乳腺腺肌上皮瘤恶变的临床病理观察
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摘要
目的:探讨乳腺腺肌上皮瘤恶变的病理组织学特点、诊断标准及鉴别诊断。方法:对1例恶变的乳腺腺肌上皮瘤伴腋窝淋巴结转移的病例,应用光镜观察及免疫组化染色进行临床病理学分析,并复习相关文献。结果:肿瘤由结节状增生的腺上皮细胞及多层的肌上皮细胞共同组成。腺上皮细胞呈扁平或立方形排列在中心腔缘。肌上皮细胞胞质透明呈梭形或多角形位于外层。恶变区域腺上皮及肌上皮细胞均异型性明显,可见坏死,高核分裂计数,并可见浸润性生长边界。免疫组化特征具有双向性,腺上皮细胞表达CK、EMA、CEA,肌上皮细胞表达p63、SMA、Caldesmon。肿瘤细胞ER、PR、C-erb B-2均为阴性表达,CK5/6为阳性表达。结论:乳腺腺肌上皮瘤的腺上皮和肌上皮可分别发生恶变,同时发生恶变并且伴有腋窝淋巴结转移的病例非常罕见。根据组织形态学特点,结合免疫组化检测是确诊本病的关键。
Objective: To investigate the pathological features,diagnosis and differential diagnosis for the malignant transformation of the breast adenomyoepithelioma. Methods: Morphological observation and immunohistochemistry were applied in one case of malignant adenomyoepithelioma of the breast with a positive axillary lymph node,and the related literatures were reviewed. Results: The tumor was composed of nodular proliferation of epithelial and multi-layered myoepithelial cells. Epithelial cells were flat or cuboidal and disposed toward the central or luminal portion.Myoepithelial cells,which were located in the outer layer,were spindled to polygonal in shape of clear cytoplasm. The epithelial and myoepithelial area of malignant transformation was presented cellular atypia and pleomorphism,necrosis,with a high mitotic count and irregular invasive margins. The immunohistochemical analysis showed biphasic patterns,the glandular epithelial cells of the tumor were positive for CK,EMA,CEA,while the myoepithelial cells of the tumor was positive for p63,SMA,Caldesmon. However,tumor was negative for ER,PR,C- erb B- 2 and positive for CK5 /6. Conclusion: The epithelial or myoepithelial cellular components of breast adenomyoepithelioma can be transformed into malignancies. Malignant transformation of both components in breast adenomyoepithelioma with lymphatic metastasis is rare. Histology combined with immunohistochemistry can assist the diagnosis of this disease.
Objective: To investigate the pathological features,diagnosis and differential diagnosis for the malignant transformation of the breast adenomyoepithelioma. Methods: Morphological observation and immunohistochemistry were applied in one case of malignant adenomyoepithelioma of the breast with a positive axillary lymph node,and the related literatures were reviewed. Results: The tumor was composed of nodular proliferation of epithelial and multi-layered myoepithelial cells. Epithelial cells were flat or cuboidal and disposed toward the central or luminal portion.Myoepithelial cells,which were located in the outer layer,were spindled to polygonal in shape of clear cytoplasm. The epithelial and myoepithelial area of malignant transformation was presented cellular atypia and pleomorphism,necrosis,with a high mitotic count and irregular invasive margins. The immunohistochemical analysis showed biphasic patterns,the glandular epithelial cells of the tumor were positive for CK,EMA,CEA,while the myoepithelial cells of the tumor was positive for p63,SMA,Caldesmon. However,tumor was negative for ER,PR,C- erb B- 2 and positive for CK5 /6. Conclusion: The epithelial or myoepithelial cellular components of breast adenomyoepithelioma can be transformed into malignancies. Malignant transformation of both components in breast adenomyoepithelioma with lymphatic metastasis is rare. Histology combined with immunohistochemistry can assist the diagnosis of this disease.
