Objective To investigate the clinicopathological and immunohistochemical features of fibromatosis-like metaplastic carcinoma of the breast.Methods A case of fibromatosis-like metaplastic carcinoma of the breast was collected and studied by haematoxylin-eosin staining and immunohistochemistry.Clinicopathological characteristics were observed and analyzed with literature review.Results Histopathologically,the tumor showed a proliferation of bland spindle cells,and abundant spindle cells were only observed in the regions near the duct cells,with low-grade to intermediate-grade atypia.The tumor stoma showed pseudoangiomatous,myxoid or collagen elements,and the tumor surrounded by breast hyperplastic lesions.Immunohistochemically,the tumor cells were positive for CK(AE1/AE3),CKH(34βE12),CK7,CK5/6,p63,CD10,and negative for ER、PR,HER-2,SMA,desmin,CD34,CD117,and S-100.After ten months of follow-up,we found no evidence of recurrence or metastasis.Conclusion Fibromatosis-like metaplastic carcinoma of the breast is a subtype of metaplastic carcinoma.The diagnosis should combine histological morphology and immunohistochemical phenotype,and should be differentiated from other spindle cell lesions of the breast.