摘要目的 探讨乳腺囊性高分泌性病变的临床病理特点、免疫组织化学表型及鉴别诊断.方法 收集2010至2013年6例乳腺囊性高分泌性病变的临床病理及随访资料,进行光镜观察和免疫组织化学染色,并对相关文献进行复习.结果 6例患者均为女性,发病年龄37 ～ 71岁(平均49.3岁).3例为囊性高分泌性增生,3例为囊性高分泌性癌.临床表现为乳腺肿块或因钼靶X线检查发现钙化灶就诊.病变大体呈多个大小不等的囊腔,内含胶冻样物,与周围组织界限不清.镜下见病变广泛,多个囊性扩张的导管内含均质红染分泌物,其中缺乏细胞成分,酷似甲状腺滤泡胶质,1例囊腔内见钙盐沉积.囊腔内衬上皮呈扁平、立方或柱状,单层排列或增生呈簇状、实性或微乳头状,细胞可出现不典型增生及癌变.本组3例囊性高分泌性癌中,2例为浸润性导管癌,1例为导管原位癌.囊性高分泌性病变表达S-100蛋白、CK5/6和CK14.3例囊性高分泌性癌中仅1例雌激素受体(ER)和孕激素受体(PR)阳性,HER2均阴性.淀粉酶消化后过碘酸-雪夫染色和黏液卡红染色显示管腔内分泌物为阳性.随访3 ～18个月不等,1例失访,其余患者均存活.结论 多个扩张的囊腔、充满甲状腺胶质样的均质红染分泌物是囊性高分泌性病变的主要组织学特征,病变与周围正常组织界限不清.囊腔内衬上皮可见普通型增生、不典型增生及原位癌,少数病例伴浸润性癌.

abstractsObjective To study the clinicopathologic features,immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast.Methods Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed.Results All six patients were female,age ranged from 37 to 71 years (average 49.3 years).Three cases were cystic hypersecretory hyperplasia (CHH),the other three cases were cystic hypersecretory carcinoma (CHC).Clinically the lesions presented as either breast mass or mammographic calcification.Grossly,the cystic hypersecretory lesions were poorly circumscribed,with multiple colloid containing cysts on the cut surface.Microscopically,the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles,and calcification was seen in the cyst in one case.The secretion was D-PAS and mucicarmine positive.The lining epithelium of the cysts was uniformly fiat,cuboid or columnar,and arranged in a monolayer.The cells may be arranged in turfs,solid or micropapillary patterns in CHH.In cases with dysplasia,the epithelium showed cytological and structural atypia,but the usual morphology of atypical dutal hyperplasia such as arcades,rigid bridges or cribriform pattern was less common.The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL,there was immunoreactivity to S-100 protein,CK5/6 and CK14.Of the three CHCs,ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up,and the rest were uneventful at 18 months.Conclusions CHL of the breast is a rare pathological entity.Multiple colloid-filled cysts is a unique histological feature.The epithelium of CHL may show usual hyperplasia,dysplasia or carcinoma.