引文
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[7]杨光之,李静,丁华野.乳腺恶性腺肌上皮瘤临床病理观察[J].诊断病理学杂志,2009,16(3):177-180.
[8]Hungermann D,Buerger H,Oehlschlegel C,et al.Adenomyoepithelial tumours and myoepithelial carcinomas of the breast-a spectrum of monophasic and biphasic tumours dominated by immature myoepithelial cells[J].BMC Cancer,2005,5:92-101.
[9]Han B,Mori I,Nakamura M,et al.Myoepithelial carcinoma arising in an adenomyoepithelioma of the breast:Case report with immunohistochemical and mutational analysis[J].Pathol Int,2006,56(4):211-216.
[10]Nadelman CM,Leslie KO,Fishbein MC."Benign",matastasizing adnomyo epithelioma of the breast:A report of 2 cases[J].Arch Pathol Lab Med,2006,130(9):1349-1353.
[11]龚西騟,丁华野.乳腺病理学[M].北京:人民卫生出版社,2009:215-216,388-390.
[12]Howlett DC,Mason CH,Biswas S,et al.Adenomyoepithelioma of the breast:Spectrum of disease with associated imaging and pathology[J].AJR Am J Roentgenol,2003,180(3):799-803.
[13]Zizi-Sermpetzoglou A,Vasilakaki T,Grammatoglou X,et al.Malignant adenomyoepithelioma of the breast:Case report[J].Eur J Gynaecol Oncol,2009,30(2):234-236.
[2]裴炜,张海增,石素胜,等.乳腺恶性腺肌上皮瘤5例临床病理分析并文献复习[J].中国肿瘤临床,2008,35(19):1097-1099.
[3]Suresh Attili VS,Kamal Saini,Laskshmaiah KC,et al.Malignant adenomyoepithelioma of the breast[J].Indian J Surg,2007,69:14-16.
[4]Ahmed AA,Heller DS.Malignant adenomyoepithelioma of the breast with malignant proliferation of epithelial and myoepithelial elements:A case report and review of the literature[J].Arch Pathol Lab Med,2000,124(4):632-636.
[5]Kihara M,Yokomise H,Irie A,et al.Malignant denomyoepithelioma of the breast with lung metastases:Report of a case[J].Surg Today,2001,31(10):899-903.
[6]周晓莉,范钦和,鲍永仪,等.乳腺恶性腺肌上皮瘤临床病理学观察[J].临床与实验病理学杂志,2011,27(8):838-842.
[7]杨光之,李静,丁华野.乳腺恶性腺肌上皮瘤临床病理观察[J].诊断病理学杂志,2009,16(3):177-180.
[8]Hungermann D,Buerger H,Oehlschlegel C,et al.Adenomyoepithelial tumours and myoepithelial carcinomas of the breast-a spectrum of monophasic and biphasic tumours dominated by immature myoepithelial cells[J].BMC Cancer,2005,5:92-101.
[9]Han B,Mori I,Nakamura M,et al.Myoepithelial carcinoma arising in an adenomyoepithelioma of the breast:Case report with immunohistochemical and mutational analysis[J].Pathol Int,2006,56(4):211-216.
[10]Nadelman CM,Leslie KO,Fishbein MC."Benign",matastasizing adnomyo epithelioma of the breast:A report of 2 cases[J].Arch Pathol Lab Med,2006,130(9):1349-1353.
[11]龚西騟,丁华野.乳腺病理学[M].北京:人民卫生出版社,2009:215-216,388-390.
[12]Howlett DC,Mason CH,Biswas S,et al.Adenomyoepithelioma of the breast:Spectrum of disease with associated imaging and pathology[J].AJR Am J Roentgenol,2003,180(3):799-803.
[13]Zizi-Sermpetzoglou A,Vasilakaki T,Grammatoglou X,et al.Malignant adenomyoepithelioma of the breast:Case report[J].Eur J Gynaecol Oncol,2009,30(2):234-236.