乳腺梭形细胞/肉瘤样化生性癌的超声造影表现及诊断
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摘要
目的探讨乳腺梭形细胞/肉瘤样化生性癌的临床病理学特征、二维超声及超声造影表现与鉴别诊断。方法对1例62岁女性乳腺梭形细胞/肉瘤样化生性癌患者进行常规二维超声、超声造影、穿刺活检、手术切除、病理HE染色、免疫组化检测,并与相关文献对比分析。结果患者肿块位于右侧乳腺腺体层深面、胸大肌间隙,常规超声表现为以囊性为主的囊实混合回声肿块,超声造影表现为不均匀高增强伴不规则无增强区;病理提示肿瘤细胞主要由梭形细胞构成,杂乱分布,其间夹杂少许新生毛细血管,并伴肿瘤细胞液化坏死,间质平滑肌细胞及炎性细胞侵润可见。免疫表型:肿瘤细胞表达vimentin、SMA、CK,不表达CD34、CD56、S-100、CK7、HCK、ER、PR、EMA、desmin、BCL-2及P36,Ki-67增殖指数为75%。结论乳腺梭形细胞/肉瘤样化生性癌极为罕见,肿块常巨大,边缘多规整,常伴有囊性变,常规超声可发现病灶及其基本形态特征,超声造影可观察肿块微血管灌注情况指导穿刺,确诊需结合病理组织学、免疫表型的检测。
Objective To investigate the clinical and pathological characteristics of spindle cell/sarcoma of the breast, and to evaluate the expression and differential diagnosis of conventional ultrasound and contrast-enhanced ultrasound.Methods 1 cases of breast spindle cell/sarcoma were treated with conventional ultrasound, contrast-enhanced ultrasound, biopsy, surgical resection, pathological HE staining, immunohistochemistry test and review of the literature. Results The female patient was 62 years old. The mass was located between the right side of the mammary gland layer and pectoralis major muscle, conventional ultrasound showed a predominantly cystic echo mass that mixed cystic and solid, contrast-enhanced ultrasound showed inhomogeneous high enhanced with irregular enhanced area. The tumor cells were mainly composed of spindle cells, random distribution, interspersed with a few new capillaries, and necrosis in tumor cells. Stromal smooth muscle cells and inflammatory cells infiltration were visible. Immunohistochemically, the tumor cells expressed vimentin, SMA, CK, but the tumor cells did not express CD34, CD56,S-100, CK7, HCK, ER, PR, EMA, desmin, BCL-2 and P36. The proliferation index of the Ki-67 was 75%. Conclusion Spindle cell/sarcoma of the breastis is extremely rare. The mass is often huge and edge warping and associated with cystic degeneration. There is no obvious specificity of conventional ultrasound and contrast-enhanced ultrasound. The diagnosis should be combined with histopathological and immunohistochemical detection.
Objective To investigate the clinical and pathological characteristics of spindle cell/sarcoma of the breast, and to evaluate the expression and differential diagnosis of conventional ultrasound and contrast-enhanced ultrasound.Methods 1 cases of breast spindle cell/sarcoma were treated with conventional ultrasound, contrast-enhanced ultrasound, biopsy, surgical resection, pathological HE staining, immunohistochemistry test and review of the literature. Results The female patient was 62 years old. The mass was located between the right side of the mammary gland layer and pectoralis major muscle, conventional ultrasound showed a predominantly cystic echo mass that mixed cystic and solid, contrast-enhanced ultrasound showed inhomogeneous high enhanced with irregular enhanced area. The tumor cells were mainly composed of spindle cells, random distribution, interspersed with a few new capillaries, and necrosis in tumor cells. Stromal smooth muscle cells and inflammatory cells infiltration were visible. Immunohistochemically, the tumor cells expressed vimentin, SMA, CK, but the tumor cells did not express CD34, CD56,S-100, CK7, HCK, ER, PR, EMA, desmin, BCL-2 and P36. The proliferation index of the Ki-67 was 75%. Conclusion Spindle cell/sarcoma of the breastis is extremely rare. The mass is often huge and edge warping and associated with cystic degeneration. There is no obvious specificity of conventional ultrasound and contrast-enhanced ultrasound. The diagnosis should be combined with histopathological and immunohistochemical detection.
引文
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[20] 李利,刘淑萍,汪娜,等.乳腺实性病灶实时超声造影增强模式的研究[J].医学影像学杂志,2011,21(7):1008-1011.
