乳腺放射状瘢痕复杂硬化性病变临床病理的的特点.docVIP

乳腺放射状瘢痕复杂硬化性病变临床病理的的特点 　　[摘要] 目的 探讨乳腺放射状瘢痕/复杂硬化性病变的（RS/CSL）临床病理特点。方法 收集2014年1月―2016年12月收治的RS/CSL临床资料，分析其病理形态学及免疫组化特点，并复习文献。结果 6例患者年龄34～72岁， 2例术前考虑为乳腺癌。病变范围0.3～1.8 cm，瘢痕中央伴胶原变性，周围导管及小叶由中央向四周放射状分布，硬化区可见挤压变形的腺管，可呈尖角，常见导管上皮增生、旺炽性增生，2例局灶伴轻度不典型增生，有时可见导管上皮簇状甚至单个分布，也可见良性的小腺管侵犯神经。免疫组化标记SMA、P63、calponin 、CK5/6显示绝大部分导管周边肌上皮存在，硬化区内少量小导管周边染色缺失；导管上皮增生区显示CK5/6、 CK-H镶嵌性表达，个别病例局灶呈阴性。 结论 乳腺RS/CSL少见，需要全面掌握其形态特点及鉴别诊断，避免误诊。 　　[关键词] 放射状瘢痕；复杂硬化性病变；乳腺 　　[中图分类号] R730 [文献标识码] A [文章编号] 1674-0742（2017）11（b）-0026-03 　　[Abstract] Objective This paper tries to investigate the clinicopathological features of the breast radial scar/complex sclerosing lesions （RS/CSL）. Methods The clinical data of 6 cases of RS/CSL from January 2014 to December 2016 were collected， and the pathological and immunohistochemical features were analyzed. Related literatures were also reviewed. Results The ages ranged from 34 to 72 years of the 6 cases， 2 cases were considered as breast cancer. The size was 0.3～1.8 cm， ducts and lobules radiating from the central with collagen degeneration， the sclerosing region showed a compressive deformation of the gland with sharp angles， often with ductal epithelial hyperplasia， florid hyperplasia， 2 cases with mild atypical hyperplasia focally， some ductal epithelial clusters or even single distribution， benign gland invading nerve could be observed. SMA， P63， calponin， CK5/6 showed the presence of the majority of peripheral myoepithelial， with few deficiency in the sclerosing region. CK5/6 and CK-H mosaic were expressed in hyperplasia area， and the focal area was negative. Conclusion RS/CSL is rare and the morphological features and differential diagnosis need to be fully understood so as to avoid misdiagnosis. 　　[Key words] Radial scar； Complex sclerosis lesions； Breast 　　乳腺放射?铖：?/复杂硬化性病变（Radial scar，RS/complex sclerosing lesion，CSL）不仅是临床及影像学较容易误诊的一种病变，也是病理诊断可能误诊的病变，其放射状、毛刺状的外观与乳腺癌极为相似，甚至病理组织学形态也较为相似，因此必须深入了解掌握其诊断标准及鉴别诊断。现结合2014年1月―2016年12月收治的6例RS/CSL的临床病理资料，并复习相关文献，探讨其临床病理