摘要目的 探讨乳头部腺瘤的临床病理形态学及免疫表型特点、诊断及鉴别诊断.方法 应用光镜观察、免疫组织化学EnVision两步法等对18例乳头部腺瘤进行分析,并复习文献.结果 肿瘤局限于乳头或乳晕下,多数与表皮相连,主要由扩张的导管与纤维化间质组成,腺上皮不同程度增生,多数为复层或有实性巢状、筛状、乳头状或微乳头状等复杂结构,细胞杂乱、拥挤、重叠,导管周围存在完整肌上皮;有时间质明显纤维化、硬化.免疫组织化学染色显示34βE12上皮阳性,CK5/6上皮与肌上皮片状阳性,p53和c-erbB-2阴性,p63、平滑肌肌动蛋白、Calponin等染色显示导管周围存在完整肌上皮.结论 乳头部腺瘤是少见的良性肿瘤,常表现为硬化性乳头状瘤病、乳头状瘤病型腺病或旺炽型硬化性腺病等形态,易与导管上皮不典型增生/导管内癌、浸润性导管癌、低度恶性腺鳞癌等混淆;应密切结合肿瘤部位及形态学,辅之以免疫组织化学诊断.

abstractsObjective To investigate the clinicopathological and immunohistochemical features,diagnosis and differential diagnosis of nipple adenoma of the breast.Methods Morphological observation and immunohistochemistry were applied to 18 cases of nipple adenoma with a review of the related literatures.Results The neoplasms were localized at nipples or under the areola of breast,adherent to the epidermis,mainly composed of dilated ducts in a tubular appearance associated with fibrotic matrix.The glandular epithelium showed various type of proliferation,forming thick layers or complex structures such as papillae,micropapillae,tufts,fronds,arcades or bridges accompanying with solid or cribriform cell nests.The tumor cells were crowding,lack of an uniform morphology and polarity with intact myoepithelial cells around the ducts.By immunostaining,the glandular epithelium was diffusely positive for 34pE12,patchily positive for CK5/6,and negative for p53 and c-erbB-2.The myoepithelium,positive for p63,smooth muscle actin and Calponin,was well preserved and outlining the ducts.Conclusions Nipple adenoma is an infrequent type of benign breast neoplasm,presenting as sclerosing papilloma,papillomatosis or florid sclerosing adenosis.It is easily confused with atypical ductal hyperplasia/low grade ductal carcinoma in situ,invasive ductal carcinoma or low grade adenosquamous carcinoma.A correct diagnosis is based on the peculiar location and morphology of the tumor,and immunohistochemistry is helpful in some cases.