[21] Zhao LX,Liu H,Wei Q,et al.Contrast-Enhanced Ultrasonography Features of Breast Malignancies withDifferent Sizes:Correlation with Prognostic Factors[J].BioMed research international,2015,2015:613831.
[2] DavisW G,HennessyB,BabieraG,et al.Metaplastic sarcomatoid carcinoma of the breast with absent or minimal overt invasive carcinomatous component:a misnomer[J].AmJSurgPathol,2005,29(11):1456 -63.
[3] Rakha EA,Aleskandarany MA,Lee AH.An approach to the diagnosis of spindle cell lesions of the breast[J].Histopathology,2016,68(1):33-44.
[4] 傅静,魏兵,步宏,等.乳腺梭形细胞/肉瘤样化生性癌临床病理和免疫表型分析[J].临床与实验病理学杂志,2010,26(3):270-274.
[5] 苏哲.乳腺梭形细胞化生性癌7例临床病理分析[J].诊断病理学杂志,2016,23(8):570-573.
[6] 官忠燕,丰宇芳,干振康,等.乳腺梭形细胞癌3例临床病理学观察[J].临床与实验病理学杂志,2015,31(9):996-1000.
[7] White SR,Auguste LJ,Guo H.Periductal Stromal Sarcoma of the Breast With Liposarcomatous Differentiation:A Case Report With 10-Year Follow-up and Literature Review[J].International journal of surgical pathology,2015,23(3):221-224.
[8] Choi B B,Shu K S.Metaplastic carcinoma of the breast:multimo-dality imaging and histopathologic assessment[J].Acta Radiol,2012,53(1):5-11.
[9] 张玲,廖昕,徐维敏,等.乳腺肉瘤的X线和超声表现分析[J].临床放射学杂志,2013,32(6):793-797.
[10] 罗冉,汪登斌,王丽君.乳腺叶状肿瘤的MRI特征及鉴别诊断[J].国际医学放射学杂志,2014,37(5):426-429.
[11] 石颖,雷成功.乳腺叶状囊肉瘤超声诊断及鉴别诊断[J].临床医药实践,2010,19(10):727-728.
[12] 蔡丽珊,张建兴,宋光辉,等.超声造影在乳腺癌早期诊断中的临床应用[J].南方医科大学报,2013,33(12):1801-1805.
[13] Liu H,Jiang Y,Dai Q,et al.Differentiation of benign and malignant sub-1-cm breast lesions using contrast-enhanced sonography[J].J Ultrasound Med.2015 Jan;34(1):117-123.
[14] Lassau N,Coiffier B,Kind M,et al.Selection of an early biomarker for vascular normalization using dynamic contrast-enhanced ultrasonography to predict outcomes of metastatic patients treated with bevacizumab[J].Annals of oncology :official journal of the European Society for Medical Oncology / ESMO,2016 Oct;27(10):1922-1928.
[15] Zhang YX,Wang XM,Kang S,et al.Contrast-enhanced ultrasonography in qualitative diagnosis of sentinel lymph node metastasis in breast cancer:A meta-analysis[J].Journal of cancer research and therapeutics,2015,11(4):697-703.
[16] Liu J,Gao YH,Li DD,et al.Comparative study of contrast-enhanced ultrasound qualitative and quantitative analysis for identifying benign and malignant breast tumor lumps.Asian Pac J Cancer Prev.2014;15(19):8149-8153.
[17] 徐小艳.乳腺肿瘤的超声造影与微血管密度的关联性研究[D].山西医科大学,2011.
[18] Hu Q,Wang XY,Zhu SY,et al.Meta-analysis of contrast-enhanced ultrasound for the differentiation of benign and malignant breast lesions[J].Acta radiologica,2015,56(1):25-33.
[19] Cai L,Zhang J,Song G,et al.Value of contrast-enhanced sonography in early diagnosis of breast cancer[J].Journal of Southern Medical University,2013,33(12):1801-1805.
[20] 李利,刘淑萍,汪娜,等.乳腺实性病灶实时超声造影增强模式的研究[J].医学影像学杂志,2011,21(7):1008-1011.
[21] Zhao LX,Liu H,Wei Q,et al.Contrast-Enhanced Ultrasonography Features of Breast Malignancies withDifferent Sizes:Correlation with Prognostic Factors[J].BioMed research international,2015,2015:613831.